Hyperthyroidism Discussion Paper

Hyperthyroidism Discussion Paper

Dysfunctions of the thyroid can present as either hypothyroidism or hyperthyroidism. The prevalence of both hypothyroidism and hyperthyroidism in communities with depletion of iodine ranges from 0.5-4% and their occurrence is twice higher in women compared to men. There exists a strong correlation between hypothyroidism, hyperthyroidism, and infertility, mental/behavioral disorders, metabolic disorders such as hyperlipidemia and dyslipidemia, reproductive disorders, and a wide range of cerebrovascular and cardiovascular diseases. Besides, based on the findings of the study by Journy et al (2017), both hyperthyroidism and hyperthyroidism are associated with up to a 20% increase in cardiovascular and all-cause mortalities.

Hyperthyroidism is the most common thyroid disorder encountered in endocrine clinics in the US and across the globe. Its approach to diagnosis and management varies but is highly dependent on clinical assessment, the presence of thyroid autoantibodies, and an ultrasound exam. Its primary characteristic is an increase in the secretion and synthesis of thyroid hormone caused by either a toxic nodular goiter or Graves’ disease (Doubleday & Sippel, 2020). Graves’ disease, the leading cause of hyperthyroidism, has an autoimmune etiology that primarily manifests in younger populations. In comparison, a TNG (toxic multinodular goiter) is the commonest cause in older populations. However, there are other causes such as thyroid adenomas, iodine-induced hyperthyroidism, and postpartum thyroiditis.

ORDER A PLAGIARISM -FREE PAPER NOW

This paper discusses the incidence and impact of hyperthyroidism, its pathophysiology, current research findings, differential diagnoses, and collaborative treatment options. This knowledge is vital for nurses to be able to make early diagnoses for early intervention.

Incidence and Impact

Based on the statistics provided by Ross et al. (2016) the prevalence of hyperthyroidism is close to 1.2% and its most common cause is toxic adenoma (TA) Grave’s disease, and toxic multinodular goiter (TMNG) (Taylor et al., 2018). However, in parts of the world with iodine insufficiency, its prevalence ranges between 0.2-1.3 percent. In the United Kingdom, its annual incidence per 100,000 is approximately 100-200 cases with a prevalence of 0.23% in men and 2.7% in women (Taylor et al., 2018). UK’s incidence per 100,000 is higher than that of the US, which has an annual incidence of 30 cases.Hyperthyroidism Discussion Paper

After a follow-up, the US incidence was reportedly 80 per 100,000 (Taylor et al., 2018). According to a survey by the US NHANES (National Health and Nutrition Examination Survey), the US population with overt hyperthyroidism is 0.5% and that with subclinical hyperthyroidism is 0.7% yet the overall prevalence of hyperthyroidism of 1.3%. Studies from other countries such as Norway, Sweden, Japan, and Denmark have also reported similar rates (Taylor et al., 2018). However, European studies revealed an annual incidence of 51 cases per 100,000 and a prevalence of 0.75%.

Globally, the incidence of hyperthyroidism varies though it is challenging to make comparisons among nations due population differences, thresholds for diagnosis and the sensitivity of assays. In the US and Europe, the prevalence of overt hyperthyroidism is nearly the same (0.5% and 0.7%) (Taylor et al., 2018). The prevalence in Australia is slightly lower (0.3%) for both subclinical hyperthyroidism and overt hyperthyroidism and a five-year approximated incidence of 0.5%. There is a correspondence between the incidence of hyperthyroidism and iodine nutrition of the population with significantly high rates in countries deficient of iodine. Taylor et al. (2018) attribute this to the high incidences of nodular thyroid disease in the elderly population. A perfect example is the prevalence of hyperthyroidism in a Southern Italy village with iodine deficiency, which was higher (2.9%) than in countries with sufficient iodine. This is probably due to numerous cases of toxic nodular goiter (Taylor et al., 2018). In China, the prevalence of overt and subclinical hyperthyroidism in areas that are sufficient of iodine is higher than areas with iodine deficiency (1.2% and 1.0% respectively).

