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{{
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Distinguish|Hyperthyroxinemia|Hypothyroidism}}
{{Use dmy dates|date=April 2020}}
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| 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 the condition that occurs due to excessive production of [[thyroid hormone]]s by the [[thyroid gland]].<ref name=ATA2011/> '''Thyrotoxicosis''' is the condition that occurs due to excessive thyroid hormone 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
<!-- 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
<!-- 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/>
==Signs and symptoms==
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|website=The Lecturio Medical Concept Library |access-date= 7 August 2021}}</ref>
Major clinical signs of hyperthyroidism include [[weight loss]] (often accompanied by an increased [[appetite]]), anxiety, [[heat intolerance]], hair loss (especially of the outer third of the eyebrows), muscle aches, weakness, fatigue, hyperactivity, irritability, [[hyperglycemia|high blood sugar]],<ref name="Thyrotoxicosis and Hyperthyroidism"/> [[polyuria|excessive urination]], [[polydipsia|excessive thirst]], [[delirium]], [[tremor]], [[pretibial myxedema]] (in [[Graves' disease]]), [[emotional lability]], and sweating. [[Panic attacks]], inability to concentrate, and [[memory]] problems may also occur. [[Psychosis]] and [[paranoia]], common during [[thyroid storm]], are rare with milder hyperthyroidism. Many persons will experience complete remission of symptoms 1 to 2 months after a [[euthyroid]] state is obtained, with a marked reduction in anxiety, sense of exhaustion, irritability, and depression. Some individuals may have an increased rate of anxiety or persistence of [[affective]] and cognitive symptoms for several months to up to 10 years after a euthyroid state is established.<ref>{{cite book|title=Bradley's neurology in clinical practice.|publisher=Elsevier/Saunders|location=Philadelphia, PA|chapter=Depression and Psychosis in Neurological Practice.|year=2012|isbn=978-
Bone loss, which is associated with overt but not subclinical hyperthyroidism, may occur in 10 to 20% of patients. This may be due to an increase in bone remodelling and a decrease in bone density, and increases fracture risk. It is more common in postmenopausal women; less so in younger women, and men. Bone disease related to hyperthyroidism was first described by Frederick von Recklinghausen, in 1891; he described the bones of a woman who died of hyperthyroidism as appearing "worm-eaten".<ref>{{cite web | last=Miragaya | first=Joanna | title=Preventing 'Worm-eaten Bones' From Hyperthyroidism | website=Medscape | date=31 July 2023 | url=https://www.medscape.com/viewarticle/994801}}</ref>
Neurological manifestations can include [[tremor]]s, [[Chorea (disease)|chorea]], [[myopathy]], and in some susceptible individuals (in particular of Asian descent) [[Thyrotoxic periodic paralysis|periodic paralysis]]. An association between thyroid disease and [[myasthenia gravis]] has been recognized. Thyroid disease, in this condition, is [[autoimmune]] in nature and approximately 5% of people with myasthenia gravis also have hyperthyroidism. Myasthenia gravis rarely improves after thyroid treatment and the relationship between the two entities is
In [[Graves' disease]], [[ophthalmopathy]] may cause the eyes to look enlarged because the eye muscles swell and push the eye forward. Sometimes, one or both eyes may bulge. Some have swelling of the front of the neck from an enlarged thyroid gland (a goiter).<ref name="next.thyroid.org">{{cite web |url=http://next.thyroid.org/patients/patient_brochures/hyperthyroidism.html |title=Hyperthyroidism | publisher = American Thyroid Association |access-date=2010-05-10 |url-status=dead |archive-url=https://web.archive.org/web/20110305123450/http://next.thyroid.org/patients/patient_brochures/hyperthyroidism.html |archive-date=5 March 2011}}</ref>
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{{main|Thyroid storm}}
Thyroid storm is a severe form of thyrotoxicosis characterized by rapid and often [[cardiac arrhythmia|irregular heart beat]], high temperature, vomiting, diarrhea, and mental agitation. Symptoms may not be typical in the young, old, or pregnant.<ref name=Clin2014/> It usually occurs due to untreated hyperthyroidism and can be provoked by infections.<ref name=Clin2014/> It is a [[medical emergency]] and requires hospital care to control the symptoms rapidly.
