Symptoms of overactive thyroid
If you have an overactive thyroid, the symptoms can vary from mild to severe. Symptoms can also be different depending on your age, and can sometimes seem like an existing health problem has got worse.
How severe your symptoms are doesn’t always reflect how severe your condition is. For example, you may have mild symptoms but have a severely overactive thyroid. The symptoms you have can also depend on what’s causing your overactive thyroid.
The main symptoms of overactive thyroid include:
- feeling hot / less able to cope with heat
- losing (or sometimes gaining) weight
- feeling hungry and eating more
- feeling tired with weak muscles
- sweating more than usual
- having irregular or no periods
- feeling emotionally up and down, restless and irritable
- having a lump in your throat (this is called a goitre and can be caused by a large thyroid gland)
- feeling nervous and anxious
- shaking (tremors)
- a fast or irregular heart rate
If you have any of these symptoms, contact your GP.
Diagnosis of overactive thyroid
Your GP will ask about your symptoms and examine you. They may ask you about your medical history, and if anyone in your family has an overactive thyroid gland.
If your GP thinks you may have an overactive thyroid, they will ask you to have one or more blood tests. This is to check the level of thyroid hormones in your body. The main hormones measured in blood tests are:
- TSH – thyroid stimulating hormone
- FT4 – free T4 (the active part of thyroxine)
- FT3 – free T3 (the active part of triiodothyronine)
If you have an overactive thyroid, you will have a low TSH level with a high FT4 level and a high FT3 level. The exact levels of hormones measured may vary between different laboratories. So what’s classed as a normal, high or low level for each of the hormones may vary from one area to the next.
If the results of the blood tests show you have an overactive thyroid, your GP will refer you to a specialist. This will be an endocrinologist, who specialises in treating thyroid conditions.
A small number of people may also have a radionucleotide thyroid scan. This involves having a small amount of a radioactive substance injected into your blood. This can be seen inside your thyroid gland using a special camera.
Treatment of overactive thyroid
Treatment for overactive thyroid depends on what has caused it and how severe your symptoms are. Any treatment you have aims to lower your thyroid hormones levels and ease your symptoms.
When you’re first diagnosed as having an overactive thyroid, your doctor may prescribe beta-blockers. These help to ease symptoms such as a fast heartbeat (palpitations) or shaking. You may need to take these until your thyroid hormone levels come down. If you can’t take a beta blocker, you may be given a medicine called a calcium channel blocker.
Your doctor may prescribe the antithyroid drugs, carbimazole or propylthiouracil. These help to reduce the amount of hormone your thyroid gland produces. These medicines usually work quite quickly, but it can take two to three weeks until you get the full benefit.
You’ll be asked to take these medicines for 12 to 18 months. You may be able to stop taking them, although up to half of people find that their symptoms come back after stopping treatment. If this happens, you may need to carry on with your medication, or try a different treatment.
If you’re pregnant, your doctor may change your medicines after the first trimester (the first three months). This is to make sure your baby develops properly and is healthy.
Radioactive iodine aims to destroy your thyroid gland, so that it stops producing hormones. You take radioactive iodine as a single capsule or tablet. It takes around three to four months to work fully.
Your doctor might suggest radioiodine treatment if:
- you can’t take the medicines for overactive thyroid
- you have other health conditions
- medicines for thyroid disease haven’t worked
Once the radioactive iodine has worked, your body won’t produce any more thyroid hormones. This means you’ll need to take levothyroxine (thyroid hormone replacement) for the rest of your life.
You can’t have radioactive iodine treatment if you’re pregnant or breastfeeding. You should also use contraception for at least six months after your treatment.
Another option for treating an overactive thyroid is to have all or most of your thyroid gland removed. It’s not commonly used as a treatment. But your doctor may suggest it if:
- medicines and radioactive iodine treatments haven’t worked, or you can’t take them
- you need treatment very quickly
- you’re pregnant, or want to become pregnant in the next six months
After the operation, your body won’t produce any more thyroid hormones. This means you’ll need to take tablets for the rest of your life to replace them.