In Africa, there is a huge challenge in monitoring the epidemiology of thyroid disorders particularly to lack of detailed population studies. Researchers obtained data used in currently existing studies from hospital-based cohorts, which exclude rural population segments. Therefore, the findings are less likely a representation of the general population (Taylor et al., 2018). Based on the findings of an elderly population-based study in a long-term care facilitiy in Cape Town, the researchers estimated the prevalence of hypothyroidism and hyperthyroidism to be 1.7% and 0.6% respectively yet more than two-thirds of cases remain undiagnosed (Taylor et al., 2018).  This study however incorporated individuals with a mixed or Caucasian descent and excluded black South Africans. In the 1980s, the annual incidence of Grave’s in Johannesburg was 5.5. However, following an improvement in dietary iodine among urban immigrants, researchers note a 60% increase in the prevalence and incidence of Graves’ disease in the last ten years (Taylor et al., 2018). In Ghana, recent studies indicate that Graves’ disease accounts for 54% of thyroid disorders and this finding contradicts previous reports. However, recent findings reveal that there has been a huge increase in the incidences of nodular disease as well as Graves’ disease.

Pathophysiology

Generally, the pathophysiology of hyperthyroidism occurs when there is an increase in serum T3 than T4 and this may be because of an increase in the production of T3 or when T4 gets converted to T3 in the peripheral system. However, some patients can only have an elevated T3, a condition referred to as toxicosis (Taylor et al., 2018). Toxicosis is the primary cause of other forms of hyperthyroidism such as Graves’ disease, and the multinodular goiter. If left unmanaged, patients have abnormal laboratory findings that suggest hyperthyroidism. However, other thyroiditis forms usually have a common hyperthyroid followed by a hypothyroid phase.

Graves’ disease

The pathophysiology of hyperthyroidism is highly dependent on the type of hyperthyroidism. For instance, Graves’ disease has an autoimmune cause and it happens when TS-immunoglobulins bind to the receptors of thyroid-stimulating hormone-mimicking TSH effects (Mathew & Rawla, 2020).  It presents with two signs that are not present in other hyperthyroidism forms. One of the signs is ophthalmopathy and its primary characteristic is retro-orbital edema that causes the ocular lobes to protrude anteriorly (Mathew & Rawla, 2020). The other sign is pretibial myxedema, which refers to the thickening of the tibial anterior skin when glycosaminoglycans infiltrate the dermis.

Toxic Multinodular Goiter

There is also the toxic multinodular goiter, which clinically presents with thyroid nodules that a provider can palpate. Today, TNG is the leading cause of hyperthyroidism among elderly people (Mathew & Rawla, 2020). It primarily presents with the excessive production of thyroid hormone resulting in thyrotoxicosis.Hyperthyroidism Discussion Paper

Thyroid Adenoma

Thyroid adenomas are benign and commonly present in older women with a single papillary nodule as opposed to toxic multinodular goiter that presents with multiple nodules (Mathew & Rawla, 2020). Then the thyroid adenomas hyper-function, they secrete excess thyroid hormone and this ultimately suppresses TSH.

Hyperthyroidism Secondary to Thyroiditis

When there is a mechanical disruption of thyroid follicles, there is a transient increase in the circulating thyroid hormone. Is acute form follows an acute infection such as a URTI (upper respiratory tract infection) characterized by an inflamed granulomatous and a tender thyroid (LiVolsi & Baloch, 2018). lymphocytic thyroiditis, a painless form of thyroiditis, is common in the post-partum period. Clinicians can distinguish it from the subacute form using clinical history and physical exam that reveals a non-tender thyroid gland.

