My name is Dr Amit Allahabadia

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
or tetraiodothyronine

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.

Hyperthyroidism
is a relatively common condition

and amongst the most common
of all endocrinal conditions known.

Overproduction of thyroid hormone makes
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
or palpitations,

feeling shaky and disturbances of mood,
particularly irritability or anxiety.

Patients may also notice
difficulties with breathing

and ladies may have problems
with menstruation,

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 titrated
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
goes away.

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 of
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
thyroxine treatment

for the rest of their life
after surgery

to ensure that their thyroid function
remains normal.

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.