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Hyperthyroidism: who to see and what helps

Hyperthyroidism · Kitchener, Waterloo & Cambridge

Hyperthyroidism, an overactive thyroid, means the thyroid gland is making too much hormone, and the body runs fast: a racing heart, weight loss, shaky hands, feeling hot and on edge. It is treated medically, with antithyroid medicine, radioactive iodine or surgery, and early treatment may lower the risk of more serious problems. An endocrinologist or physician decides the treatment. At CARESPACE a Nurse Practitioner can test, refer and monitor; our other services support that care and do not replace it.

What hyperthyroidism is

You will also see it called thyrotoxicosis. Graves’ disease is by far the most common cause in Canada: an autoimmune condition, affecting roughly one person in a hundred, in which an antibody drives the thyroid to overproduce. It is more common in women and tends to run in families. The opposite problem, an underactive thyroid, is covered on our Hypothyroidism & Thyroid Conditions page, and the two can follow each other: treatment for an overactive thyroid often leaves it underactive.

Symptoms of hyperthyroidism

  • A fast pulse, sometimes over 100 beats a minute, or an irregular one
  • Nervousness, irritability and trouble sleeping
  • Shaky hands and muscle weakness
  • Weight loss even though you are eating normally or more
  • Feeling hot and sweating a lot
  • More frequent bowel movements or diarrhea
  • Fine hair that falls out, and lighter or less frequent periods
  • A swelling at the front of the neck (goitre)
  • With Graves’ disease: bulging, red or watery eyes, swollen eyelids, sometimes double vision

Some people have no symptoms at all.

What causes hyperthyroidism

  • Graves’ disease.
  • Thyroid nodules that make hormone on their own.
  • Thyroiditis. An inflamed thyroid leaks stored hormone, typically after a viral infection or a pregnancy. It usually settles within weeks to months, and an underactive spell can follow.
  • Medicines, including amiodarone and some cancer immunotherapy drugs.
  • Large amounts of iodine, from food or medicines. Uncommon.

How hyperthyroidism is diagnosed

By a blood test: thyroid-stimulating hormone (TSH) is low and the thyroid hormones T4 and T3 are high. The next question is the cause, because it decides the treatment. A blood test for TSH receptor antibodies confirms Graves’ disease; if it is negative, a thyroid scan may follow. Canada’s endocrinologists advise against a routine ultrasound unless a lump can be felt. One thing to mention before any thyroid blood test: high-dose biotin, sold for hair and nails, can make results look like an overactive thyroid (the detail is on our Hypothyroidism & Thyroid Conditions page).

When hyperthyroidism is an emergency

Call 911 if you have hyperthyroidism (an overactive thyroid) and your symptoms turn severe. The signs of thyroid storm are shock; delirium, confusion, unusual sleepiness or a change in alertness; agitation; a pounding or very fast heartbeat; a high temperature; diarrhea; restlessness; shaking; sweating; and bulging eyes. Thyroid storm is a rare, life-threatening flare of uncontrolled hyperthyroidism. It usually follows a major stress such as an infection, an injury or a heart attack, and rarely follows radioactive iodine treatment, sometimes a week or more later.

Call 911 as well for chest pain or discomfort (pressure, squeezing, fullness, burning or heaviness) or for trouble breathing. Heart & Stroke lists chest discomfort and shortness of breath among the signs of a heart attack and says to call 911 immediately.

Get medical care right away, from your physician or nurse practitioner, an urgent care clinic or an emergency department, if you have been diagnosed and have any of these: marked irritability; severe fatigue; nausea or vomiting; blood pressure that is unusually high or low for you; or a fever or diarrhea on its own. A fever or diarrhea that is severe, or that comes with any other sign of thyroid storm, is a 911 call.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

If you take antithyroid medicine (methimazole or propylthiouracil), get medical care immediately for a fever or a severe sore throat: you need a blood count, because these medicines can, rarely, cause a dangerous drop in white blood cells. Take no more doses until a physician or nurse practitioner has cleared you. Contact your prescriber immediately about a rash or hives, and about yellow skin or eyes, itching or dark urine, which can be signs of liver injury.

See a physician or nurse practitioner soon about bulging or red eyes without the severe signs above, a swollen throat or trouble swallowing, weakness or tiredness that does not lift, or weight loss when you are eating normally. If you are pregnant, or become pregnant, while being treated for hyperthyroidism, contact your prescriber right away.

What the evidence says about treating hyperthyroidism

  • Where this comes from. The UK’s national guideline (NICE, updated 2023), read alongside the Thyroid Foundation of Canada, because the UK’s antithyroid drug is not used here; in Canada the two available are methimazole and propylthiouracil. In the guideline’s language, “offer” is a firmer instruction than “consider”.
  • Three treatments, chosen with a specialist: antithyroid medicine, radioactive iodine and surgery. The benefits and risks of all three should be discussed with you.
  • Radioactive iodine. Offer it as the first-line definitive treatment for adults with Graves’ disease, the guideline says, unless medicine is likely to bring remission or it is unsuitable, for example in pregnancy, when trying to conceive within four to six months, or with active thyroid eye disease, which it can worsen. Most people need one dose and about one in ten a second, and most become hypothyroid afterwards and take levothyroxine for life.
  • Antithyroid medicine. Where remission is likely, as in mild, uncomplicated Graves’ disease, offer a choice between a 12- to 18-month course and radioactive iodine. About 20 to 30 per cent of people are in remission after such a course, and the condition can flare again once the medicine stops.
  • Surgery to remove the thyroid is offered first when a goitre is pressing on the windpipe or food pipe, when cancer is suspected, or when the other two treatments are unsuitable. Its risks include low calcium and a hoarse voice, and thyroid hormone is needed for life afterwards.
  • Beta-blockers ease the racing heart, shakiness and nervousness without changing thyroid hormone levels. They may be all that thyroiditis needs.
  • Smoking greatly increases the risk of Graves’ eye disease, and of it worsening after radioactive iodine.
  • No food or supplement treats it. Iodine supplements are unnecessary and can make hyperthyroidism worse by working against antithyroid medicine. Selenium has one recognised use, in mild thyroid eye disease, and that is a decision for the specialist treating your eyes: in one study, high doses (more than 300 micrograms a day) were linked to a higher death rate from all causes.