Iodine-induced hyperthyroidism

Also referred to as the Jod-Basedow phenomenon, iodine-induced hyperthyroidism is iatrogenic and occurs after the administration of medications that contain iodine. When there is an excess of iodine circulating in the blood, it creates the Wolff-Chaikoff effect with excess production of thyroid hormone. However, when a provider discontinues the offending agent (iodine), the hyperthyroidism resolves (Mathew & Rawla, 2020). There is the type 1 and type 2 amiodarone-induced thyrotoxicosis whereby, in the former, patients often present with a thyroid pathology, an increase in the flow of blood in the thyroid parenchyma, and reduced uptake of RAI. Clinicians prescribe anti-thyroid drugs for the management of type 1. Patients with type 2 might not have a history of thyroid disease (LiVolsi & Baloch, 2018). The diagnostic findings reveal a decrease in the flow of blood in thyroid parenchyma and low uptake of RAI. The management for type 2 amiodarone-induced thyrotoxicosis involves the use of steroids.

 Recent Research Findings

Dekkers et al (2017) conducted a study whose objective was to determine the relation between hyperthyroidism, mortality, and cardiovascular events. Using a population based cohort study design, the researchers obtained and compared data on the rates of PCI (percutaneous coronary intervention), non-ischemic and ischemic stroke, VTE (venous thromboembolism), arterial embolism, AF (arterial fibrillation), and MI (myocardial infarction) from two cohorts and estimated the hazard ratios with 95% CI. The study had 85, 856 patients with hyperthyroidism followed in 9.2 mean years.

Dekkers et al (2017) found that the mortality risk was the highest in the initial three months after diagnosis and during follow-up. There was also an increase in the risk of cardiovascular events and the highest risk was in the initial three months post-diagnosis. The highest risk was that of arterial embolism and AF (HR: 6.08, 95% CI: 4.30–8.61 and HR: 7.32, 95% CI: 6.58–8.14) respectively.  Besides, there was a 2-3 fold increase in the risk of AMI, PCI, VTE, non-ischemic and ischemic stroke in patients with hyperthyroidism. The researchers concluded that there was a high risk of cardiovascular events in patients with hyperthyroidism.

Differential Diagnoses

Since hyperthyroidism presents with non-specific signs and symptoms such as unintentional weight loss, palpitations, and an increased frequency of bowel movements, clinicians should rule out other potential diagnoses that match a patient’s symptoms. The most likely differential diagnoses of hyperthyroidism to rule are based on findings of the physical exam of the thyroid gland. In the context of hyperthyroidism, palpating a normal thyroid gland can be specific to thyrotoxicosis factitia, Graves’ disease, or painless thyroiditis. However, Grave’s disease can also present as an enlarged and non-tender thyroid.

During palpation, an enlarged and tender thyroid can indicate subacute thyroiditis (DeQuervain thyroiditis). However, when a clinician palpates a single nodule, it is likely to be a thyroid adenoma while multiple thyroid nodules are characteristic of a toxic multinodular goiter. Other potential differential diagnoses that clinicians should consider are struma ovarii and euthyroid hyperthyroxinemia wherein the latter, there is elevated serum T4 and T3 but TSH levels within normal limits.Hyperthyroidism Discussion Paper

Collaborative Treatment Options

The management of hyperthyroidism depends on the underlying cause. However, management can either be in the form of definitive or symptomatic therapy. Clinicians can manage the classic symptoms as unintentional loss of weight, palpitations, tremors, and anxiety using beta-adrenergic antagonists as the first-line agents (Ross et al., 2016). However, for patients with contraindications or intolerance to beta-blockers, clinicians can prescribe calcium channel blockers. For other transient forms of hyperthyroidism, clinicians should only initiate symptomatic therapy since they are self-limiting (Ross et al., 2016).

The three major transient forms managing hyperthyroidism that expose patients to lower TSH levels in the long term and require collaboration between healthcare providers are subtotal thyroidectomy, radioactive iodine therapy (RAI), and thionamide therapy. For all patients who undergo any form of the aforementioned forms of treatment, clinicians (laboratory specialist and NP) must conduct ongoing clinical assessment and monitoring of free T4 rather than the TSH levels since the latter remains suppressed until when the patient is euthyroid (Mathew  & Rawla 2020). It is for the same reason that immediately after definitive therapy; clinicians should not monitor the TSH status

RAI Therapy

This is the most preferred and highly efficient treatment of choice for all patients diagnosed with Graves’ disease. However, it remains contraindicated for breastfeeding mothers and pregnant women (Mathew & Rawla 2020). Post-therapy, patients need several months to have a euthyroid status and with evaluations in 4-6 weeks intervals. In case of therapy failure characterized by an inability to achieve a euthyroid status, patients may have a repeat RAI therapy or they are initiated into thyroxine therapy.

