Hyperthyroidism: Key Questions and Considerations for Patients

Q: Hyperthyroidism: Key Questions and Considerations for Patients

Dear Ms. <br>Lin：<br>1. <br>In our country, most testing laboratories are certified, and to maintain their reputation, the likelihood of significant errors in test results is low. <br>Additionally, Free T4 and TSH levels do not fluctuate rapidly under normal physiological conditi

Hyperthyroidism

Hello Doctor: Recently, during a routine health check at my company, I found that my Thyroid Stimulating Hormone (TSH) level was 0.01, Free Thyroxine (Free T4) was 3.07, fasting blood glucose was 100, heart rate was approximately 100 beats per minute, and my white blood cell count was low.
I have already visited an endocrinology clinic once, and the doctor looked at the health check report and immediately diagnosed me with hyperthyroidism (without a physical examination) and prescribed medication (Carbimazole and Inderal).
Blood tests were done afterward, and an ultrasound examination is scheduled for two weeks later.
I sometimes experience a rapid heartbeat and frequent headaches, and I have always been a person who is easily anxious.
However, my weight has remained stable within ±1 kg over the past few years (158 cm, 48 kg), my appetite has not changed significantly, and I do not have high blood pressure or tremors.
I also do not feel any bulging eyes or swelling in my neck.
I tend to be constipated, feel cold rather than hot, and do not sweat easily (which seems contrary to typical symptoms).
I would like to ask the following questions:
1.
Is it possible that my abnormal data was simply due to poor physical condition on the day of the health check? Or does the presence of these two abnormal values necessarily indicate hyperthyroidism?
2.
I have never had my thyroid-related data checked before, and this issue was only discovered due to the health check.
Is it possible that I have had hyperthyroidism for a long time (like 3-4 years), or did this condition only start in the last two to three months?
3.
Once diagnosed with hyperthyroidism, is it necessary to take medication or undergo surgery for treatment? Or is it possible for the body to recover naturally after removing the source of mental stress?
4.
Once treatment for hyperthyroidism begins, must it continue without interruption for one or two years until recovery (similar to taking antibiotics, which must be completed to avoid resistance)?
5.
I have plans to travel abroad for two to five months in the next two to three months.
What impact does hyperthyroidism have on long-term travel? Is it possible to obtain a prescription for four to five months of medication to take abroad?
6.
If my symptoms are mild, can I wait until I return after four to five months to start treatment for hyperthyroidism to avoid interrupting the treatment?
7.
What advice do you have for patients recently diagnosed with hyperthyroidism who need to travel abroad for an extended period?
8.
I currently have a habit of drinking a cup of coffee every day.
Should I avoid coffee in the future?
All of these questions are very important to me, and I would greatly appreciate it if you could answer them individually!

Lin, 20~29 year old female. Ask Date: 2017/03/28

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
Lin:
1.
In our country, most testing laboratories are certified, and to maintain their reputation, the likelihood of significant errors in test results is low.
Additionally, Free T4 and TSH levels do not fluctuate rapidly under normal physiological conditions.
This means that the chance of abnormal results due to poor health on the day of the examination is minimal.
On the other hand, Free T4 and TSH are indeed the fundamental data for diagnosing hyperthyroidism or hypothyroidism in clinical practice.
Experienced physicians can usually determine potential issues based on these results, along with clinical observations.
2.
We cannot ascertain how long you have had hyperthyroidism; it could have been present for 3 to 4 years or only for 2 to 3 months.
From personal experience and the records of many physicians, we have encountered elderly patients who presented with symptoms of atrial fibrillation, only to be diagnosed with hyperthyroidism incidentally through blood tests.
There have even been tragic cases discussed in medical center mortality meetings where the diagnosis was only confirmed post-mortem.
Therefore, relatively speaking, you are quite fortunate.
3.
The majority of hyperthyroidism cases are due to Graves' disease, which is an autoimmune disorder.
Current treatments include medication, surgery, or radioactive ablation.
There are no reports or studies indicating that removing stressors will lead to spontaneous recovery, unless the hyperthyroidism is caused by other factors; in that case, discussions and treatment plans would need to be tailored accordingly.
4.
Treatment for hyperthyroidism generally lasts about two to three years before considering discontinuation of medication.
Sometimes, there may be a recurrence, necessitating further treatment.
It is crucial not to interrupt treatment, as the rebound effect of autoimmune diseases can sometimes exceed our expectations.
5.
If medications are taken as prescribed, hyperthyroidism is typically well-controlled.
However, due to the normalization of metabolism, if dietary habits are not properly managed, weight gain may be noticeable.
On the other hand, a very small number of individuals may experience a decrease in white blood cell count as a side effect of the medication, leading to severe infections that can be life-threatening, requiring immediate attention even abroad.
These aspects require special attention.
Regarding carrying a supply of medication for 4 to 5 months, to my knowledge, the National Health Insurance Bureau only allows a three-month supply, and a copy of the flight ticket must be provided.
Some hospitals even require a declaration; otherwise, the scrutiny from the insurance bureau can be quite stringent for hospitals.
6.
It is advisable to begin treatment immediately and not to discontinue medication on your own.
Hyperthyroidism can sometimes progress to a thyroid storm, which can cause rapid heart failure and death; this is a nightmare for emergency or intensive care teams.
7.
If you plan to stay abroad for 4 to 5 months, in addition to taking your medication on time, it is recommended to maintain contact with your attending physician for advice and consultation in case of emergencies.
Alternatively, inform a local physician in advance to ensure appropriate responses in urgent or special situations.
8.
Generally, hyperthyroidism is not related to coffee consumption.
However, coffee itself can increase heart rate and has a stimulating effect.
Therefore, many physicians, including myself, do not recommend drinking coffee, especially for those with hyperthyroidism, myocardial ischemia, anxiety disorders, poor sleep quality, insomnia, gastroesophageal reflux disease, and other conditions where coffee is unnecessary.
Of course, for those addicted to caffeine, withdrawal from coffee should be gradual to avoid discomfort.
Note: Based on your description, your attending physician's diagnosis and management are very precise and straightforward; please make sure to discuss and treat your condition thoroughly with them.
Additionally, patients with hyperthyroidism often exhibit increased anxiety and emotional reactivity, so it is essential to approach problems calmly and without haste.

