Symptoms of hyperthyroidism

There are many different signs of a thyroid that is working too hard. When there are too many thyroid hormones, the metabolism speeds up. Some common signs of hyperthyroidism are:

  • Restlessness, nervousness, anger, and changes in mood are all signs of bipolar disorder.
  • sleep disorders
  • Palpitations and a racing heart (tachycardia) up to cardiac arrhythmia
  • blood pressure went up
  • a lot more sweating
  • clammy skin
  • Being too sensitive to heat
  • drank more water
  • diarrhea, sometimes vomiting
  • Loss of weight despite cravings (because the metabolism is accelerated)
  • hair loss
  • Weakness in muscles
  • Pain and slowness in the muscles
  • shaking ( tremor )
  • menstrual disorders
  • 70 to 90% of people have an enlarged thyroid gland (goiter).

Hyperthyroidism signs and symptoms

Signs of hyperthyroidism

When there are too many thyroid hormones, these symptoms show up.

Learn more The Hypothyroidism Solution

Most of the time, a problem with the immune system is what leads to hyperthyroidism. Graves’ disease is the name for this type of hyperthyroidism caused by the immune system. In addition to the above symptoms, those who have it also have problems with their eyes (endocrine orbitopathy). Here are some typical signs:

  • Feelings of pressure behind the eyes and/or a “foreign body”
  • the number of tears
  • visual disturbances (double vision)
  • photophobia
  • protruding eyeballs (exophthalmos)

People often call these eyes “googly eyes” or “goggle eyes” because they stick out and don’t move. How much the eyeballs bulge doesn’t say anything about how bad the hyperthyroidism is. Some people’s eyes bulge a lot even though they only have mild hyperthyroidism, and vice versa.[1]

The “Merseburg Triad” is a name for the three main symptoms of eyeballs, a fast heart rate, and a swollen thyroid. It’s common for people with Graves’ disease.

Hyperthyroidism in older people often looks different than it did when they were younger. Many of the typical symptoms may not be present, and the ones that are present are usually less severe. Some of the older patients, for example, only have a fast, irregular heartbeat or are just losing weight. In this age group, heart rhythm problems are sometimes the only sign of a problem.

If you have diabetes (diabetes mellitus), an overactive thyroid gland has another effect: the body’s cells no longer respond as well to insulin, so they take in less sugar (glucose) from the blood (insulin resistance increases). At the same time, the overactive thyroid causes things like the liver to release sugar. Because of these things, the level of sugar in the blood goes up. When hyperthyroidism is not treated, people with diabetes need more insulin than usual.

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Treatment for Hyperthyroidism

Hyperthyroidism is a very dangerous illness. It needs to be taken care of by a specialist, like an internal medicine specialist or an endocrinologist. The doctor will tell each patient what kind of treatment they should get. This mostly depends on how bad the hyperthyroidism is. The therapy plan is also based on how old the patient is and how healthy they are in general.

Why smoking is so bad for people with hyperthyroidism

Three questions to

PD dr Joachim Feldkamp

PD dr Joachim Feldkamp ,

expert on the thyroid, expert in internal medicine


How do I know if my thyroid is working too hard?

PD dr Joachim Feldkamp

PD dr Joachim Feldkamp

Symptoms of an overactive thyroid include restlessness, rapid heart rate, insomnia, a tendency to diarrhea, heat intolerance, and rapid weight loss within a few weeks. The symptoms are usually much more pronounced than with hypofunction, so that you feel ill more quickly.


How important is quick treatment?

PD dr Joachim Feldkamp

PD dr Joachim Feldkamp

Even mild hyperfunction can trigger cardiac arrhythmias such as atrial fibrillation. The risk increases the older a patient is. Bone density also decreases sharply in women after menopause, which means there is an increased risk of osteoporosis. Prompt treatment, especially in older patients, is therefore important.


Why would you rather stop smoking?

