metaboliq
Shalini is 34 and teaches chemistry at a school in Dehradun. Over the summer she lost five kilos without trying. Her heart raced while she sat marking papers, and her hands shook enough to spoil her writing on the board. She blamed exam stress and the heat until her sister, a nurse at Doon Hospital, made her get a thyroid test. Shalini is a composite of the readers who ask this, not a real patient.
Hyperthyroidism means the thyroid makes too much hormone, which speeds the body up. Typical signs are weight loss despite a good appetite, a racing heart, shaky hands, feeling hot, anxiety and loose stools. A TSH and free T4 blood test finds it. Graves' disease is the commonest cause, and it responds well to treatment.
What is hyperthyroidism?
The thyroid, a small gland at the front of the neck, sets the pace of the body's metabolism. In hyperthyroidism it makes too much hormone, and nearly everything speeds up: heart rate, digestion, the burning of energy and even thinking. Simone De Leo's review in The Lancet describes it as one of the most common gland disorders, far more frequent in women than in men.
Shalini's body had been running hot for months. She was eating more than ever, including second helpings of rajma chawal and a sandwich at break, and still losing weight. She felt warm in rooms where her colleagues wore cardigans, and she was sleeping badly. Each of those can have ordinary explanations. Together, in a woman in her thirties, they point clearly at the thyroid.
Sources: [1]
What are the symptoms of hyperthyroidism in women?
The classic set starts with weight loss despite a normal or bigger appetite, a fast or pounding heartbeat and fine trembling of the hands. Sweating, feeling hot, anxiety, poor sleep, loose stools and weak thighs often follow. Periods often become lighter or less regular.
Older people may have fewer of these and present instead with an irregular heartbeat or unexplained tiredness. Shalini noticed the trembling first, when her chalk writing turned spidery, and then the stairs to the staff room began to tire her legs. Her sister spotted something else at a family dinner: Shalini's eyes looked wider and more staring than in old photos, which is a clue to one particular cause.
Sources: [1]
What causes hyperthyroidism?
Graves' disease, most of the time. Terry Smith and Laszlo Hegedüs reviewed it in the New England Journal of Medicine. In Graves' the immune system makes an antibody that keeps switching on the thyroid's receptor, so the gland never rests. It runs in families, and in some people it also inflames the tissue behind the eyes.
Shalini's aunt in Mussoorie was treated for an overactive thyroid twenty years ago, and Shalini's eyes now look wider in photographs than they did at her wedding. Those two facts made Graves' the likely answer before her antibody test came back positive. Less common causes include thyroid lumps that make hormone on their own, and thyroiditis, an inflamed gland that sometimes follows a viral illness or childbirth and often settles without treatment.
Sources: [2]
Can hyperthyroidism start after pregnancy?
Yes, and it is easy to miss. Up to a few months after delivery, some women develop postpartum thyroiditis, an inflamed gland that leaks its stored hormone. For a few weeks it looks like hyperthyroidism, with a racing heart, poor sleep and weight dropping faster than expected. Then it often swings the other way into an underactive phase, with exhaustion and low mood, before settling. De Leo's review notes that this kind of thyroiditis usually passes on its own and is treated differently from Graves' disease.
New mothers in India rarely get a thyroid test for these symptoms, because a newborn explains almost everything. Shalini's neighbour Kavya, back at her bank job four months after a caesarean, put the pounding heart down to broken nights and the kilos falling away to breastfeeding. Only when her hands shook too much to hold a feeding bottle steady did her doctor send her for a TSH. A TSH is worth asking for in the year after a baby if anything feels wrong, and earlier in a woman with a thyroid history.
Sources: [1]
Which blood tests confirm hyperthyroidism?
TSH comes first. When the thyroid overproduces, the pituitary gland turns its signal down, so TSH drops below the lab's lower limit. Free T4, and sometimes free T3, are raised. The American Thyroid Association guideline led by Douglas Ross adds antibody tests, and sometimes a thyroid scan, to find the cause.
Shalini's report showed a TSH of 0.01 and a free T4 well above the range, and her TSH-receptor antibody was positive. Her endocrinologist also asked for an ECG, because a fast heart can slip into an irregular rhythm, and a blood count and liver test before starting treatment. An eight-city Indian survey found thyroid disorders common and often undiagnosed, so Shalini's sister has booked a TSH for herself as well.