Monitoring your thyroid levels
During and after treatment for an overactive thyroid, you may need to have regular blood tests and check-ups. This is to measure the amount of thyroid hormones in your body and to check that treatment has worked. How often you will need these will depend on what caused your condition and what treatment you had. Your doctor will tell you what you need to do.
Causes of overactive thyroid
There are a number of causes of overactive thyroid. The most common cause is Graves’ disease, which is an autoimmune disease. This means that your body starts attacking your thyroid gland and it responds by producing too much hormone. Other causes of an overactive thyroid include:
- conditions which produce swellings on your thyroid gland
- some medicines, such as amiodarone and lithium
Complications of overactive thyroid
Most people with an overactive thyroid recover well after treatment. But some people may develop complications, some of which can be serious or life-threatening. The main complications are listed below.
- Heart problems, such as heart failure or an irregular and fast heartbeat (atrial fibrillation).
- Sight problems – if you have Graves’ disease, you may develop a condition called thyroid eye disease. Find out more about this by reading the FAQ Thyroid eye disease.
- Thyroid storm – this is a severe condition that needs emergency treatment. The symptoms include a high fever, heart problems and restlessness.
- If you’re pregnant, an overactive thyroid can mean your baby may be born early or underweight. It can also lead to miscarriage.
After treatment for overactive thyroid
While your thyroid was producing too much hormone, you may have felt hungry and eaten more to keep your weight up. After your treatment, you may need to eat less to avoid putting on weight.
Because treatment lowers the levels of thyroid hormone in your body, it’s important to make sure that these don’t become too low. If your hormone levels become too low, this is called hypothyroidism. The main symptoms are:
- putting on weight
- feeling the cold
- dry skin and hair
- lack of energy
- a puffy face
If you develop any of these symptoms, contact your GP who may organise a blood test.
FAQ: What precautions do I need to take after having radioactive iodine?
The iodine used for this treatment is radioactive. It’s very safe for you to have, but it takes a few days for it to completely leave your body. During this time, you’ll need to take some precautions to make sure that you, and the people around you, are safe.
After you’ve taken radioactive iodine, most of it leaves your body in your urine. Some also leaves your body in your sweat, tears, faeces and saliva. This takes a few days and as time goes on, the amount of radioactive iodine in your body gets less and less.
When your body is getting rid of the radioactive iodine, it’s important to be careful about what contact you have with other people, and for how long. Your doctor will give you some specific advice about this. You may be asked to:
- limit your contact with children and pregnant women
- stay more than an arm’s length away from other people
- sleep alone
- stay away from busy places such as cinemas, pubs and restaurants
- only travel for short periods on public transport
- wash your hands, crockery and cutlery thoroughly
- flush the toilet twice after using it
How long you need to follow the precautions will depend on how much radioiodine you were given. Your doctor will be able to give you more advice.
If you’re pregnant or breastfeeding, you shouldn’t have radioactive iodine. This is because radiation can pass through the placenta and into breast milk, so it may harm your baby. You shouldn’t get pregnant for six months after having your treatment. Men should wait at least three months before trying for a baby.
If you have any concerns or questions about radioiodine treatment, talk to your doctor.
FAQ: Can an overactive thyroid gland cause eye problems?
If you have Graves’ disease, you could develop eye problems. Up to half of all people with Graves’ disease develop a condition called Grave’s ophthalmology, or thyroid eye disease. It’s more common in people who smoke and in women.
The main symptoms of thyroid eye disease are:
- bulging or staring eyes
- swollen and red eyelids
- dry or watery eyes
- an ache behind your eye, which gets worse in the morning and when you move your eyes
- red and irritated eyes
Most people who have thyroid eye disease have mild eye problems which get better with treatment. But around one in 20 people may develop more serious problems.
If your eyes and the tissues around them become very swollen, it can affect your optic nerve. This can cause you to lose your sight. So, if you have any of these symptoms it’s important to see your GP as soon as you can. Your GP may refer you to an ophthalmologist (a doctor who specialises in eye health, including eye surgery).
The type of treatment you have for thyroid eye disease depends on your symptoms and how severe they are. Treatments include eye drops, medicines, such as steroids, and surgery.
FAQ: Can I get pregnant if I have an overactive thyroid?