PD dr Joachim Feldkamp

PD dr Joachim Feldkamp

For example, smoking is very bad if you have Graves’ disease, which is a common cause of hyperthyroidism. Not only do smokers get sick more often. The disease also gets worse as it goes on. Above all, the eye disease called endocrine orbitopathy, which is common in people with Graves’ disease, is much worse in smokers than in people who don’t smoke.[2]

PD dr Joachim Feldkamp

PD dr Joachim Feldkamp ,

expert on the thyroid, expert in internal medicine

First Chief Physician of the Clinic for General Internal Medicine, Endocrinology, Diabetes, and Infectious Diseases at the Bielefeld Clinic and First Chairman of the Advisory Board of Forum Thyroid eV.


Medication for hyperthyroidism

“Thyroid blockers,” also called “antithyroid drugs,” are used to treat a thyroid gland that is working too much. They make sure that the blood has less thyroid hormone. Different antithyroid drugs do this in their own ways. Most of what is used today are things like carbimazole and thiamazole that are called “thionamides.” These antithyroid drugs stop thyroid hormones from being made in a direct way.

During treatment with these kinds of drugs, the doctor often checks the patient’s blood to see how much thyroid hormone is in it. Most of the time, the hormone levels go back to normal after a few weeks. The symptoms of hyperthyroidism then get better. The goal is to get the thyroid’s metabolism back on track (euthyroid metabolism). Depending on the disease at the root, more treatment may come next ( radioiodine therapy , thyroid surgery ).

If you have Graves’ disease, you must take antithyroid drugs for at least a year. About half of the patients’ thyroids then work normally again, and the signs of hyperthyroidism don’t come back after they stop taking the medicine.

But drug therapy alone doesn’t work (long-term) for the other half of the patients. Giving the antithyroid drugs for a longer time doesn’t make any sense. It’s not a good idea because it has bad side effects. Instead, doctors tell these people to get radioiodine therapy or have surgery.

Doctors also give medicines that make the symptoms of an overactive thyroid go away. For example, beta blockers are used to treat heart palpitations. Some beta blockers, like propranolol, also make it take longer for T4 to turn into the much more active T3.

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Hyperthyroidism: treatment with radioiodine

As part of this treatment, radioactive iodine is given to the person with hyperthyroidism. It is either put into a vein with a syringe or taken as a pill. The thyroid gland stores both normal and radioactive iodine. In particular, many of them are taken in by cells that make more thyroid hormones. When radioactive iodine breaks down, it gives off what are called beta rays. The cells are killed. In this way, the thyroid gland’s metabolism gets back to normal and hormone production goes down.

When it is done right, radioiodine therapy doesn’t put other organs in the body at risk. When the iodine that was given breaks down, the radioactive rays that come out are only a few millimeters long.

Because radioiodine therapy exposes patients to radiation, they should avoid getting too close to other people for a while. Most of the time, though, it only takes a few days for the radiation to leave the body again. In Germany, on the other hand, radioiodine therapy is done in a hospital, just to be safe. At least for a few days, the patients are kept alone in a special hospital.

Radioiodine therapy is not good for women who are pregnant or who are nursing because it exposes them to radiation.

Radioiodine therapy can cause hypothyroidism in many people. If the treatment kills too much active thyroid tissue, the body can’t make enough thyroid hormones. But the lack of hormones can be easily made up for by taking hormone preparations (usually levothyroxine, L-thyroxine ).[3]

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Finally, come to rest and sleep well. The best ways to deal with inner restlessness and trouble sleeping.

Surgery for hyperthyroidism

If you have an overactive thyroid and other treatments don’t work or if you have a big goiter, you might want to think about having surgery. Surgery is also done if there is a chance that hyperthyroidism is caused by a cancerous growth on the thyroid gland (thyroid cancer).