===Hypothyroidism===
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==Causes==
[[File:Causes of hyperthyroidism.png|thumb|Most common causes of hyperthyroidism by age.<ref>{{cite journal | vauthors = Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, Laurberg P | title = Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study | journal = European Journal of Endocrinology | volume = 164 | issue = 5 | pages = 801–809 | date = May 2011 | pmid = 21357288 | doi = 10.1530/EJE-10-1155 | s2cid = 25049060 | doi-access = free }}</ref>]]
There are several causes of hyperthyroidism. Most often, the entire gland is overproducing thyroid hormone. Less commonly, a single nodule is responsible for the excess hormone secretion, called a "hot" nodule. Thyroiditis (inflammation of the thyroid) can also cause hyperthyroidism.<ref>{{cite web |url=http://www.endocrineweb.com/hyper2.html |title=Hyperthyroidism Overview |access-date=2010-04-27 |url-status=live |archive-url=https://web.archive.org/web/20100428091701/http://www.endocrineweb.com/hyper2.html |archive-date=28 April 2010}}</ref> Functional thyroid tissue producing an excess of thyroid hormone occurs in a number of clinical conditions.
The major causes in humans are:
* [[Graves' disease]]. An autoimmune disease (usually, the most common cause with 50–80% worldwide, although this varies substantially with location- i.e., 47% in Switzerland (Horst et al., 1987) to 90% in the USA (Hamburger et al. 1981)). Thought to be due to varying levels of iodine in the diet.<ref name="AnderssonZimmermann2010">{{cite book | vauthors = Andersson M, Zimmermann MB |title=Thyroid Function Testing |chapter=Influence of Iodine Deficiency and Excess on Thyroid Function Tests |volume=28 |year=2010 |pages=45–69 |issn=1566-0729 |doi=10.1007/978-1-4419-1485-9_3 |series=Endocrine Updates |isbn=978-1-4419-1484-2 }}</ref> It is eight times more common in females than males and often occurs in young females, around 20
* [[Toxic thyroid adenoma]] (the most common cause in Switzerland, 53%, thought to be atypical due to a low level of dietary iodine in this country)<ref name="AnderssonZimmermann2010" />
* [[Toxic multinodular goiter]]
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Measuring specific [[antibody|antibodies]], such as anti-TSH-receptor antibodies in Graves' disease, or anti-thyroid peroxidase in [[Hashimoto's thyroiditis]]—a common cause of [[hypothyroidism]]—may also contribute to the diagnosis. The diagnosis of hyperthyroidism is confirmed by blood tests that show a decreased thyroid-stimulating hormone (TSH) level and elevated T<sub>4</sub> and T<sub>3</sub> levels. TSH is a hormone made by the pituitary gland in the brain that tells the thyroid gland how much hormone to make. When there is too much thyroid hormone, the TSH will be low. A radioactive iodine uptake test and thyroid scan together characterizes or enables radiologists and doctors to determine the cause of hyperthyroidism. The uptake test uses radioactive iodine injected or taken orally on an empty stomach to measure the amount of iodine absorbed by the thyroid gland. Persons with hyperthyroidism absorb much more iodine than healthy persons which includes radioactive iodine which is easy to measure. A thyroid scan producing images is typically conducted in connection with the uptake test to allow visual examination of the over-functioning gland.<ref name="Thyrotoxicosis and Hyperthyroidism"/>
