Editing Hyperthyroidism (section)

{{Short description|Excessive production of thyroid hormone}}
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{{Distinguish|Hyperthyroxinemia|Hypothyroidism}}
{{Use dmy dates|date=April 2020}}
{{Infobox medical condition
| name = Hyperthyroidism
| image = Triiodothyronine.svg
| caption = [[Triiodothyronine]] (T<sub>3</sub>, pictured) and [[thyroxine]] (T<sub>4</sub>) are both forms of [[thyroid hormone]].
| field = [[Endocrinology]]
| synonyms = Overactive thyroid, hyperthyreosis
| symptoms = [[Irritability]], [[muscle weakness]], [[insomnia|sleeping problems]], [[tachycardia|fast heartbeat]], [[heat intolerance]], [[diarrhea]], [[goiter|enlargement of the thyroid]], [[weight loss]]<ref name=NIH2012/>
| complications = [[Thyroid storm]]<ref name=Clin2014/>
| onset = 20–50 years old<ref name=Clin2014/>
| duration = 
| causes = [[Graves' disease]], [[multinodular goiter]], [[toxic adenoma]], [[thyroiditis|inflammation of the thyroid]], eating too much [[iodine]], too much [[synthetic thyroid hormone]]<ref name=NIH2012/><ref name=Clin2014/>
| risks = 
| diagnosis = Based on symptoms and confirmed by [[blood tests]]<ref name=NIH2012/>
| differential = 
| prevention = 
| treatment = [[Radioiodine therapy]], medications, thyroid surgery<ref name=NIH2012/>
| medication = [[Beta blockers]], [[methimazole]]<ref name=NIH2012/>
| prognosis = 
| frequency = 1.2% (US)<ref name=ATA2011/>
| deaths = Rare directly, unless [[thyroid storm]] occurs; associated with increased mortality if untreated (1.23 [[hazard ratio|HR]])<ref name="Lillevang-Johansen Abrahamsen Jørgensen Brix 2017 pp. 2301–2309">{{cite journal | last1=Lillevang-Johansen | first1=Mads | last2=Abrahamsen | first2=Bo | last3=Jørgensen | first3=Henrik Løvendahl | last4=Brix | first4=Thomas Heiberg | last5=Hegedüs | first5=Laszlo | title=Excess Mortality in Treated and Untreated Hyperthyroidism Is Related to Cumulative Periods of Low Serum TSH | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=102 | issue=7 | date=2017-03-28 | issn=0021-972X | doi=10.1210/jc.2017-00166 | pages=2301–2309| pmid=28368540 | s2cid=3806882 | doi-access=free }}</ref>
}}

<!-- Definition and symptoms -->
'''Hyperthyroidism''' is a [[endocrine disease]] in which the [[thyroid gland]] produces excessive amounts of [[thyroid hormone]]s.<ref name=ATA2011/> '''Thyrotoxicosis''' is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperthyroidism.<ref name=ATA2011>{{cite journal | vauthors = Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN | title = Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists | journal = Thyroid | volume = 21 | issue = 6 | pages = 593–646 | date = June 2011 | pmid = 21510801 | doi = 10.1089/thy.2010.0417 }}</ref> Some, however, use the terms interchangeably.<ref>{{cite web| vauthors = Schraga ED |title=Hyperthyroidism, Thyroid Storm, and Graves Disease|website=Medscape|url=http://emedicine.medscape.com/article/767130-overview|access-date=20 April 2015|date=30 May 2014|url-status=live|archive-url=https://web.archive.org/web/20150405111836/http://emedicine.medscape.com/article/767130-overview|archive-date=5 April 2015}}</ref> Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems, a [[tachycardia|fast heartbeat]], [[heat intolerance]], [[diarrhea]], [[goitre|enlargement of the thyroid]], hand [[tremor]], and [[weight loss]].<ref name=NIH2012/> Symptoms are typically less severe in the elderly and during [[pregnancy]].<ref name=NIH2012/> An uncommon but life-threatening complication is [[thyroid storm]] in which an event such as an [[infection]] results in worsening symptoms such as confusion and a [[hyperthermia|high temperature]]; this often results in death.<ref name=Clin2014/> The opposite is [[hypothyroidism]], when the thyroid gland does not make enough thyroid hormone.<ref>{{cite web|author1=NIDDK|title=Hypothyroidism|url=http://www.niddk.nih.gov/health-information/health-topics/endocrine/hypothyroidism/Pages/fact-sheet.aspx|access-date=20 April 2015|date=13 March 2013|url-status=live|archive-url=https://web.archive.org/web/20160305010654/http://www.niddk.nih.gov/health-information/health-topics/endocrine/hypothyroidism/Pages/fact-sheet.aspx|archive-date=5 March 2016}}</ref>