Before the surgery, the thyroid’s hormone metabolism must be brought back to normal with medicine. During the procedure, the patient is given general anesthesia and part or all of their thyroid gland is removed. The less thyroid hormones that can be made after surgery, the more thyroid tissue has to be cut out. So, surgery can make the thyroid gland less active (hypothyroidism). Patients must then take hormone pills for the rest of their lives.

Latent hyperthyroidism needs to be treated.

Patients with incipient (latent) hyperthyroidism don’t have any symptoms of the disease yet. However, if they eat too much iodine, they may develop a full-blown case of the disease. So, as a safety measure, they can get treatment with radioiodine.

When a patient also has atrial fibrillation, the doctor may give them antithyroid drugs for a short time. If the heart symptoms get better, it’s likely that the latent hyperthyroidism was the cause. Then it makes sense to use radioiodine therapy.

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Is your thyroid in good shape?

Checking the thyroid

Small body, big effect.

The thyroid is a small organ that has a big effect. In particular, the hormones triiodothyronine (T3) and thyroxine (T4) that it makes affect most of the body’s functions, such as the heartbeat, metabolism, heat production, and blood pressure. When the thyroid is out of balance, the effects are just as severe. Here, you can find out how to spot a mistake and what to do next.

a big woman

Hypothyroidism makes people fat and tired.

If the thyroid gland is underactive, there are not enough thyroid hormones circulating in the blood. Then the basal metabolic rate of the body decreases – those affected gain weight. Chronic constipation, excessive freezing and tiredness are also common. Memory and thinking skills can be impaired by hypofunction. As the desire for sex dwindles, men develop erectile dysfunction. In addition, people with hypothyroidism often have unkempt hair and doughy-looking skin.


Dangerous for children

Thyroid hormones are important for body growth and brain maturation. This is why having an underactive thyroid gland in childhood is particularly dangerous. Short stature and serious mental development disorders can be the result. [4]


When the immune system attacks the thyroid,

Some people are born with an underactive thyroid. In most cases, however, it is the result of chronic inflammation triggered by an autoimmune disease, in particular what is known as Hashimoto’s thyroiditis. The immune system attacks the thyroid tissue.


knots in the throat

Iodine deficiency can also cause an underactive thyroid. Because the body needs the trace element to produce the thyroid hormones. If the thyroid gets too little iodine, it can no longer produce enough hormones. She tries to make up for this deficit by enlarging herself. Knots form or a so-called goiter (goiter) develops, which can take on tennis ball-sized dimensions. Such goiters used to be common, especially in areas where there is a lack of iodine in the soil.

shirt; collar

One in four adults

For a long time, a goiter cannot be seen from the outside and is not noticeable in any other way. It is only later that symptoms such as difficulty swallowing appear, you get hoarse or your shirt collar is too tight. Experts estimate that every fourth adult in Europe has a lump in the thyroid gland or a goiter – depending on the soil conditions (iodine content). The word differs. Significantly fewer suffer from real hypofunction.

Fish protects the thyroid.

People must take in enough iodine through food to prevent goiters from forming. An adult needs around 200 micrograms a day. Fish and seafood in particular contain a lot of iodine. Table salt enriched with iodine is now also available everywhere. Strongly visible goiters due to iodine deficiency only rarely occur.

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Unwanted weight loss

An overactive thyroid is also problematic. Since the basal metabolic rate of the body is boosted by the thyroid hormones, those affected lose weight even though they eat enough. The heartbeat accelerates, the body temperature rises, the hands tremble. People with an overactive thyroid suffer from inner restlessness, nervousness, insomnia, and diarrhea. [5]


Overzealous organ

The most common cause of hyperthyroidism is an autoimmune reaction, especially Graves’ disease, which stimulates the thyroid gland to produce more hormones. However, a so-called autonomy can also be the reason for the hyperfunction. The hormone-producing cells of the thyroid no longer respond properly to the body’s regulatory mechanisms.

