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Hyperthyroidism: Overactive thyroid


Text by Henrylito D. Tacio

Photo: istockphotos.com

If there’s a disease that most Filipinos never heard of, it’s hyperthyroidism. But they came to know about it when Chinese martial arts actor Jet Li’s frail photos were circulated on the Internet two years ago.

In a statement sent to The Washington Post, manager Steven Chasman said that the Chinese actor is “all well and good.” “He has hyperthyroidism that he’s been dealing with for almost 10 years,” he added. “It’s nothing life-threatening and he’s dealing with it.”

Li was diagnosed as suffering from hyperthyroidism in 2013. At that time, his doctor told him that he could “either continue making (action) films or spend the rest of his life in a wheelchair.”

The thyroid is a small, butterfly-shaped gland—measuring about 2 inches across—found just below the Adam’s apple. “The thyroid gland secretes thyroid hormones, which control the speed at which the body’s chemical functions proceed (metabolic rate),” explains The Merck Manual of Medical Information. “Thyroid hormones influence the metabolic rate in two ways: by stimulating almost every tissue in the body to produce proteins and by increasing the amount of oxygen the cells use.

“Thyroid hormones affect many vital body functions: the heart rate, the respiratory rate, the rate at which calories are burned, skin maintenance, growth, heat production, fertility and digestion,” the manual adds.

Contrary to what most Filipinos think, the Philippines has more thyroid cases than diabetes. Dr. Clarito Cairo Jr., program manager of the Thyroid Disorder Prevention and Control of the Department of Health, reported that 8.9% of the country’s total population of 106 million are affected with thyroid-related diseases. In comparison, only 5-6 million Filipinos are affected by diabetes.

The most common thyroid gland problem in the country is goiter or iodine deficiency disorder. As goiter causes the enlargement of the thyroid glands, people who have this kind of disease have unusually big lumps on their necks.

Generally, goiter is caused by iodine deficiency. But in some instances, according to Dr. Cairo, goiter could also be inherited or caused by hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

“Hyperthyroidism is the medical term applied to an overactive thyroid gland with consequent excess secretion of thyroid hormones (T3 and T4), causing the body to ‘speed up.’ Hyperthyroidism with an enlarged thyroid gland is more popularly known as toxic goiter,” explains the Philippine Society of Endocrinology and Metabolism (PSEM) in its fact sheet, The Thyroid Gland: Hyperthyroidism.

Diagnosing hyperthyroidism is hard as it mimics other health problems, according to the Minnesota-based Mayo Clinic. It causes a wide variety of signs and symptoms, including the following: unintentional weight loss, even when the appetite and food intake stay the same or increase; rapid heartbeat (commonly more than 100 beats a minute); irregular heartbeat (arrhythmia); pounding of the heart (palpitations), and increased appetite.

Other signs and symptoms: nervousness, anxiety, and irritability; tremor (usually a fine trembling in the hands and fingers); sweating; changes in menstrual patterns; increased sensitivity to heat; changes in menstrual patterns (especially more frequent bowel movements); an enlarged thyroid gland (goiter); fatigue, muscle weakness; difficulty sleeping; skin thinning; and fine, brittle hair.

“Usually, hyperthyroidism develops slowly,” the website webMd.com contends. “If you’re young when you get it, the symptoms might come on suddenly.” 

On the other hand, “older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities,” the Mayo Clinic states.

Certain medicines can mask the signs of hyperthyroidism. “If you take betablockers to treat high blood pressure or another condition, you might not know you have it,” webMd.com warns. “Be sure your doctor knows about all the medications you take.” 

There are several causes of hyperthyroidism. “Graves’ disease is an autoimmune disorder and is the most common cause of hyperthyroidism,” the PSEM states. “The thyroid gland is diffusely enlarged and patients usually complain of eye discomfort or, in extreme cases, bulging eyes. This is most commonly seen among young females and affects multiple family members.”

The Mayo Clinic calls this Graves’ ophthalmopathy, and among the signs and symptoms are as follows: dry eyes; red or swollen eyes; excessive tearing or discomfort in one or both eyes; light sensitivity, blurry or double vision, inflammation, or reduced eye movement; and protruding eyeballs.

Other conditions that can cause hyperthyroidism are thyroid nodules and thyroiditis. Thyroid nodules are “lumps of tissue in the thyroid which become overactive, creating too much hormone.” Thyroiditis is “an infection or an immune system problem which causes the thyroid to swell and leak hormones.”

“You can also get hyperthyroidism if you get lots of iodine in your diet (like in a medication or supplement) or from taking too much thyroid hormone medication,” the webMd.com points out.

As stated earlier, diagnosing hyperthyroidism is difficult. “It is diagnosed with blood tests such as thyroid-stimulating hormone (TSH), tri-iodothyronine (T3), or tetra-iodothyronine (T4) levels,” PSEM informs. “A low TSH level is the most accurate indicator. If the TSH is low, it is important to check the thyroid level (high T3 and T4) to confirm the diagnosis.

“Radioactive iodine uptake may also be used to diagnose,” the PSEM continues. “It is a measurement of how much iodine the thyroid gland can collect. A thyroid scan shows how the iodine is distributed throughout the gland. This information is useful in determining the cause of hyperthyroidism.”

Aside from eye problems (particularly those suffering from Graves’ ophthalmopathy), other complications that arise from hyperthyroidism include the following, according to the Mayo Clinic:

Heart problems: Some of the most serious complications involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation that increases the risk of stroke, and congestive heart failure (a condition in which the heart can’t circulate enough blood to meet the body’s needs).

Brittle bones: Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with the body’s ability to incorporate calcium into the bones.

Red, swollen skin: In rare cases, people with Graves’ disease develop Grave’s dermopathy. This affects the skin, causing redness and swelling, often on the shins and feet.

Thyrotoxic crisis: Hyperthyroidism also places a person at risk of thyrotoxic crisis – a sudden intensification of symptoms, leading to a fever, a rapid pulse, and even delirium. If this occurs, seek immediate medical care.

So, how is hyperthyroidism being treated? “Treatment of hyperthyroidism aims at stopping the overproduction of thyroid hormones,” PSEM states. “Anti-thyroid medications like PTU, carbimazole, or methimazole are used to block the production of thyroid hormones.”

“For some people, this clears up the problem permanently, but other people may experience a relapse,” the Mayo Clinic says. “(These drugs) can cause serious liver damage, sometimes leading to death.”

Radioactive iodine may be given to destroy thyroid cells. Taken by mouth, radioactive iodine is absorbed by the thyroid gland, where it causes the gland to shrink. The disadvantage of this treatment: This can kill too many cells causing hormone levels to become low, leading to hypothyroidism.

Surgery, called a thyroidectomy, removes part or all of the hyperfunctioning thyroid gland. This is the preferred method of treating a toxic nodule. Risks of this method include damage to the vocal cords and parathyroid glands (four tiny glands situated on the back of the thyroid gland that helps control the level of calcium in the blood).  

“The long-term outlook for hyperthyroidism depends on its cause,” Verneda Lights, Matthew Solan, and Michael Fantauzzo wrote in an article for the website healthline.com. “Some causes can go away without treatment. Others, like Graves’ disease, get worse over time without treatment. The complications of Graves’ disease can be life-threatening and affect your long-term quality of life. Early diagnosis and treatment of symptoms improve the long-term outlook.” 

Meanwhile, Jet Li told Associated Press in 2013 that his health problem came back with a vengeance. He’s unsure, he said, if he’ll be able to carry on with work (as an action actor), but he’s determined. “I’m in pain,” he admitted, “but I’m not suffering. I’m happy.”

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