How each CARESPACE service helps with hyperthyroidism

Nurse Practitioner

In Ontario a Nurse Practitioner is authorized to order and interpret tests, diagnose, prescribe and refer to a specialist. With an overactive thyroid that means the first TSH, T4 and T3 tests, the antibody test for Graves’ disease, and the referral to an endocrinologist. While you wait for that appointment, the UK guideline says to consider antithyroid medicine along with supportive treatment such as a beta-blocker. A Nurse Practitioner can also do the six-weekly blood tests it suggests until TSH is back in range, and look after the levothyroxine many people need later.

See our nurse practitioner team →

Nutrition

Food does not treat an overactive thyroid, so a Registered Dietitian’s part is a supporting one that changes as treatment works. While hormone levels are high, appetite rises and weight usually falls. After treatment the lost weight returns, and some people gain more because they have become used to eating more; a dietitian can help you plan for that shift. Alberta’s health service also advises getting enough calcium from food and avoiding kelp. Ordinary iodine sources such as iodized salt, bread and seafood are fine in a balanced diet; a low-iodine diet is only for when your doctor asks for one.

See our nutrition team →

Other services people ask about

Naturopathic Medicine. Nothing we read supports treating hyperthyroidism with herbs or supplements, and iodine and kelp products can make it worse. A suspected overactive thyroid goes to a physician or nurse practitioner first. Thyroid blood tests are on the list that Ontario’s Naturopathic Doctors can requisition, but a result that points to an overactive thyroid still needs a physician or nurse practitioner without delay. Talk to a pharmacist, physician or nurse practitioner before taking any supplement during treatment.

Where most people start

With a Nurse Practitioner or your own physician, as soon as you suspect it. Waiting to see whether it passes is not advised.

How your team works together

Hyperthyroidism is mainly a one-service condition at CARESPACE. Your endocrinologist or physician decides the treatment; a Nurse Practitioner can test, refer and monitor, and a dietitian can help with eating and weight as your levels change.

Browse by service: nurse practitioners and registered dietitians.

What to expect at your first visit

  1. Bring your thyroid results and any specialist letters, with a list of everything you take: medicines and supplements, biotin, iodine and kelp included.
  2. You may be asked about your symptoms, thyroid conditions in your family, and whether you are pregnant or planning to be.
  3. An examination may include your pulse, hands, skin, neck and eyes.
  4. Blood tests may be arranged, and a specialist referral.
  5. You leave with a plan.

What you can do at home

  • Take your medicine exactly as prescribed, at the same time each day.
  • Do not smoke; ask your physician, nurse practitioner or pharmacist about help to stop.
  • Avoid caffeine and other stimulants.
  • For sore eyes: artificial tears, sunglasses, and your head raised at night.
  • Tell every health professional you see that you have hyperthyroidism, because some medicines contain iodine.
  • If someone in your family has Graves’ disease, relatives who develop symptoms should be tested.

Outlook

Thyroiditis generally clears on its own within weeks to months. Graves’ disease goes into remission for a minority of people on medicine alone; for the rest, radioactive iodine or surgery ends the overactivity, at the price of a daily thyroid hormone tablet. Our sources give no figure for how often it returns after medicine is stopped, only that it can.

Hyperthyroidism support in Kitchener, Waterloo and Cambridge

The medical care for an overactive thyroid comes from a physician, nurse practitioner or endocrinologist; nutrition support comes alongside it.

Kitchener. Nutrition in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nurse Practitioner in Waterloo and Nutrition in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutrition in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is hyperthyroidism the same as Graves’ disease?

Graves’ disease is the most common cause of hyperthyroidism, not the only one. Overactive nodules, thyroiditis and some medicines cause it too, and the treatment differs, which is why the cause is tested for.

Can hyperthyroidism be treated naturally?

No food, herb or supplement treats it in anything we read, and iodine or kelp supplements can make it worse. The treatments are antithyroid medicine, radioactive iodine and surgery.

Will I gain weight after treatment?

Usually you regain what the overactive thyroid took off, and some people gain more because their appetite has been running high.

Can I have radioactive iodine if I want to get pregnant?

It is not given in pregnancy or while breastfeeding, and the UK guideline treats trying to conceive within four to six months as a reason to choose another treatment. Tell your specialist your plans before you decide.

Can I see someone about an overactive thyroid at CARESPACE in Waterloo?

Yes. Nurse Practitioner and nutrition appointments are offered in Waterloo. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Hypothyroidism & Thyroid Conditions · Autoimmune Disease · Anxiety · Osteoporosis

The CARESPACE Central Reception Team

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