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Wirksame Medikamente

Medication works well for both a thyroid that works too much and one that works too little. But it can take a while for the values to be set in the best way. If an enlarged thyroid makes it hard to speak or swallow, or if it affects the flow of blood, it can be shrunk through surgery or radiation.



a medical editor

Nutrition and Hyperthyroidism

Diet is a big part of hyperthyroidism. Because of their “fast” metabolism, many people with hyperthyroidism lose weight. Then it is important to consume enough calories with meals. At the same time, the diet should be well-balanced and full of different foods. Once the metabolism is back to normal (for example, with medication), the number of calories eaten needs to be cut back. The best thing for a patient to do is talk to the doctor who is treating them about what their ideal menu should look like.

In general, people with hyperthyroidism should stay away from coffee, soda, and alcohol. Your metabolism is already very fast, but these drinks make it even faster.

More tips for hyperthyroidism

If you have hyperthyroidism, be careful not to give your body too much iodine. This means that you shouldn’t use disinfectants that have iodine in them.

X-rays and MRIs should also be used with care, since iodinated contrast media are sometimes given before. Since you have hyperthyroidism, you should tell the doctor before such an exam. Then he or she can give you more medicine that stops the thyroid gland from taking in iodine. Or, he uses a contrast agent that doesn’t have iodine in it.

People who have latent hyperthyroidism should also stay away from too much iodine. If that doesn’t happen, the latent disease can become visible.

If the treatment for your overactive thyroid makes your thyroid less active and you need to take thyroid hormones, your doctor should check your blood levels often. So, you can always tell if you are taking the right amount of your medicine and if your thyroid levels are in the normal range.

Find out more about the cures.

Here is more information about therapies that can help:


Therapy with radioiodine

Surgery on Thyroid

Causes of and risk factors for hyperthyroidism

When a thyroid is overactive, it makes too much of two hormones: thyroxine (T4) and triiodothyronine (T3). These hormones have an effect on the heart and blood flow, and they also play an important role in how the body uses energy. When there are too many of them, they speed up the metabolism, making it run at full speed.

thyroid hormones are made.

thyroid hormones are made.

When the hypothalamus releases the hormone TRH, it tells the pituitary gland to release the hormone TSH. In turn, TSH causes the thyroid hormones to be made.

Several things can cause the thyroid to make too many hormones. Graves’ disease and autoimmunity of the thyroid are the most common. Hyperthyroidism can also have causes that happen less often.

Graves’ illness (immune hyperthyroidism)

A lot of the time, an autoimmune reaction in the body is to blame for a thyroid that works too much. An autoimmune reaction is when the body’s immune system makes a mistake and attacks its own tissue with antibodies. This type of antibody is called an autoantibody.

In Graves’ disease, the immune system makes autoantibodies that attack the thyroid gland. These autoantibodies tell the cells of the organ to make more thyroid hormones. This is how a thyroid that works too much happens.

No one knows yet why the immune systems of people with this disease attack the thyroid. Experts think, though, that Graves’ disease is caused by a genetic predisposition, emotional stress, and smoking.

Most cases of the disease happen after the age of 35. Women are much more likely to be affected than men. Graves’ disease is the most common cause of hyperthyroidism in children. The disease can also happen in children.

thyroid autonomy

Most of the time, an overactive thyroid happens in older people because the organ works on its own. This means that the thyroid “decides” on its own to make more hormones, either in part or as a whole, instead of continuing to follow orders from the brain, which is the central control organ. Then, doctors talk about the thyroid’s ability to work on its own.

There are three kinds of autonomy in the thyroid:

In disseminated autonomy, the cells that work on their own are spread out all over the thyroid gland.

In unifocal autonomy, there is a single group of autonomic cells in the thyroid. This group is called a node. In the past, this kind of knot was called a “autonomous adenoma.”

In multifocal autonomy, the thyroid has more than one node with cells that work on their own.