Thyroid [[scintigraphy]] is a useful test to characterize (distinguish between causes of) hyperthyroidism, and this entity from thyroiditis. This test procedure typically involves two tests performed in connection with each other: an [[Radioactive iodine uptake test|iodine uptake test]] and a scan (imaging) with a [[gamma camera]]. The uptake test involves administering a dose of radioactive iodine (radioiodine), traditionally [[iodine-131]] (<sup>131</sup>I), and more recently [[iodine-123]] (<sup>123</sup>I). [[Iodine-123]] may be the preferred radionuclide in some clinics due to its more favorable radiation [[dosimetry]] (i.e. less radiation dose to the person per unit administered radioactivity) and a gamma photon energy more amenable to imaging with the [[gamma camera]]. For the imaging scan, I-123 is considered an almost ideal isotope of iodine for imaging thyroid tissue and thyroid cancer metastasis.<ref>{{cite journal | vauthors = Park HM | title = 123I: almost a designer radioiodine for thyroid scanning | journal = Journal of Nuclear Medicine | volume = 43 | issue = 1 | pages = 77–78 | date = January 2002 | pmid = 11801707 | url = http://jnm.snmjournals.org/cgi/content/full/43/1/77 | access-date = 2010-05-10 | url-status = dead | archive-url = https://web.archive.org/web/20081012074621/http://jnm.snmjournals.org/cgi/content/full/43/1/77 | archive-date = 12 October 2008 }}</ref> Thyroid scintigraphy should not be performed in those who are pregnant, a thyroid ultrasound with color flow doppler may be obtained as an alternative in these circumstances.<ref name="Lee 2023" />
Typical administration involves a pill or liquid containing sodium iodide (NaI) taken orally, which contains a small amount of [[iodine-131]], amounting to perhaps less than a grain of salt. A 2-hour fast of no food prior to and for 1 hour after ingesting the pill is required. This low dose of radioiodine is typically tolerated by individuals otherwise allergic to iodine (such as those unable to tolerate contrast mediums containing larger doses of iodine such as used in [[X-ray computed tomography|CT scan]], [[intravenous pyelogram]] (IVP), and similar imaging diagnostic procedures). Excess radioiodine that does not get absorbed into the thyroid gland is eliminated by the body in urine. Some people with hyperthyroidism may experience a slight allergic reaction to the diagnostic radioiodine and may be given an [[antihistamine]].{{citation needed|date=August 2020}}
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===Subclinical===
{{See also|Symptoms and signs of Graves' disease#Subclinical hyperthyroidism}}
In overt primary hyperthyroidism, TSH levels are low and T<sub>4</sub> and T<sub>3</sub> levels are high. Subclinical hyperthyroidism is a milder form of hyperthyroidism characterized by low or undetectable serum TSH level, but with a normal serum free thyroxine level.<ref>{{cite journal | vauthors = Biondi B, Cooper DS | title = The clinical significance of subclinical thyroid dysfunction | journal = Endocrine Reviews | volume = 29 | issue = 1 | pages = 76–131 | date = February 2008 | pmid = 17991805 | doi = 10.1210/er.2006-0043 | doi-access = free }}</ref> Although the evidence for doing so is not definitive, treatment of elderly persons having subclinical hyperthyroidism could reduce the number of cases of [[atrial fibrillation]].<ref>{{cite journal | vauthors = Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, Franklyn JA, Hershman JM, Burman KD, Denke MA, Gorman C, Cooper RS, Weissman NJ
A 2022 meta-analysis found subclinical hyperthyroidism to be associated with cardiovascular death.<ref>{{cite journal |last1=Müller |first1=P |last2=Leow |first2=MK |last3=Dietrich |first3=JW |title=Minor perturbations of thyroid homeostasis and major cardiovascular endpoints-Physiological mechanisms and clinical evidence. |journal=Frontiers in Cardiovascular Medicine |date=2022 |volume=9 |pages=942971 |doi=10.3389/fcvm.2022.942971 |pmid=36046184|pmc=9420854 |doi-access=free }}</ref>
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===Antithyroid drugs===