<!-- Cause and diagnosis -->
[[Graves' disease]] is the cause of about 50% to 80% of the cases of hyperthyroidism in the United States.<ref name=NIH2012>{{Cite web|title = Hyperthyroidism|url = http://www.niddk.nih.gov/health-information/health-topics/endocrine/hyperthyroidism/Pages/fact-sheet.aspx|website = www.niddk.nih.gov|access-date = 2015-04-02|date = July 2012|url-status = dead|archive-url = https://web.archive.org/web/20150404183926/http://www.niddk.nih.gov/health-information/health-topics/endocrine/hyperthyroidism/Pages/fact-sheet.aspx|archive-date = 4 April 2015}}</ref><ref name=NEJM2008>{{cite journal | vauthors = Brent GA | title = Clinical practice. Graves' disease | journal = The New England Journal of Medicine | volume = 358 | issue = 24 | pages = 2594–2605 | date = June 2008 | pmid = 18550875 | doi = 10.1056/NEJMcp0801880 }}</ref> Other causes include [[multinodular goiter]], [[toxic adenoma]], [[thyroiditis|inflammation of the thyroid]], eating too much [[iodine]], and too much [[synthetic thyroid hormone]].<ref name=NIH2012/><ref name=Clin2014>{{cite journal | vauthors = Devereaux D, Tewelde SZ | title = Hyperthyroidism and thyrotoxicosis | journal = Emergency Medicine Clinics of North America | volume = 32 | issue = 2 | pages = 277–292 | date = May 2014 | pmid = 24766932 | doi = 10.1016/j.emc.2013.12.001 }}</ref> A less common cause is a [[pituitary adenoma]].<ref name=NIH2012/> The diagnosis may be suspected based on signs and symptoms and then confirmed with blood tests.<ref name=NIH2012/> Typically blood tests show a low [[thyroid stimulating hormone]] (TSH) and raised [[triiodothyronine|T<sub>3</sub>]] or [[thyroxine|T<sub>4</sub>]].<ref name=NIH2012/> [[Radioiodine]] uptake by the thyroid, [[thyroid scan]], and measurement of [[antithyroid autoantibodies]] (thyroidal thyrotropin receptor antibodies are positive in Graves disease)  may help determine the cause.<ref name=NIH2012/>

<!-- Management and epidemiology -->
Treatment depends partly on the cause and severity of disease.<ref name=NIH2012/> There are three main treatment options: [[radioiodine therapy]], medications, and thyroid surgery.<ref name=NIH2012/> Radioiodine therapy involves taking [[iodine-131]] by mouth which is then concentrated in and destroys the thyroid over weeks to months.<ref name=NIH2012/> The resulting hypothyroidism is treated with synthetic thyroid hormone.<ref name=NIH2012/> Medications such as [[beta blockers]] may control the symptoms, and [[anti-thyroid medication]]s such as [[methimazole]] may temporarily help people while other treatments are having an effect.<ref name=NIH2012/> Surgery to remove the thyroid is another option.<ref name=NIH2012/> This may be used in those with very large thyroids or when cancer is a concern.<ref name=NIH2012/> In the United States hyperthyroidism affects about 1.2% of the population.<ref name=ATA2011/> Worldwide, hyperthyroidism affects 2.5% of adults.<ref name="Lee 2023">{{cite journal |last1=Lee |first1=Sun Y. |last2=Pearce |first2=Elizabeth N. |title=Hyperthyroidism: A Review |journal=JAMA |date=17 October 2023 |volume=330 |issue=15 |pages=1472–1483 |doi=10.1001/jama.2023.19052|pmid=37847271 |pmc=10873132 |s2cid=265937262 }}</ref> It occurs between two and ten times more often in women.<ref name=NIH2012/> Onset is commonly between 20 and 50 years of age.<ref name=Clin2014/> Overall the disease is more common in those over the age of 60 years.<ref name=NIH2012/>