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Hyperthyroidism
What about some of the other causes of hyperthyroidism, such as toxic nodules or goiters?
Sometimes the thyroid gland also has lumps--also known as nodules. These nodules can be too active and produce too much of the thyroid hormone. Such nodules are called "toxic nodules." When there are many of these, it is referred to as a "toxic multinodular goiter." Note that not all nodules result in hyperthyroidism.

What about iodine as a cause of hyperthyroidism?
Iodine is used by the thyroid gland to make thyroid hormones. Too much iodine can result in hyperthyroidism. Hyperthyroidism caused by an excess of iodine is usually characterized by an abnormal thyroid gland--as in a gland with goiters or a multinodular goiter. Iodine excess can be caused by certain medications that contain larger amounts on iodine. An example is amiodarone--a heart medicine.

What is thyroiditis and how is it a cause of hyperthyroidism?
Thyroiditis is inflammation of the thyroid gland. It generally occurs after a viral illness (which is known as subacute thyroiditis) or a pregnancy (postpartum thyroiditis). No specific virus or bacteria has been identified as causing the condition.

This condition is temporary, but runs through a cycle of about six to three months. First, the thyroid will release too much thyroid hormone, resulting in hyperthyroidism. Then, because the thyroid gland is depleted of the hormone, too little thyroid hormone is released, resulting in hypothyroidism. Diagnosis of thyroiditis is usually made by means of a thyroid scan, as discussed above. Thyroiditis will reveal itself because the thyroid will take up very little of the RAI.

Thyroiditis is rare as a cause for hyperthyroidism. Because it is largely self-limited, patients are usually only given a beta-blocker medicine for relief of symptoms, rather than any additional treatment. They may also be given anti-inflammatory medicine, such as aspirin to decrease the pain of the inflamed thyroid gland. If the thyroiditis is severe, a corticosteroid may also be used to reduce gland inflammation.

If I ignore my hyperthyroidism, will it go away?
For most forms of hyperthyroid disease, no. Not treating most forms of hyperthyroid can be dangerous. Initially it can lead to an irregular heat beat, worsening heart failure, and chest pain. Eventually it can lead to high blood pressure, irregular heart rhythms, overly strong and fast heartbeats, possible severe emotional disorders, and even heart failure. When the hyperthyroid condition gets severe, it's called a thyroid crisis or thyroid storm.

Is there any way to quickly control the dangerous symptoms of hyperthyroidism?
Regardless of the method of treatment eventually used, a doctor may initially recommend a beta blocking drug--such as atenolol (Tenormin), nadolol (Corgard), metoprolol (Lopressor), or propranolol (Inderal ) to block the action of circulating thyroid hormone on your body tissues, slow your heart rate and reduce your nervousness. These drugs can be useful in rapidly reducing these potentially dangerous symptoms until your treatment has taken effect. However, they should not be used if you have asthma or heart failure, as they can worsen these conditions. Diabetic patients taking insulin should also take care because the beta-blocking drugs may mask the warning symptoms of low blood sugar. These drugs are not a substitute for treatment, but they will normally make you feel better - sometimes in as little as a few hours.

What is the initial treatment for Graves' Disease?
The first course of action--when the disease is mild, or occurs in children or young adults, or needs to be promptly controlled (as with elderly patients who cannot tolerate the increased heart rate associated with Grave's Disease) --is a course of antithyroid drugs, such as propylthiouracil (PTU) and methimazole (Tapazole). These drugs make it more difficult for your thyroid to use the iodine it needs to make thyroid hormone, resulting in a decrease in thyroid hormone production. Although both drugs can be used during pregnancy, PTU is preferable.

How successful is this drug treatment of Graves' Disease?
It only works for about 20 to 30% of patients. In these patients, antithyroid drug treatment for 12 to 18 months will result in prolonged remission of the disease, particularly if the disease is relatively mild when treatment is begun. This is another reason to see your doctor early if you suspect you have hyperthyroidism.



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