My name is Dr Amit Allahabadia.
I'm a consultant endocrinologist
based at the Sheffield
Teaching Hospitals in Sheffield.
The thyroid gland
is a very important gland
which is located within the neck.
It produces two main types of hormones.
One is known as thyroxine
and the other one
is known as triiodothyronine or T3.
There are three main causes
of an overactive thyroid gland
within the United Kingdom.
The most common condition by far
is a disease known as Graves' disease,
which accounts for
about three quarters of all cases
of an overactive thyroid gland.
Less commonly patients may have
a toxic multinodular goitre,
or a condition known as a toxic adenoma,
in which they have a nodule
within the thyroid gland
that overproduces thyroid hormone.
is a relatively common condition
and amongst the most common
of all endocrinal conditions known.
Overproduction of thyroid hormone
patients feel generally quite unwell
and leads to a number of symptoms.
Probably the most common symptoms
are weight loss, feeling tired.
Very occasionally patients feel
they have more energy,
but it's more common to feel tired.
Other common symptoms
include having awareness
of an increased heart rate
feeling shaky and disturbances of
particularly irritability or anxiety.
Patients may also notice
difficulties with breathing
and ladies may have problems
with periods often becoming
less frequent or stopping altogether.
Patients may also have bowel problems
and find that they have to
visit the toilet more frequently.
The aim of treatment in most patients
is to give a course
of antithyroid drugs
for a period of several months
in order to try and induce a remission
of the underlying problem
that causes Graves' disease.
Patients are started
on antithyroid medication
and either that medication is
according to their blood test
or they have one set dose given,
and when thyroid hormone levels
return to within the normal range
patients have thyroxine
given in combination
with their antithyroid medication.
These two methods are known
as either a titration method
or a block-and-replace regimen.
Most patients who are started
on antithyroid medication
tolerate the treatment well.
They may occasionally
get mild side effects
such as a skin rash
or joint aches and pains,
which often subside spontaneously.
The treatment is given for anywhere
between six and 18 months
and at the end of the course
of treatment drugs are stopped
and it is seen at that point whether
the Graves' disease has settled down
and the overactive thyroid gland
Once the course
of antithyroid treatment has stopped,
and if the patient's Graves disease
doesn't go into remission
and the overactive thyroid
returns once again,
the main treatment options
for curing the overactive thyroid gland
are either to give a treatment
known as radioiodine,
which is given
to try and destroy thyroid cells
which overproduce thyroid hormone,
or to perform an operation
to remove the entire thyroid gland.
The only common side effect
of radioactive iodine treatment
is the development of an underactive
thyroid gland or hypothyroidism.
This can be expected in about half
all patients one year after treatment,
but there is the risk of developing
hypothyroidism long term,
and this can occur in two to three
per cent of patients every year
after they have radioiodine treatment.
Patients who have surgery
for Graves' disease
are usually treated
with a near total thyroidectomy
to remove most of the thyroid gland.
Such patients will always require
for the rest of their life
to ensure that their thyroid
In patients who have
a multi-nodule goitre,
again, like Graves' disease,
they will usually have
all of their thyroid gland removed.
Patients who have a toxic adenoma
due to a nodule which is producing
too much thyroid hormone
may be offered removal
of part of their thyroid gland.
In such cases,
thyroid function may remain normal,
or in the long term some patients
may become hypothyroid
and require thyroxine treatment.