Thionamide Therapy

Thionamide therapy is a form of definitive therapy particularly for patients who are unwilling to undergo RAI therapy or have several RAI therapy contraindications (pregnancy, breastfeeding, and allergy). Since it has no permanent effect on the functioning of the thyroid gland, most patients who discontinue it undergo remission (Ross et al., 2016). To obtain a euthyroid status, patients require several months after initiation of therapy. Its common side effects are hepatitis, agranulocytosis, drug-induced lupus, and vasculitis.

Subtotal Thyroidectomy

For the long-term management of hyperthyroidism, an endocrine specialist may consider a subtotal thyroidectomy. Before surgery, the administration of atenolol 1 to 2 weeks before surgery helps to reduce the resting heart rate and this helps to decrease complications post-surgery that may be associated with exacerbation of hyperthyroidism preoperatively (Ross et al., 2016). The likely complications of subtotal thyroidectomy are hypothyroidism following an increase in the secretion of T4.

ORDER A PLAGIARISM -FREE PAPER NOW

Conclusion

Hyperthyroidism is the most common thyroid disorder encountered in endocrine clinics in the US and across the globe. Its primary characteristic is an increase in the secretion and synthesis of thyroid hormone caused by either a toxic nodular goiter or Graves’ disease. The prevalence of overt hyperthyroidism in US and Europe is nearly the same (0.5% and 0.7%). Although the pathophysiology of hyperthyroidism is highly dependent on the type of hyperthyroidism, generally, it occurs when there is an increase in serum T3 than T4 and this may be because of an increase in the production of T3 or when T4 gets converted to T3 in the peripheral system. Current research findings reveal that patients with hyperthyroidism are at high risk of cardiovascular events and all-cause mortality. Therefore, clinicians must have adequate knowledge on its incidence, pathophysiology and management to be able to make early diagnosis and implement appropriate interventions.Hyperthyroidism Discussion Paper

 References

Doubleday, A. R., & Sippel, R. S. (2020). Hyperthyroidism. Gland Surgery, 9(1), 124–135. https://doi.org/10.21037/gs.2019.11.01

Dekkers, O. M., Horváth-Puhó, E., Cannegieter, S. C., Vandenbroucke, J. P., Sørensen, H. T., & Jørgensen, J. O. (2017). Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study. Eur J Endocrinol, 176(1), 1-9.

Journy, N., Bernier, M. O., Doody, M. M., Alexander, B. H., Linet, M. S., & Kitahara, C. M. (2017). Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women. Thyroid: official journal of the American Thyroid Association, 27(8), 1001–1010. https://doi.org/10.1089/thy.2017.0063

LiVolsi, V. A., & Baloch, Z. W. (2018). The Pathology of Hyperthyroidism. Frontiers in endocrinology, 9, 737. https://doi.org/10.3389/fendo.2018.00737

Mathew P., & Rawla P., (2020).  Hyperthyroidism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK537053/

Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., & Walter, M. A. (2016). 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid, 26(10), 1343-1421.

Taylor, P. N., Albrecht, D., Scholz, A., Gutierrez-Buey, G., Lazarus, J. H., Dayan, C. M., & Okosieme, O. E. (2018). Global epidemiology of hyperthyroidism and hypothyroidism. Nature Reviews Endocrinology, 14(5), 301.

One of the endocrine glands, known as the thyroid gland, located at the anterior part of the trachea between the suprasternal notch and the cricoid cartilage. It secretes hormones, which include triiodothyronine, which contains three atoms of Iodine (T3), and thyroxine, which has four atoms of Iodine (T4). Thyroid hormones regulate several physiological functions such as heartbeat and burning of calories (Doubleday & Sippel, 2020). Thyroxine and triiodothyronine also influence the manufacture of energy from food, metabolism in the human cells. The thyroid glands may contract disorders to behave abnormally, by either uncontrollable producing amounts of the thyroid glands or less. Thyroid diseases are common in women than in men.

