Typical symptoms
- fast, forceful or irregular heartbeat
- inner restlessness, nervousness, irritability
- increased sweating and sensitivity to heat
- fine tremor of the hands
- weight loss despite a good or increased appetite
- more frequent bowel movements, up to and including diarrhoea
- sleep problems and exhaustion despite restlessness
- lighter or absent periods
- hair loss and thinning skin
At a glance
- Typical signs: palpitations, inner restlessness, sweating, tremor, sleep problems, weight loss
- Most common causes: Graves' disease and so-called thyroid autonomy
- Diagnosis: TSH, fT3, fT4, TRAb and ultrasound with blood-flow measurement
- Treatment: antithyroid drugs, plus beta blockers for the heart symptoms if needed
- Permanent solutions: radioiodine therapy or surgery – we organise both
- Appointment: book online or call us on +43 1 5333 654
“I thought it was stress”
Palpitations, nervousness and sleep problems are almost reflexively put down to stress. With an overactive thyroid, however, the pattern persists even when life calms down – and sensitivity to heat, tremor and weight loss are added to it.
If you recognise yourself here, the work-up is quickly done: a blood test is enough for the first answer. A suppressed TSH together with raised fT4 or fT3 confirms the diagnosis.
The two most common causes
Graves' disease is an autoimmune disease: antibodies (TRAb) stimulate the thyroid continuously. It mainly affects younger women. In some cases the eyes are also involved – they protrude, burn or water. This is called thyroid eye disease (endocrine orbitopathy) and we treat it together with an ophthalmologist.
Thyroid autonomy arises when areas of the thyroid escape the body's central control and produce hormones independently – often in the form of a “hot” nodule. It tends to affect older people and develops slowly. Find out more under Thyroid nodules and goitre.
Less commonly, a temporary inflammation, too high a dose of levothyroxine, or iodine-containing medicines and contrast agents are behind it.
How it is treated
First, hormone production is slowed down with antithyroid drugs. They do not work immediately, because the thyroid initially lives on its stored hormone – during this time, beta blockers help against palpitations and restlessness.
In Graves' disease, a course of treatment of around twelve to eighteen months is tried first. After that, the disease stays permanently quiet in some patients. If it comes back, or if autonomy is the cause, a permanent solution makes sense: radioiodine therapy or surgery.
The path to diagnosis
Laboratory
TSH, fT4, fT3
Antibodies
TRAb to distinguish Graves' disease from autonomy
Ultrasound
structure, nodules, blood flow
Treatment plan
medication first, then a decision on the permanent solution
Frequently asked questions
Do I have to avoid iodine if I have an overactive thyroid?
You do not have to give up iodised table salt or normal foods. What you should avoid are high-dose iodine supplements, seaweed and kelp products and – after consulting us – iodine-containing X-ray contrast agents. Before a CT scan, please always say that you have an overactive thyroid.
How long does it take for the medication to work?
Blood levels usually improve within two to six weeks; how you feel often follows a little later. Beta blockers, on the other hand, work against palpitations and tremor within just a few days.
Can I get pregnant with an overactive thyroid?
Yes, but it should be well controlled beforehand, and the choice of medication changes during pregnancy. Please plan this together with us – see also Thyroid in pregnancy and breastfeeding.