Thyrostatics ([[Antithyroid agent|antithyroid drugs]]) are drugs that inhibit the production of thyroid hormones, such as [[carbimazole]] (used in the UK) and [[methimazole]] (used in the US, Germany and Russia), and [[propylthiouracil]]. Thyrostatics are believed to work by inhibiting the [[iodination]] of [[thyroglobulin]] by [[thyroperoxidase]] and, thus, the formation of tetraiodothyronine (T<sub>4</sub>). Propylthiouracil also works outside the thyroid gland, preventing the conversion of (mostly inactive) T<sub>4</sub> to the active form T<sub>3</sub>. Because thyroid tissue usually contains a substantial reserve of thyroid hormone, thyrostatics can take weeks to become effective and the dose often needs to be carefully titrated over a period of months, with regular doctor visits and blood tests to monitor results.<ref name="Thyrotoxicosis and Hyperthyroidism"/>
===Beta-blockers===
Many of the common symptoms of hyperthyroidism such as palpitations, trembling, and anxiety are mediated by increases in beta-adrenergic receptors on cell surfaces. [[Beta blockers]], typically used to treat high blood pressure, are a class of drugs that offset this effect, reducing rapid pulse associated with the sensation of palpitations, and decreasing tremor and anxiety. Thus, a person with hyperthyroidism can often obtain immediate temporary relief until the hyperthyroidism can be characterized with the Radioiodine test noted above and more permanent treatment take place. Note that these drugs do not treat hyperthyroidism or any of its long-term effects if left untreated, but, rather, they treat or reduce only symptoms of the condition.<ref>{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/beta-blockers-in-the-treatment-of-hyperthyroidism|access-date=2021-05-17|website=www.uptodate.com}}</ref>
Some minimal effect on thyroid hormone production however also comes with [[propranolol]]—which has two roles in the treatment of hyperthyroidism, determined by the different isomers of propranolol. L-propranolol causes beta-blockade, thus treating the symptoms associated with hyperthyroidism such as tremor, palpitations, anxiety, and [[heat intolerance]]. D-propranolol inhibits thyroxine deiodinase, thereby blocking the conversion of T<sub>4</sub> to T<sub>3</sub>, providing some though minimal therapeutic effect. Other beta-blockers are used to treat only the symptoms associated with hyperthyroidism.<ref>{{cite journal | vauthors = Eber O, Buchinger W, Lindner W, Lind P, Rath M, Klima G, Langsteger W, Költringer P
===Diet===
People with autoimmune hyperthyroidism (such as in [[Graves' disease|Grave's disease]]) should not eat foods high in iodine, such as [[edible seaweed]] and [[
From a public health perspective, the general introduction of iodized salt in the United States in 1924 resulted in lower disease, goiters, as well as improving the lives of children whose mothers would not have eaten enough iodine during pregnancy which would have lowered the IQs of their children.<ref name=BI72213>{{cite news|title=How Adding Iodine To Salt Resulted in a Decade's Worth of IQ Gains for the United States|url=http://www.businessinsider.com/iodization-effect-on-iq-2013-7|access-date=23 July 2013|newspaper=Business Insider|date=22 July 2013| vauthors = Nisen M |url-status=live|archive-url=https://web.archive.org/web/20130723154256/http://www.businessinsider.com/iodization-effect-on-iq-2013-7|archive-date=23 July 2013}}</ref>
===Surgery===
[[Surgery]] ([[thyroidectomy]] to remove the whole thyroid or a part of it) is not extensively used because most common forms of hyperthyroidism are quite effectively treated by the radioactive iodine method, and because there is a risk of also removing the [[parathyroid glands]], and of cutting the [[recurrent laryngeal nerve]], making swallowing difficult, and even simply generalized [[staphylococcus|staphylococcal]] infection as with any major surgery. Some people with Graves' may opt for surgical intervention. This includes those that cannot tolerate medicines for one reason or another, people that are allergic to iodine, or people that refuse radioiodine.<ref>{{cite journal | vauthors = Catania A, Guaitoli E, Carbotta G, Bianchini M, Di Matteo FM, Carbotta S, Nardi M, Fabiani E, Grani G, D'Andrea V, Fumarola A
