Hyperthyroidism: Symptoms, Diagnosis, and Treatment Options

Q: Hyperthyroidism: Symptoms, Diagnosis, and Treatment Options

Hello： Question 1： The distinction between mild and severe is quite subjective. <br>Based on your values： FT4： 1.86 (reference range 0.59-1.43), it is not significantly above the upper limit. <br>Question 2： Please follow your attending physician's advice; if the doctor has not i

Thyroid issues

Hello Doctor, I received the AZ vaccine on August 5th, and about 10 days later, I experienced rapid heartbeat, chest tightness, and some shortness of breath until I sought medical attention on August 19th.
My thyroid blood test results were as follows, while other blood tests were normal: TSH <0.00 (reference range 0.38-5.33), FT4: 1.86 (reference range 0.59-1.43), T3: 161.5 (reference range 72-172).
Since these reports were viewed through my health app, I later visited Clinic A, where the doctor informed me that I have hyperthyroidism and prescribed me anti-thyroid medication (once daily for one week) and a heart rhythm medication (twice daily).
I only took the anti-thyroid medication and took the heart rhythm medication as needed.
After finishing that, I went to Specialist Clinic B, where the doctor also confirmed hyperthyroidism and prescribed me levothyroxine (once daily for one month) and the heart rhythm medication (twice daily).
Since I am not familiar with this condition, I did not ask the doctor detailed questions at the time, so I would like to ask you the following questions:
Question 1: Are my blood test values considered mild or severe? Currently, I only have a rapid heartbeat (80-100 while sitting, increasing to 100-110 when moving), chest tightness, and shortness of breath; I do not have other hyperthyroid symptoms (such as tremors or weight loss).
I have no prior medical history or family history related to this condition.
Question 2: Do I need to go to a lab for another blood test to confirm my condition?
Question 3: Since starting these medications, I have experienced increased flatulence and burping.
Are these medications a significant burden on my body?
Question 4: In the morning, I feel noticeably uncomfortable in my chest, and when measuring my blood pressure, my heart rate occasionally reaches the 90s.
Should I see a cardiologist for this?
Thank you for your assistance with these questions.

Niming, 30~39 year old female. Ask Date: 2021/08/27

Dr. Lin Jianliang reply Internal Medicine

Hello: Question 1: The distinction between mild and severe is quite subjective.
Based on your values: FT4: 1.86 (reference range 0.59-1.43), it is not significantly above the upper limit.
Question 2: Please follow your attending physician's advice; if the doctor has not instructed you to have another blood test for confirmation, it is advisable not to do so.
Question 3: These medications rarely cause the symptoms you mentioned.
Question 4: You can consult a cardiologist.

Reply Date: 2021/08/27

More Info

Understanding hyperthyroidism is crucial for managing its symptoms and ensuring appropriate treatment. Hyperthyroidism occurs when the thyroid gland produces excessive amounts of thyroid hormones, leading to an accelerated metabolism. This condition can manifest through various symptoms, including rapid heartbeat, anxiety, weight loss, increased appetite, heat intolerance, and changes in bowel habits.
Based on the blood test results you provided, your TSH (Thyroid Stimulating Hormone) level is significantly low (<0.00), while your Free T4 level is elevated (1.86), indicating hyperthyroidism. Your T3 level is within the normal range, but the elevated T4 and suppressed TSH suggest that your thyroid is overactive.

Addressing Your Questions:
1. Severity of Your Condition:
Your symptoms, including a rapid heartbeat (80-110 bpm), chest discomfort, and shortness of breath, indicate that you are experiencing hyperthyroid symptoms, but the absence of more severe symptoms like tremors or significant weight loss suggests that your condition may be on the milder side. However, even mild hyperthyroidism can lead to complications if left untreated, such as heart problems or osteoporosis, so it is essential to monitor your condition closely.

2. Need for Follow-Up Blood Tests:
Yes, it is advisable to have follow-up blood tests to monitor your thyroid hormone levels and ensure that your treatment is effective. Regular monitoring can help your healthcare provider adjust your medication dosage as needed and track any changes in your condition.

3. Side Effects of Medication:
The medications you are taking, such as the anti-thyroid medication (likely methimazole) and beta-blockers (for heart rate control), can have side effects. The gastrointestinal symptoms you mentioned, like increased flatulence and belching, may be related to the medications or changes in your metabolism due to hyperthyroidism. It is essential to discuss these side effects with your doctor, as they may need to adjust your treatment plan if the symptoms are bothersome.

4. Chest Discomfort and Heart Rate:
If you are experiencing persistent chest discomfort and your heart rate is frequently elevated (90 bpm or higher), it is crucial to consult a healthcare provider, preferably a cardiologist. They can evaluate your heart health and determine if your symptoms are related to hyperthyroidism or if there are other underlying issues that need to be addressed.

Additional Considerations:
- Diagnosis: Hyperthyroidism can be caused by several conditions, including Graves' disease, toxic nodular goiter, or thyroiditis. A thorough evaluation, including imaging studies or additional blood tests, may be necessary to determine the underlying cause of your hyperthyroidism.

- Treatment Options: Treatment for hyperthyroidism may include anti-thyroid medications, radioactive iodine therapy, or surgery, depending on the cause and severity of the condition. Your healthcare provider will discuss the best options for you based on your specific situation.

- Lifestyle Modifications: In addition to medication, certain lifestyle changes can help manage symptoms. These may include a balanced diet, regular exercise, stress management techniques, and avoiding stimulants like caffeine.

In summary, while your symptoms may currently be manageable, it is essential to maintain regular follow-ups with your healthcare provider to monitor your condition and adjust treatment as necessary. Hyperthyroidism is a manageable condition, and with appropriate care, you can lead a healthy life.

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It is advisable to consult another physician.