Most of the time, thyroid autonomy is caused by a chronic lack of iodine. If there isn’t enough iodine, the thyroid gland doesn’t make enough hormones. It tries to make up for this by making growth faster. This can lead to thyroid nodules, which make hormones that the brain can’t control. If these nodules are big enough, the thyroid gland won’t stop making hormones when the iodine supply comes back. This can also happen all of a sudden, like if the person gets a lot of iodine (for example in the form of iodinated X-ray contrast media).

Learn more The Hypothyroidism Solution

Other causes of a thyroid that works too hard

Thyroiditis, an inflammation of the thyroid gland, and some types of thyroid cancer are rare causes of hyperthyroidism. You can also get hyperthyroidism if you take too much thyroid hormone as medicine (e.g. in the case of hypothyroidism). This is known as a “hyperthyroidism factitia” by doctors.

Behind it, there is sometimes a tumor of the pituitary gland. The pituitary gland is a part of the brain that controls how the thyroid gland works with a hormone called thyrotropin (TSH). When there is a tumor in the pituitary gland, TSH production can go up. This causes the thyroid gland to make too many hormones, leading to a thyroid gland that works too much.

Hyperthyroidism can also happen when the body gets too much iodine. This can happen with drugs that have iodine in them as well as with contrast media that has iodine in it. These are given, for example, before X-ray or magnetic resonance imaging tests (MRI). People who eat a lot of iodine-rich foods, like seaweed, over a long period of time can also get a thyroid gland that works too much.

Hyperthyroidism and Being Expectant

Chorionic gonadotropin, or hCG, is a hormone that is made by the placenta and is similar to the pituitary gland hormone TSH. So, it makes the thyroid gland make more hormones because it makes the gland work harder. Because of this, some pregnant women get mild hyperthyroidism for a short time. Most of the time, you don’t need to take antithyroid drugs to treat your condition.

But if hyperthyroidism during pregnancy lasts for more than a few weeks or is very noticeable (with tachycardia, tremors, etc.), it’s likely because of something else. This is most of the time Graves’ disease. The next step is to treat the overactive thyroid. If you don’t stop, it could lead to bad things. These include giving birth too soon, having a baby with a low birth weight, a miscarriage, a stillbirth, and preeclampsia.

Tip: Before getting pregnant, women who know they have hyperthyroidism should get treatment to bring their hormone levels back to normal. For a child to grow up healthy, the thyroid needs to work at its best (especially in the first few weeks of pregnancy). Also, having too many thyroid hormones can make it harder to get pregnant.

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Investigations and diagnosis of hyperthyroidism

If the doctor thinks you have an overactive thyroid gland, he will first ask you about your medical history (anamnesis). For example, he will ask about your symptoms, any illnesses you’ve had in the past, and what you eat (iodine deficiency!). He also wants to know about thyroid problems in your family. He will also ask what medicines you are on and if you’ve had a contrast agent exam in the past few months ( X- ray , MRI).

The next step is to check the person’s health. The doctor will, among other things, feel your throat. He looks to see if your thyroid gland is big and maybe feels lumpy. He can also figure out how big the neck is.

Where can you find the thyroid?

where the thyroid is

The two-lobed thyroid gland is right in front of the trachea, below the thyroid cartilage.

The doctor can do an ultrasound (sonography) of the neck to get a better idea of how the thyroid gland is doing. This lets him get a better idea of the thyroid gland’s position, shape, size, and structure. If Graves’ disease is suspected, an ultrasound is also done on the eye sockets (by specialized ophthalmologists).

Hyperthyroidism can be seen clearly in blood tests. The amount of the thyroid hormones T3 and/or T4, as well as the pituitary gland hormone TSH, are measured. When the thyroid is overactive, the levels of T3 and T4 go up, but the level of TSH goes down. The pituitary gland makes TSH, which is what controls the thyroid gland. When the thyroid makes too many hormones, the pituitary gland responds by putting out less TSH.