A 2019 [[systematic review]] concluded that the available evidence shows no difference between visually identifying the nerve or utilizing intraoperative [[neuroimaging]] during surgery, when trying to prevent injury to recurrent laryngeal nerve during thyroid surgery.<ref>{{Cite journal |last1=Cirocchi |first1=Roberto |last2=Arezzo |first2=Alberto |last3=D'Andrea |first3=Vito |last4=Abraha |first4=Iosief |last5=Popivanov |first5=Georgi I |last6=Avenia |first6=Nicola |last7=Gerardi |first7=Chiara |last8=Henry |first8=Brandon Michael |last9=Randolph |first9=Justus |last10=Barczyñski |first10=Marcin |date=2019-01-19 |editor-last=Cochrane Metabolic and Endocrine Disorders Group |title=Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery |journal=Cochrane Database of Systematic Reviews |volume=1 |issue=1 |pages=CD012483 |language=en |doi=10.1002/14651858.CD012483.pub2|pmid=30659577 |pmc=6353246 }}</ref>
If people have toxic nodules treatments typically include either removal or injection of the nodule with alcohol.<ref>{{cite book |title=Endocrinology : adult and pediatric|date=2010|publisher=Saunders/Elsevier|location=Philadelphia|isbn=9781416055839|page=Chapter 82|edition=6th|url=https://www.inkling.com/read/endocrinology-jameson-de-groot-6th/chapter-82/chapter082-reader-1 |url-access=subscription}}</ref>▼
▲If people have toxic nodules treatments typically include either removal or injection of the nodule with alcohol.<ref>{{cite book |title=Endocrinology : adult and pediatric|date=2010|publisher=Saunders/Elsevier|location=Philadelphia|isbn=
===Radioiodine===
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Since iodine is picked up more readily (though not exclusively) by thyroid cells, and (more important) is picked up even more readily by over-active thyroid cells, the destruction is local, and there are no widespread side effects with this therapy. Radioiodine ablation has been used for over 50 years, and the only major reasons for not using it are pregnancy and breastfeeding ([[Breast|breast tissue]] also picks up and concentrates iodine). Once the thyroid function is reduced, replacement hormone therapy ([[levothyroxine]]) taken orally each day replaces the thyroid hormone that is normally produced by the body.<ref>{{cite web
|
|
| title = levothyroxine
| url = https://medlineplus.gov/druginfo/meds/a682461.html
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===Thyroid storm===
[[Thyroid storm]] presents with extreme symptoms of hyperthyroidism. It is treated aggressively with [[resuscitation]] measures along with a combination of the above modalities including: an intravenous beta blockers such as [[propranolol]], followed by a [[thioamide]] such as [[methimazole]], an iodinated radiocontrast agent or an iodine solution if the radiocontrast agent is not available, and an intravenous [[steroid]] such as [[hydrocortisone]].<ref>{{cite book |title=Emergency Medicine: A Comprehensive Study Guide | edition = Sixth | vauthors = Tintinalli J |year=2004 |publisher=McGraw-Hill Professional |isbn=978-0-07-138875-7 |page=1312 }}</ref> [[Propylthiouracil]] is the preferred thioamide in thyroid storm as it can prevent the conversion of T4 to the more active T3 in the peripheral tissues in addition to inhibiting thyroid hormone production.<ref name="Lee 2023" />
=== Alternative medicine ===