What happens if hyperthyroidism is left untreated?
The heart takes much of the strain. A racing heart can tip into atrial fibrillation, an irregular rhythm that raises the risk of stroke, especially in older people. Over years, excess thyroid hormone also thins the bones, and the muscle loss leaves people weak. In Graves' disease, the eyes can become more swollen and sore.
Rarely, a severe flare called thyroid storm brings high fever, a very fast pulse and confusion, and needs emergency care. Shalini's grandmother, who lived in a hill village with no lab nearby, had what the family called a nervous heart for years before anyone checked her thyroid. By then she had an irregular pulse for life. Treated early, as Shalini was, most of these problems never develop.
Sources: [1]
How is hyperthyroidism treated?
There are three routes, and an endocrinologist chooses between them with you. The first is anti-thyroid treatment taken by mouth, which calms the gland over a few weeks and is usually continued for twelve to eighteen months. In Graves' disease, a good share of people stay well after it stops. The second is radioactive iodine, swallowed once as a drink or capsule, which slowly shrinks the overactive tissue. The third is surgery to remove part or all of the gland.
The American Thyroid Association guideline led by Douglas Ross sets out the trade-offs, including pregnancy plans, eye disease, the size of the gland and how likely relapse is. It also covers the safety checks. The oral route needs a blood count and liver test at the start, and a rare side effect lowers the white cells that fight infection. Anyone on it who develops a sore throat with fever should stop and get a blood count that day. Treatment that slows the heart is often added for the first weeks to steady the palpitations and the tremor.
Shalini hopes to have a second child in a couple of years. That alone did not rule out radioactive iodine: the guideline's advice is to wait at least six months after it, with thyroid levels steady, before trying to conceive. She still preferred the oral route, because it might settle her gland without leaving her on thyroid hormone for life. Her endocrinologist rechecked her free T4 every month and lowered the amount as it came down. By the end of the second month her chalk writing was neat again.
Sources: [3]
What should you eat with hyperthyroidism?
Enough food to stop the muscle loss, with plenty of protein, calcium and vitamin D, because excess thyroid hormone thins bone over time. Very high iodine intake from seaweed or iodine supplements can make some forms worse and is worth avoiding; ordinary iodised salt in normal amounts is fine.
While her thyroid was running fast, Shalini needed more food rather than less. Her endocrinologist suggested curd twice a day, paneer or eggs at dinner and a glass of milk at bedtime, alongside her usual dal and sabzi. Coffee and strong tea made her palpitations worse, so she cut back to one cup in the morning until her levels settled.
Her mother wanted to stop the family's iodised salt altogether after reading a forward about iodine and the thyroid. The endocrinologist advised against it. The amount of iodine in normal cooking salt is small and needed, and India's iodised salt programme exists because deficiency once caused widespread goitre in the hills where Shalini grew up. What Shalini does avoid are kelp tablets from health shops, iodine drops and the seaweed snacks her nephew brought back from a trip abroad.
Sources: [3]
Why does weight often go up after treatment?
Because the body slows back to its normal pace while the appetite takes longer to catch up. John Dale's study of people treated for hyperthyroidism found that weight rose significantly afterwards, whichever treatment they had. Many regain what they lost during the illness, and some go past it.
Shalini saw it by Diwali. Her thyroid levels were back in range, her hands were steady, and she was still eating the second helping of rajma chawal and the sandwich at break that her racing body used to burn. In two months she had put back four kilos. Some of the five kilos she lost in the summer had been muscle, which is why the stairs had tired her legs. Her endocrinologist suggested trimming the extra portions now that her body had slowed, and adding two short strength sessions a week to rebuild the muscle the illness took.
If the regain keeps going once the thyroid is stable, it is worth treating as a weight problem in its own right, with the muscle protected. Metaboliq is a doctor-led weight programme built for that, and the aim we set with members is "Lose up to 20% of your body weight — and keep your muscle". Results vary; your doctor decides what is right for you. It starts with a home blood test that a doctor reads, thyroid included.