If a malfunctioning pituitary gland causes hyperthyroidism, which is very rare, the thyroid hormone levels in the blood rise, but the TSH level does not go down and may even go up.

More tests help find out what caused the hyperthyroidism. For example, the doctor can find iodine in the urine. So, he can find out if getting too much iodine is what makes the thyroid gland work too much.

If Graves’ disease is suspected, the blood is checked for TSH receptor-stimulating antibodies (TRAK) and other antibodies that attack the thyroid gland.

With the help of thyroid scintigraphy, more can be learned about how the organ works. To do this, the doctor gives the patient an injection of a radioactive material that builds up in the thyroid gland, especially in the areas that make hormones. Then, a special camera takes pictures of the thyroid to show where the radioactive substance is building up in the different tissue areas. The doctor can tell the difference between “hot” and “cold” nodes in the following ways:

“Hot nodes” are places that are very active (make a lot of thyroid hormones) and have a lot of the radioactive substance because of this.

On the other hand, less radioactive material has built up in the “cold nodes” than in the tissue around them. These parts of the body have a lot less metabolic activity than healthy tissue. Most of the time, a harmless change in the tissue is to blame.

If there are hot nodules, it means that the thyroid is doing its job. Graves’ disease is more likely, though, if the thyroid makes more hormones in all of its parts.

Even with “cold knots,” the thyroid gland can be overactive if other parts of the gland make more hormones for it.

The doctor may also take a small piece of tissue from the thyroid gland with a thin, hollow needle (fine-needle puncture). In the lab, it can be looked at more closely. For example, it is possible to tell if changes in the tissue are good or bad. When the tissue sample is looked at, inflammation of the thyroid gland can also be found.

how bad hyperthyroidism is

Depending on how bad it is, an overactive thyroid is:

Latent hyperthyroidism is a kind of early stage of hyperfunction. The levels of thyroid hormones (T3 and T4) in the blood are still normal, and the level of TSH is low. Most of the time, this is caused by too much thyroid hormone. When there are too many hormones, the pituitary gland shuts down the release of TSH.

Hyperthyroidism that lasts for a long time and has clear symptoms is called “manifest hyperthyroidism.” Here, the levels of T3 and T4 in the blood go up, while the level of TSH goes down.

When there is a lot of thyroid hormone in the body, it hurts the body. In the worst case, thyrotoxicosis or a thyrotoxic crisis develops. The symptoms include high fever, tachycardia, diarrhea, vomiting, muscle weakness, sweating, and changes in consciousness, all the way up to coma and loss of circulation. This kind of dangerous complication doesn’t happen very often. It can happen, for example, if a thyroid gland that works too much is not treated or is not treated enough. Iodine in large amounts is another possible cause (e.g. via contrast media and iodine-containing medicines).

The thyrotoxic crisis needs to be taken care of right away in the ICU. There, antithyroid drugs are given to people through their veins. In very serious cases, the thyroid gland is also taken out as a last resort to stop the overproduction of hormones. Or, plasmapheresis is used to “clean” the blood.

Hyperthyroidism is not the only thing that can cause thyrotoxicosis. This can happen when the thyroid gland is inflamed or when a person takes a lot of thyroid hormone even though they don’t need it.

Find out more about the probes

Find out here what kinds of tests can help with this disease:

blood draw

blood test


Hyperthyroidism: how it goes and what it means

If a too-active thyroid gland is caught early and treated, the outlook is good. Graves’ disease gets better for about half of the people who take medicine for it. But even after treatment, the disease can come back.

On the other hand, thyroid autonomy does not go away on its own as a cause of hyperthyroidism. The tissue that naturally makes too many hormones can actually get bigger over time. Because of this, treatment is an absolute must. Then, most people can go on with their lives as usual.

If an overactive thyroid gland isn’t treated or isn’t noticed in time, it can lead to other diseases. One of these is heart failure. Another is osteoporosis.

Learn more The Hypothyroidism Solution

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