Reply Date: 2017/03/28

More Info

Understanding hyperthyroidism is crucial for patients who may be experiencing symptoms or have received abnormal test results. In your case, the lab results indicating a very low TSH (Thyroid Stimulating Hormone) and elevated Free T4 levels suggest hyperthyroidism, but let's address your questions one by one to clarify your concerns.

1. Could the abnormal results be due to temporary conditions?
While it is possible for lab results to be influenced by temporary factors such as stress, illness, or even the time of day when the blood was drawn, the combination of a very low TSH and high Free T4 is quite indicative of hyperthyroidism. It is essential to consider these results in conjunction with clinical symptoms and further testing. A thorough evaluation by your healthcare provider, including a physical examination, is necessary to confirm the diagnosis.

2. Could I have had hyperthyroidism for a long time without knowing?
Hyperthyroidism can develop gradually, and some individuals may not notice symptoms until they become more pronounced. Given that you have not previously had thyroid function tests, it is challenging to determine how long you may have had this condition. However, it is also possible that the hyperthyroidism has developed recently, particularly if you have experienced increased stress or other health changes.

3. Is medication or surgery necessary for hyperthyroidism?
Treatment for hyperthyroidism typically involves medication, radioactive iodine therapy, or surgery, depending on the underlying cause and severity of the condition. In some cases, if the hyperthyroidism is mild and related to stress, addressing the stressors may help improve thyroid function. However, it is crucial to follow your doctor's recommendations and not to discontinue medication without consulting them.

4. Is it necessary to continue medication for the entire treatment duration?
Unlike antibiotics, which must be taken for the full course to prevent resistance, thyroid medications may need to be adjusted based on your response to treatment. It is essential to have regular follow-ups with your healthcare provider to monitor your thyroid levels and adjust medication as necessary.

5. What are the implications of hyperthyroidism for long-term travel?
Traveling while managing hyperthyroidism can be done, but it is essential to plan ahead. Discuss your travel plans with your healthcare provider, who can advise you on the best course of action, including whether you can take a supply of medication with you. Ensure you have enough medication for your trip, and consider how you will manage any potential health issues while abroad.

6. Can I delay treatment until I return from travel?
Delaying treatment is not advisable, especially if you have been diagnosed with hyperthyroidism. It is essential to manage the condition proactively to avoid complications. If you have concerns about starting treatment before your trip, discuss this with your healthcare provider to find a suitable plan.

7. What advice do you have for patients with hyperthyroidism who need to travel?
Patients should maintain open communication with their healthcare provider about travel plans. It is advisable to carry a sufficient supply of medication, have a list of emergency contacts, and know where to seek medical help if needed while traveling. Keeping a record of your thyroid levels and treatment plan can also be beneficial.

8. Should I stop drinking coffee?
Caffeine can exacerbate symptoms of hyperthyroidism, such as increased heart rate and anxiety. It may be wise to limit or avoid caffeine while managing your condition, especially if you notice that it worsens your symptoms.

In summary, hyperthyroidism requires careful management and monitoring. It is essential to work closely with your healthcare provider to develop a treatment plan that suits your needs, especially considering your upcoming travel plans. Regular follow-ups and open communication about your symptoms and concerns will help ensure effective management of your condition.

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