If your weight changes abnormally so you get fatter or thinner fast, coupled with possible insomnia, hair loss and swollen throat, you may have Thyrotoxicosis. Let’s look at the warning signs in more detail.

Two types of Thyrotoxicosis

Shaped a bit like a butterfly, the thyroid gland is located at the front of the neck under‌ the Adam's apple, the cartilage that wraps around the front of the larynx or voice box, and adjacent to the windpipe. This particular gland is divided into two hemispheres, left and right, connected by isthmus tissue. It produces Thyroxine (T4) and Triiodothyronine (T3) hormones that regulate the body's metabolism, and Calcitonin which regulates calcium and phosphorus levels in the circulatory system.

Thyrotoxicosis is when the thyroid gland produces too much or too little hormones, causing the metabolic system to malfunction. Abnormally rapid weight changes, fast or irregular heartbeat, sweating easily and irritability follow in turn. Thyroid disease comes in these two forms:

·       Hyperthyroidism is when the level of thyroid function is too high, creating overly high levels of thyroid hormones in the blood cells, causing cells in the body to work too fast. This affects the body as follows:

o   abnormal weight loss

o   feeling hot, sweating a lot

o   tiring easily

o   less menstrual periods

o   faulty memory

o   restlessness and trouble concentrating

o   hair loss

o   irregular heartbeat

o   diarrhea

o   white skin spots

o   shaking hands, weak limbs

o   bulging eyes

o   enlarged thyroid gland

o   thick patches on legs

·       Hypothyroidism is when thyroid function is abnormally weak, leading to low thyroid hormone levels in the blood, in turn causing blood cells to work too slowly. This affects the body as follows:

o   rapid weight gain

o   coldness

o   drowsy and easily fatigued

o   hair loss

o   dry skin

o   feeling depressed

o   cramps

o   slow heart rate

o   constipation

o   swollen eyes

o   swollen face and body

o   enlarged thyroid gland

Thyrotoxicosis causes

Thyrotoxicosis is mainly caused by the body stimulating the thyroid gland to produce more hormones than necessary. This leads to toxicity impacting various systems of the body. Causes include:

·       Graves' disease

The most common factor, Graves’ causes the body to secrete so much tyrosine hormone that it becomes toxic. Exact causes of the condition are unknown. However, we do know that it occurs most often in adolescent and middle-aged women, that it can be inherited genetically, and that smoking increases the risk of contracting it.

·       Eating behavior

Thyroid toxicity can also ensue from over-ingesting iodine, a key ingredient in thyroid hormone production.

·       Thyroid tumors

This cause is quite rare. It only occurs when tumors in the thyroid and pituitary glands secrete so much thyroid hormone that they become toxic.

·       Thyroiditis

Idiopathic inflammation of the thyroid gland can lead to thyroid disfunction where the gland causes so much hormone to be produced that it leaks into the bloodstream. Inflammation of the thyroid gland isn’t usually painful, except in the less likely case of subacute thyroiditis.

·       Excessive thyroid hormone medication consumption

Certain iodine-containing medications such as amiodarone used to treat arrhythmias and drugs used to treat Hypothyroidism cause thyroid hormone secretion toxicity.

10 warning signs of Thyrotoxicosis

You may have a case of toxic thyroid disease if you have any of these symptoms:

·       Fatigue, easily tired, heart palpitations

When Thyrotoxicosis affects the functioning of the heart, it makes you less active and easily tired.

·       Hair loss

In the case of hypothyroidism when the thyroid gland is underactive.

·       Insomnia

Caused by too much thyroid hormone secretion stimulating the central nervous system to the extent that it interferes with sleep.

·       Feeling sleepy all the time

When low thyroid function makes you feel weak.

·       Unusual weight gain or loss

When the thyroid function is too high, abnormal weight loss results. Conversely, too low thyroid function leads to abnormal weight gain.

·       Frequent feelings of hunger, or conversely, not feeling hungry and rarely eating.

If your thyroid works too hard, you’ll feel hungry more often and eat more but still lose weight. If it doesn’t work hard enough, you’ll feel less hungry and eat less but tend to swell up and get fat.

·       Abnormal excretion

You go to the bathroom less than usual or have constipation despite eating fruits and vegetables. This indicates thyroid deficiency. Conversely, Hyperthyroidism produces more bowel function and more frequent defecation than normal, although it can also lead to constipation.