In countries such as China, herbs used alone or with antithyroid medications are used to treat hyperthyroidism.<ref name=":0">{{cite journal | vauthors = Zen XX, Yuan Y, Liu Y, Wu TX, Han S | title = Chinese herbal medicines for hyperthyroidism | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD005450 | date = April 2007 | volume = 2007 | pmid = 17443591 | pmc = 6544778 | doi = 10.1002/14651858.CD005450.pub2 }}</ref> Very low quality evidence suggests that [[Chinese herbology|traditional Chinese herbal medications]] may be beneficial when taken along with routine hyperthyroid medications, however, there is no reliable evidence to determine the effectiveness of Chinese herbal medications for treating hyperthyroidism.<ref name=":0" />
==Epidemiology==
In the United States hyperthyroidism affects about 1.2% of the population.<ref name=ATA2011/> About half of these cases have obvious symptoms while the other half do not.<ref name=Clin2014/> It occurs between two and ten times more often in women.<ref name=NIH2012/> The disease is more common in those over the age of 60 years.<ref name=NIH2012/>
[[Signs and symptoms of Graves' disease#
== History ==
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{{see also|Thyroid disease in pregnancy}}
Recognizing and evaluating hyperthyroidism in pregnancy is a diagnostic challenge.<ref>{{cite journal | vauthors = Fumarola A, Di Fiore A, Dainelli M, Grani G, Carbotta G, Calvanese A | title = Therapy of hyperthyroidism in pregnancy and breastfeeding | journal = Obstetrical & Gynecological Survey | volume = 66 | issue = 6 | pages = 378–385 | date = June 2011 | pmid = 21851752 | doi = 10.1097/ogx.0b013e31822c6388 | s2cid = 28728514 }}</ref> Thyroid hormones are
Propylthiouracil is the preferred [[antithyroid]] medication in the 1st trimester of pregnancy as it is less [[teratogenic]] than methimazole.<ref name="Lee 2023" />
==Other animals==
===Cats===
{{main|Feline hyperthyroidism}}
Hyperthyroidism is one of the most common endocrine conditions affecting older domesticated [[cat|housecats]]. In the United States, up to 10% of cats over ten years old have hyperthyroidism.<ref name="AAFP 2016">{{cite journal | vauthors = Carney HC, Ward CR, Bailey SJ, Bruyette D, Dennis S, Ferguson D, Hinc A, Rucinsky AR
The most common presenting symptoms are: rapid [[weight loss]], [[tachycardia]] (rapid heart rate), [[vomiting]], [[diarrhea]], increased consumption of fluids ([[polydipsia]]), increased appetite ([[polyphagia]]), and increased urine production ([[polyuria]]). Other symptoms include hyperactivity, possible aggression, an unkempt appearance, and large, thick [[claws]]. [[Heart murmurs]] and a [[gallop rhythm]] can develop due to secondary [[hypertrophic cardiomyopathy]]. About 70% of affected cats also have enlarged thyroid glands ([[goiter]]). 10% of cats exhibit "apathetic hyperthyroidism", which is characterized by anorexia and lethargy.<ref name=Gra2014>{{cite journal | vauthors = Vaske HH, Schermerhorn T, Armbrust L, Grauer GF | title = Diagnosis and management of feline hyperthyroidism: current perspectives | journal = Veterinary Medicine: Research and Reports | volume = 5 | pages = 85–96 | date = August 2014 | pmid = 32670849 | pmc = 7337209 | doi = 10.2147/VMRR.S39985 | doi-access = free }}</ref>
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===Dogs===
Hyperthyroidism is much less common in [[dog]]s compared to cats.<ref>{{cite book| vauthors = Ford RB, Mazzaferro E |title=Kirk & Bistner's Handbook of Veterinary Procedures and Emergency Treatment|date=2011|publisher=Elsevier Health Sciences|location=London|isbn=
In dogs treated for [[hypothyroidism]] (lack of thyroid hormone), iatrogenic hyperthyroidism may occur as a result of an overdose of the thyroid hormone replacement medication, [[levothyroxine]]; in this case, treatment involves reducing the dose of levothyroxine.