Hyperthyroidism, therefore, occurs when the thyroid glands become overactive to produce excess amounts of thyroid hormones. In excess amounts, it leads to symptoms such as an irregular heartbeat; and unintentional weight loss (Mathew & Rawla 2020). In more severe cases, patients can even experience diarrhea. Among women, the most common type of hyperthyroidism is Graves’ disease alternatively referred to as graves’ ophthalmopathy.

Incidence and Impact of Hyperthyroidism

Undiagnosed hyperthyroidism may lead to serious medical complications with a significant social and economic burden. Therefore, understanding the incidence and impact or prevalence of this condition is very important. Between the years 2012 and 2018, in Italy, an overall majority of 756 per 100,000 individuals, most of which were women, were infected by the disorder (Caputo et al., 2020). The incidence and impact of the disease increased with an increase in age, and the number of women affected was twice as much as that of men. The prevalence of hyperthyroidism varies from one ethnic group to the other. In Europe, the action of the disorder is affected by excessive dietary intake of Iodine. Some of the cases in Europe are a result of autoimmune disease (Caputo et al., 2020). Therefore, the impact or incidence of hyperthyroidism in the USA and Europe hits 1.3 and 0.8 percent, respectively. Statistics state that the prevalence of hyperthyroidism is higher with an approximate of about 0.7% in Europe as compared to the USA, where its prevalence only hits 0.5 % (Caputo et al., 2020). The incidence of the disease is stated to be higher in iodine-deficient places than the iodine-sufficient places.

Pathophysiology

The pathophysiology of hyperthyroidism is always dependent on some particular variants of hyperthyroidism. For instance, in Graves’ disease, the primary cause is autoimmune. The human being’s immune system always protects the human body against germs, such as viruses and harmful bacteria. When the immune systems detect those germs, it reacts by producing fighter cells to attack the invaders.

An autoimmune disorder is a disorder that occurs when the immune system attacks itself (Joshi, & Zacharin, 2018). In this case, the thyroid-stimulating immunoglobulins associated with Graves’ disease are involved. These immunoglobulins combine with TSH and adapt their effects through mimicry. Graves’ disease shows two extra-thyroidal characteristics, which, typically, are absent in other hyperthyroidism forms (Mathew & Rawla, 2020). Graves’s ophthalmopathy is always characterized by adenoma in the retro-orbital tissues, causing anterior protrusion of ocular globes in the human body. The thyroid is butterfly-shaped and located just above the windpipe, trachea, in the front part of the human neck. Typically, the thyroid weighs approximately 16 to 21 grams.

The gland is responsible for producing and circulation of two essential hormones, thyroxine and triiodothyronine, which forms from the thyroxine. The thyroxine and triiodothyronine produced ae always obtained through the metabolism of thyroid hormones and other iodine-rich components or from dietary sources (LiVolsi & Baloch, 2018). To have sufficient amounts of the thyroid hormones, the human body needs about 100 micrograms of iodide. The nutritional ingestion of iodide in the United States ranges from 201 and 550 micrograms per day and varies from place to place. Nutritional ingestion rate is higher in the western areas of the U.S than in the western areas.

Na/I protect specialized thyroid epithelial cells whose primary function is to increase the concentration of Iodine 30 to 40 times that of plasma to ensure adequate transport into the body. The thyrotrophic cells situated in the anterior lobe of the pituitary glands are responsible for TSH production. TSH, in turn, controls the hormone synthesis and functioning of the thyroid glands (Doubleday & Sippel, 2020). The thyrotropin-releasing hormone (TRH), produced by the  hypothalamus also influences the pituitary glands to produce TSH through a negative feedback mechanism from the thyroid hormone regulates the production of both TRH and TSH. During the circulation of T4 and T3 hormones, the thyroid hormones get raised, causing a decline in TRH and TSH production.Hyperthyroidism Discussion Paper

On the contrary, T4 and T3 hormones circulation are low; serum TSH gets increased, called compensation fashion. Geometrically, the average level of TSH in a normal individual is approximately 1.5 µU/ml. When the function of the pituitary glands regulated by the hypothalamus is intact, serum TSH levels are low. The mechanism where TSH activates and combines with thyroid glands is well noted. T4 binds firmly to thyroxine binding a substance called globulin, and sticks weakly to albumin, with a weaker attraction to TBPA (Mathew & Rawla 2020). Geometrically speaking, the average serum thyroxine level in a normal individual is 8 µg/dl, and the average serum T3 concentration is 130 ng/dl.

