The following symptoms and complaints may indicate hyperthyroidism (overactive thyroid):
Leading symptoms
Basal metabolic rate
- Increase in body temperature → heat intolerance or hypersensitivity to heat (thermophobia).
- Sweating including night sweats (night sweats).
- Moist warm skin
- Weight loss (despite increased appetite)
Cardial (cardiovascular)
- Tachycardia – heartbeat too fast: > 100 beats per minute [cardiac output volume (HMV) ↑]
- Systolic blood pressure elevated (blood pressure amplitude ↑).
- Palpitations (heart palpitations)
Gastrointestinal (gastrointestinal tract)
- Diarrhea (diarrhea)
- Weight loss (due to malabsorption)
Nervous system and psyche
- Hyperactivity/restlessness
- Irritability/nervousness
- Tremor (shaking)
- Insomnia (sleep disturbances; insomnia)
Eye
- Endocrine orbitopathy (EO; protrusion of the eyeballs); symptoms: ocular foreign body sensation (in the eyes), sensitivity to light (photophobia), and increased lacrimation [combination of hyperthyroidism + endocrine orbitopathy = Graves’ disease; endocrine orbitopathy > 90% associated with Graves’ disease].
Skin
- Alopecia, diffusa (hair loss, diffuse).
- Dermopathy – skin changes similar to an orange peel, mostly on the lower legs.
- Skin is warm, moist and soft; soft turgor reminiscent of an infant’s skin.
- Palmar erythema – red coloration of the palms.
- Pruritus (itching)
- Vitiligo (pigment loss usually covers larger areas than in idiopathic vitiligo).
Associated symptoms
- Acropachy – bone thickening (due to subperiosteal bone apposition) with concomitant soft tissue thickening (painless; normal temperament) at the finger and toe distal phalanges (I-III).
- Weight gain – in 5-10% of affected individuals due to increased appetite.
- Gynecomastia – enlargement of the mammary gland in men.
- Hyperreflexia
- Fatigue, weakness
- Lack of concentration
- Loss of libido – decreasing sex drive
- Oligomenorrhea – menstrual bleeding too infrequent (the interval between bleeding is > 35 days and ≤ 90 days).
- Polyuria – frequent urination (due to increased organ blood flow: GFR ↑).
- Serum cholesterol ↓
- Goiter (enlargement of the thyroid gland)
Thyrotoxic crisis (decompensated thyrotoxicosis)*
Life-threatening complication of hyperthyroidism with the following symptoms:
- Amplification of the classic symptoms of severe hyperthyroidism.
- Myasthenic muscle weakness (increasing muscle weakness with repetitive movements).
- Hyperthermia (increase in body temperature): high fever (> 40 °C; up to 41 °C) (common).
- Disturbances of consciousness (delirium, somnolence, sopor to coma).
- Cardiac symptoms:
- Tachycardia (sinus tachycardia, atrial fibrillation (VHF), supraventricular tachyarrhythmias, rarely ventricular tachyarrhythmias).
- Heart failure (cardiac insufficiency) to cardiogenic shock).
- Gastrointestinal symptoms (nausea (sickness), vomiting, and diarrhea/diarrhea).
- Desiccation (dehydration) due to fever, sweating and diarrhea.
Possible triggers of thyrotoxic crisis:
- Stressful events (e.g., myocardial infarction/heart attack, surgery, accident) in patients with undiagnosed hyperthyroidism.
- Childbirth/delivery
- Infections (frequent)
- Exacerbation (marked worsening of symptoms) of pre-existing severe hyperthyroidism.
- Medication:
- Irregular intake or discontinuation of thyrostatic drugs (medications that inhibit thyroid function and are used to treat hyperthyroidism)
- Amiodarone
- Iodine exposure in thyroid autonomy (e.g., application of iodine-containing contrast media (computed tomography, cardiac catheterization)).
- Operations
- Strumectomy (surgical removal of thyroid tissue for enlarged thyroid gland) in patients with Graves’ disease without adequate prior antithyroid therapy
- Other surgical procedures
- Triggering of thyrotoxic crisis by intensive manipulation in the neck area!
- Traumas