<ref name=HypoT>{{cite web|url=http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/40602.htm|title=Hypothyroidism|publisher=Merck Veterinary Manual|access-date=27 July 2011|url-status=live|archive-url=https://web.archive.org/web/20110526152610/http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm%2Fbc%2F40602.htm|archive-date=26 May 2011}}</ref><ref>{{cite web|url=http://usa.leventa.com/Vet/label.asp|title=Leventa-Precautions/Adverse Reactions|publisher=Intervet|access-date=27 July 2011|url-status=live|archive-url=https://web.archive.org/web/20120114181242/http://usa.leventa.com/Vet/label.asp|archive-date=14 January 2012}}</ref> Dogs which display [[coprophagy]], the consumption of feces, and also live in a household with a dog receiving levothyroxine treatment, may develop hyperthyroidism if they frequently eat the feces from the dog receiving levothyroxine treatment.<ref name="Shadwick 2013">{{cite journal | vauthors = Shadwick SR, Ridgway MD, Kubier A | title = Thyrotoxicosis in a dog induced by the consumption of feces from a levothyroxine-supplemented housemate | journal = The Canadian Veterinary Journal | volume = 54 | issue = 10 | pages = 987–989 | date = October 2013 | pmid = 24155422 | pmc = 3781434 }}</ref>
Hyperthyroidism may occur if a dog eats an excessive amount of thyroid gland tissue. This has occurred in dogs fed commercial dog food.<ref name="Broome 2015">{{cite journal | vauthors = Broome MR, Peterson ME, Kemppainen RJ, Parker VJ, Richter KP | title = Exogenous thyrotoxicosis in dogs attributable to consumption of all-meat commercial dog food or treats containing excessive thyroid hormone: 14 cases (2008-2013) | journal = Journal of the American Veterinary Medical Association | volume = 246 | issue = 1 | pages = 105–111 | date = January 2015 | pmid = 25517332 | doi = 10.2460/javma.246.1.105 | doi-access = free }}</ref>
== See also ==
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* [[Hashitoxicosis]]
==
* [https://www.liebertpub.com/doi/full/10.1089/thy.2016.0229 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis, Thyroid. Oct 2016.1343-1421.]▼
{{Reflist}}
== Further reading ==
{{refbegin}}
* {{cite book | veditors = Brent GA | url = https://books.google.com/books?id=zxBqGlxwObYC | title = Thyroid Function Testing | location = New York | publisher = Springer | series = Endocrine Updates | volume = 28 | edition = 1st | date = 2010 | isbn = 978-1-4419-1484-2}}▼
▲*
* {{Cite web | vauthors = Spadafori G| title=Hyperthyroidism: A Common Ailment in Older Cats | url=http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=138 | work=The Pet Connection | date=20 January 1997 | publisher=Veterinary Information Network | access-date=28 January 2007}}
▲* {{cite book | veditors = Brent GA | url = https://books.google.com/books?id=zxBqGlxwObYC | title = Thyroid Function Testing | location = New York | publisher = Springer | series = Endocrine Updates | volume = 28 | edition = 1st | date = 2010 | isbn = 978-1-4419-1484-2}}
* {{Cite journal | vauthors = Siraj ES |date=June 2008 |title=Update on the Diagnosis and Treatment of Hyperthyroidism |journal=Journal of Clinical Outcomes Management |volume=15 |issue=6 |pages=298–307 |url=http://www.turner-white.com/memberfile.php?PubCode=jcom_jun08_hyperthyroidism.pdf |access-date=24 June 2009 |archive-url=https://web.archive.org/web/20131019153905/http://www.turner-white.com/memberfile.php?PubCode=jcom_jun08_hyperthyroidism.pdf |archive-date=19 October 2013 |url-status=dead }}
{{refend}}
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== External links ==
* [http://www.merck.com/mmpe/sec12/ch152/ch152e.html#sec12-ch152-ch152e-239 Merck Manual article about hyperthyroidism]
*
{{Medical resources
| DiseasesDB = 6348
|
| ICD10 = {{ICD10|E05}}
| ICD9 = {{ICD9|242.90}}
| ICDO =
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{{Thyroid disease}}
[[Category:
[[Category:Endocrine-related cutaneous conditions]]▼
[[Category:Dog diseases]]
▲[[Category:Endocrine-related cutaneous conditions]]
[[Category:Thyroid]]
▲[[Category:Cat diseases]]
[[Category:Wikipedia medicine articles ready to translate]]▼
[[Category:Wikipedia emergency medicine articles ready to translate]]
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