When in a normal binding environment for proteins, 99.997% of thyroxine and 99.7% of triiodothyronine are bound. In this case, a minimal amount of the two is left to circulate in their free state. The open state is responsible for the biological behaviors of the thyroxine hormone. Several physiological conditions are associated with the rise and decline in levels serum concentration in the thyroid hormones, i.e., T4 and T3 hormones (Kong et al., 2020). These physiological conditions comprise of the ingestion of drugs, and non-thyroidal disorders, which influence the binding proteins’ levels. For example, in this situation, the total serum concentrations of thyroxine and triiodothyronine change contrary to changes in the thyroid hormone when binding proteins (Mathew & Rawla, 2020). However, the serum concentrations of free T3 and T4 remain constant, and the person remains in a euthyroid state. In contrast, a rise in the concentration of free T4 and T3 in hyperthyroidism.

Recent Research Findings

Different researchers have conducted studies on hyperthyroidism, its various symptoms, factors, and associated disorders, diagnosis, treatment, and the principal organ it affects. Research conducted in Brigham and Women’s hospital on the influences of hyperthyroidism and hypothyroidism during pregnancy reveals that the effects of thyroid situations worsen during pregnancy. Most women always worry more about their healthy babies, whether their babies will be safe or not, which is understandable. Dr. Alexander of the hospital recommended pregnant mothers to state whether they have the thyroid disorders for appropriate measures to be taken to save the babies.

Another research was conducted on the effects of thyroid on weight, whether it causes a weight gain or loss. Arthur Schneider, a professor at the University of Illinois College, Chicago, states that the criteria of excessive weight leading to underactive thyroid can seem backward, though, he further says, that some changes in thyroid functioning can lead to obesity. Recent research on the long-term effects of radioiodine therapy for hyperthyroidism (Mathew & Rawla 2020). Radioiodine therapy is a prevalent treatment for hyperthyroidism. The dosage is usually administered orally in a small capsule and is meant to destroy the thyroid cells preventing the glands from overproducing them. While this treatment method is successful, the research states that there is no concrete reason to confirm that the medicine is cancerous.

Differential Diagnosis

Hyperthyroidism portrays non-specific symptoms such as weight loss, increased bowel movements, palpitations, and many others. Therefore, physical exam findings can help to determine the differential diagnoses. The occurrence of palpations in normal thyroid glands in hyperthyroidism conditions might be due to the Graves’ disease; factitious hyperthyroidism, also called thyrotoxicosis factitial or painless thyroiditis. Besides, Graves’ disease can enlarge the thyroid Glands’ causing the neck’s frontal part to swell.

The occurrence of palpations of a tender and enlarged thyroid may also be due to DeQuervain thyroiditis, also known as subacute thyroiditis (Ross et al., 2016). However, the palpations of only one single thyroid nodule might be due to adenoma, and those of multiple thyroid nodules are likely to indicate toxic multinodular goiter. Other diagnoses are struma ovarii and euthyroid hypothyroxinemia, which refers to a situation where the total serum for the T3 and T4 are raised. Still, the TSH levels are left in their normal state.Hyperthyroidism Discussion Paper

Collaborative Treatment Options

There are three main collaborative options in the management of hyperthyroidism, and these include radioiodine ablation, surgery, and administration of antithyroid drugs. The three management options are all useful when managing patients with Graves’ disease; however, when it comes to toxic multinodular goiter and toxic edema, surgery and radioactive iodine ablation are the most suitable and applicable (Ross et al, 2016). Antithyroid drugs include carbimazole, propylthiouracil, and thiamazole. They are all actively distributed to the thyroid where they get oxidized, and organification occurs by inhibiting the thyroid peroxidase and binding of iodotyrosines from manufacturing T3 and T4.