If you have an overactive thyroid, it can affect your periods and your ability to get pregnant. Your periods can be irregular and lighter. Some thyroid conditions, such as Graves’ disease, are also linked to conditions like endometriosis and polycystic ovary syndrome. These factors can make getting pregnant more difficult.
If you have an overactive thyroid and you want to get pregnant, speak to your doctor. If at all possible, it’s best to plan your pregnancy and work with your doctor to manage your thyroid levels. If you’re taking carbimazole, you’ll need to switch to another antithyroid drug, propylthiouracil, before you start trying for children.
You can take medicines to keep your thyroid hormone levels under control while you’re pregnant. But this needs careful monitoring to make sure that you and your baby stay well. Some women choose to have radioactive iodine treatment instead. If you choose this, it’s important to wait for at least six months after treatment before you start trying to conceive.
- Hyperthyroidism. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2013
- Hyperthyroidism. The MSD manuals. www.msdmanuals.com, last full review/revision May 2014
- Stedman’s Medical Dictionary. Lippincott Williams & Wilkins. www.medicinescomplete.com, accessed 15 March 2016
- Overview of thyroid function. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2014
- Hyperthyroidism. Medscape. emedicine.medscape.com, updated November 2015
- Hyperthyroidism. PatientPlus. patient.info/patientplus, last checked December 2015
- Graves’ disease. BMJ Best Practice. bestpractice.bmj.com, last updated October 2014
- Endocrinology. Oxford handbook of geriatric medicine (online). Oxford Medicine Online. oxfordmedicine.com, published March 2014
- Thyroid. Oxford handbook of endocrinology and diabetes (online). Oxford Medicine Online. oxfordmedicine.com, published March 2014
- Hyperthyroidism. British Thyroid Foundation. www.btf-thyroid.org, revised 2015
- Thyroid scans. Australian Family Physician. www.racgp.org.au, published August 2012
- Primary hypothyroidism. BMJ Best practice. bestpractice.bmj.com, last updated April 2015
- Radioiodine in the management of benign thyroid disease. Clinical guideline. Royal College of Physicians www.bnms.org.uk/, published 2007
- Radioactive Iodine (I-131) Therapy. Radiological Society of North America. www.radiologyinfo.org, published February 2014
- Treatment of an over-active or enlarged thyroid gland with radioactive iodine guide. British Thyroid Foundation. www.btf-thyroid.org, revised 2015
- Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I: Practice recommendations of the American Thyroid Association. The American Thyroid Association Taskforce on Radioiodine Safety. Thyroid. Volume 21, Number 4, 2011
- Thyroid eye disease. PatientPlus. patient.info/patientplus, last checked December 2015
- Gillespie EF, Smith TJ, Douglas RS. Thyroid eye disease: Towards an evidence base for treatment in the 21st century. Curr neurol neurosci 2012; 12(3):318–24
- Poppe K, Velkeniers B, Gilnoer D. Thyroid disease and female reproduction. Clin Endocrinol 2007; 66(3):309–32
- Pregnancy and fertility in thyroid disorders. British Thyroid Foundation. www.btf-thyroid.org, revised 2015
- Poppe K, Velkeniers B, Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab 2008; 4(7): 394–405
- Autoimmune thyroid disease and pregnancy. Medscape. emedicine.medscape.com, updated August 2014
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form
Reviewed by Pippa Coulter, Specialist Health Editor, Bupa Health Content Team, May 2016
Peer reviewed by Dr Jonathan Katz MD FRCP, Consultant Endocrinologist
Next review due May 2019
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
We are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Meet the team
Head of Health Content
- Dylan Merkett – Lead Editor
- Graham Pembrey - Lead Editor
- Laura Blanks – Specialist Editor, Quality
- Michelle Harrison – Specialist Editor, Insights
- Natalie Heaton – Specialist Editor, User Experience
- Fay Jeffery – Web Editor
- Marcella McEvoy – Specialist Editor, Content Portfolio
- Alice Rossiter – Specialist Editor (on Maternity Leave)
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: email@example.com. Or you can write to us:
Health Content Team
Battle Bridge House
300 Grays Inn Road