·       Feeling too cold or hot

When the thyroid gland under produces hormones, the body's metabolism slows, in turn reducing body heat and leading to chills. Conversely, if the thyroid gland over-works, heatstroke and unusual sweating symptoms arise.

·       Dry skin

When Hypothyroidism slows metabolism, skin secretions are reduced leaving the skin dryer than normal.

·       Palpitations

Hyperthyroidism speeds up all body processes, including heart rate.

Easy checking

·       Look in the mirror and stretch your neck upwards, slowly turning left and right and see if you can spot any throat abnormality.

·       With the index fingers and middle fingers of both hands palpate the neck simultaneously on both sides, from back to front and top to bottom.

·       If you feel any lump, try rolling it.

·       If you find an abnormal lump, see a doctor for a thorough examination.

Treatments

Thyrotoxicosis treatment is according to age, physical condition and severity.

·       Anti-thyroid drugs

Methimazole (MMI) and Propylthiouracil (PTU) are the most widely used anti-thyroid medications in Thailand. Depending on the dosage prescribed by the doctor, the drugs correct excessive thyroid hormone production within 2-8 weeks.  Medication is usually taken for at least one year. Possible side effects include rash, fever, joint pain and, in rare cases, low white blood cell count. As such, the doctor may call for a blood test to see how the medication is impacting white blood cell count.

·       Radioactive Iodine

Radioactive iodine is a safe substance administered to the thyroid gland to destroy glandular tissue causing shrinking. The symptoms will steadily be relieved over the course of 3-6 months. This causes the thyroid gland to work less until the hypothyroidism is reduced to normal. To offset this, patients also need to take thyroid hormone supplements. Radiation therapy is applied in hyperthyroidism patients aged 60 years and older.

·       Thyroidectomy

If medications or radiation iodine treatments are unsuitable for the patient, such as if they are pregnant, treatment of Thyrotoxicosis may require surgery. In these few cases, the surgeon will relieve the symptoms by removing most of the thyroid gland. A risk is that the surgery may damage the vocal cords and parathyroid gland. Moreover, after removing most of the thyroid gland, patients need to take medication to maintain hormone levels for the rest of their life. If the parathyroid gland is also removed, patients also need to take medication to control their calcium level.

·       Beta blockers

Anti-beta drugs slow the heart rate, relieving heart palpitations and reducing anxiety. They are mostly used with patients who have high blood pressure. Side effects can include tiredness, headache, upset stomach, constipation, diarrhea and dizziness.

·       Compensating for dehydration

Thyroid disease can cause dehydration which can be relieved by staying hydrated.

Possible complications

·       Eye problems

Such as dry eyes, sensitivity to light, watery eyes, double vision, red eyes, swollen eyes, bulging eyes, red and swollen eyelids, and bulging eyelids. In most cases, symptoms improve with the treatment of hyperthyroidism. However, in some cases, patients can lose their vision.

·       Heart problems

This complication can be as serious as a heart attack and is considered extremely dangerous.

·       Hypothyroidism

-      Fragile bones

If untreated, hypothyroidism can affect bones and lead to osteoporosis. Excessive thyroid undermines bones’ ability to absorb calcium, leading to weakness and fragility.

-      Critical Thyrotoxicosis

If the thyroid level isn’t well controlled, the severity of the symptoms increases, potentially to the point of being life-threatening.

If you notice any abnormal changes in your body, don’t keep it to yourself. It is the nature of our bodies to give warning signs when something’s wrong, so go see a doctor straight away for a detailed diagnosis, prescription and timely cure. Make monitoring your body’s signaling an ingrained habit and basis for a happy and healthy life.

Krungthai-AXA Life Insurance customers diagnosed with thyroid disease needing ongoing treatment can consult our “We care for you more than anyone” project for suitable hospitals and specialists. For more information, please visit: www.krungthai-axa.co.th/th/health-services/care-coordination

References

·       Bangkok Hospital
https://www.bangkokhospital.com/content/10-thyroid-disease-signs

·       Faculty of Medicine, Siriraj Hospital, Mahidol University
https://bit.ly/3bugrDB

·       Phyathai Hospital
https://www.phyathai.com/article_detail/2887/th/view

·       Bumrungrad Hospital
https://www.bumrungrad.com/th/health-blog/october-2020/thyrotoxicosis

·       Pobpad website
https://bit.ly/3oMpMK2