On the other end, radioactive therapy is a bit preferable and can be adopted as a first-line treatment for the multinodular goiter, Graves’ disease, and toxic adenoma (Doubleday & Sippel, 2020). When undergoing the treatment, absolute contraindications include breastfeeding, safety with radiations, and planning for pregnancy. For patients with thyroid nodules whose biopsy specimens are suspicious for diagnosis, surgery is recommended, and radioiodine therapy is completely discouraged.

Although other doctors and nurse practitioners disagree, radioiodine therapy has also been discovered to be responsible for worsening the graves’ orbitopathy rather than treating it in some patients. Elderly patients and those with comorbidities may require special treatment when undergoing therapy (Doubleday & Sippel, 2020). The special treatment includes pretreatment with Antithyroid drugs (ATDs); however, the need for this treatment is also debatable among different specialists. The final option to select when treating a patient with hyperthyroidism is surgery since there is no exposure to any radioactive rays or substances.

Though risky, surgery is the best option for dealing with any form of hyperthyroidism, the Graves’ disease, toxic multinodular goiter, or toxic adenoma. A total thyroidectomy is the only choice that guarantees immediate best outcomes for hyperthyroidism (Doubleday & Sippel, 2020). People have different allergies and some might be allergic to antithyroid drugs and vulnerable to the radioactive environment. Therefore, the only choice remaining for him or her to get the problem solved is through surgery. It is also advisable where the thyroid glands have grown very large and may cause other disorders like cancer. Hyperthyroidism Discussion Paper

Conclusion

            Hyperthyroidism is a condition caused by overproduction of thyroxine resulting to symptoms such as an increased heartbeat, weight loss or even diarrhea .Based on the numerous studies conducted on hyperthyroidism, findings suggest that patients undergoing radioactive Iodine should not plan to get pregnant or breastfeeding as that could have adverse effects on their babies. The best and most recommended management strategies include surgery, radioactive iodine therapy, and those with Graves’ disease, should consider taking antithyroid drugs (ATDs).

References

Doubleday, A. R., & Sippel, R. S. (2020). Hyperthyroidism. Gland Surgery, 9(1), 124–135. https://doi.org/10.21037/gs.2019.11.01

LiVolsi, V. A., & Baloch, Z. W. (2018). The Pathology of Hyperthyroidism. Frontiers in endocrinology, 9, 737. https://doi.org/10.3389/fendo.2018.00737

Mathew P., & Rawla P., (2020).  Hyperthyroidism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK537053/

Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., & Walter, M. A. (2016). 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid, 26(10), 1343-1421.

Nguyen, Caroline T., Elizabeth B. Sasso, Lorayne Barton, and Jorge H. Mestman. “Graves’ hyperthyroidism in pregnancy: a clinical review.” Clinical diabetes and endocrinology 4, no. 1 (2018): 4. https://doi.org/10.1186/s40842-018-0054-7

Caputo, M., Pecere, A., Sarro, A., Mele, C., Ucciero, A., Pagano, L., … & Barone-Adesi, F. (2020). Incidence and prevalence of hyperthyroidism: a population-based study in the Piedmont Region, Italy. Endocrine, 1-6. https://doi.org/10.1007/s12020-020-02222-7

Joshi, K., & Zacharin, M. (2018). Hyperthyroidism in an infant of a mother with autoimmune hypothyroidism with positive TSH receptor antibodies. Journal of Pediatric Endocrinology and Metabolism, 31(5), 577-580. https://doi.org/10.1515/jpem-2017-0425

Kong, S. H., Kim, J. H., Park, Y. J., Lee, J. H., Hong, A. R., Shin, C. S., & Cho, N. H. (2020). Low free T3 to free T4 ratio was associated with low muscle mass and impaired physical performance in community-dwelling aged population. Osteoporosis International, 31(3), 525-531. https://doi.org/10.1210/jcem.82.10.4296 Hyperthyroidism Discussion Paper