Pathophysiology of Hyperthyroidism



the disease state in humans and in vertebrates caused by insufficient production of thyroid  hormone by the thyroid gland.

 Early symptoms                

 Poor muscle tone (muscle hypotonia)  Fatigue Cold intolerance, increased sensitivity to cold   Depression  Muscle cramps and joint pain Carpal Tunnel Syndrome Goiter Thin, brittle fingernails Thin, brittle hair  Paleness Osteoporosis  Decreased sweating  Dry, itchy skin Weight gain and water retention  Bradycardia (low heart rate – less than sixty beats per minute) Constipation

 Late symptoms  Slow speech and a hoarse, breaking voice – deepening of the voice can also be noticed   Dry puffy skin, especially on the face Thinning of the outer third of the eyebrows (sign of   Hertoghe)  Abnormal menstrual cycles  Low basal body temperature 

 

 

 Less common symptoms  Impaired memory  Impaired cognitive function (brain fog) and  inattentiveness  A slow heart rate with ECG changes including low voltage signals. Diminished cardiac output and  decreased contractility.  Reactive (or post-prandial) hypoglycemia  Sluggish reflexes  Hair loss  Anemia caused by impaired haemoglobin synthesis (decreased EPO levels), impaired intestinal iron and   folate absorption or B12 deficiency from pernicious anemia  Difficulty swallowing  



   





 About three percent of the general population is hypothyroidic. Factors such as iodine deficiency or exposure to Iodine-131 can increase that risk. There are a number of causes for hypothyroidism. Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine-replete individuals hypothyroidism is generally caused by Hashimoto's thyroiditis, or otherwise as a result of either an absent thyroid gland or a deficiency in stimulating hormones from the hypothalamus or  pituitary.



Thyroid hormone replacement therapy generally maintains normal thyroid hormone levels unless treatment is interrupted or discontinued.

II. ANATOMY & PHYSIOLOGY





The thyroid glands are found on the trachea. The main hormone produced is called  thyroxine. This hormone controls the growth and development of animals. Iodine is required for its production.  Lack of  thyroxine causes deformation and  retardation. The glands swell if not enough hormone is produced  – this is called goitre in humans.

These are located on either side of the thyroid. They  produce two hormones: Parathormone and Calcitonin. These hormones control the level of calcium, magnesium and phosphate in the body.



Thymus   A

very small gland located on the neck. Has some involvement in the production of lymphocytes, which are involved in immune response.

 Normal Thyroid 

 Hypothyroidism

 Hyperthyroidism

IV. NURSING DIAGNOSIS

 Imbalanced

Nutrition: More than Body Requirements related to a slowed metabolic rate resulting in weight gain

 Activity

Intolerance related to weakness and apathy secondary to a decreased metabolic rate resulting in an increased heart rate and shortness of breath with activity



Constipation related to decreased peristalsis secondary to slowed metabolic rate and activity intolerance, resulting in decreased frequency of stools and painful defecation



Hypothermia related to slowed metabolic rate resulting in subnormal body temperature

V. NURSING INTERVENTIONS

 The

patient with hypothyroidism experiences decreased energy and moderate to severe lethargy. As a result, the risk for complications from immobility increases. 

A major role of the nurse is assisting with care and hygiene while encouraging the patient  to participate in activities within established  tolerance levels to prevent the complications of  immobility.

 The

nurse closely monitors the patients ital signs and cognitive level to detect the following:  Deterioration of physical and mental status  Signs and symptoms indicating that treatment  has resulted in the metabolic rate exceeding the ability of the cardiovascular and pulmonary systems to respond.  Continued limitations or complications of  myxedema

The

patient often experiences chilling and  extreme intolerance to cold, even if the room feels comfortable or hot to others.  Extra clothing and blankets are provided, and  the patient is protected from drops  Use of heating pads and electric blanket is avoided because of the risk of peripheral  vasodilation, further loss of body heat, and  vascular collapse.

 The

patient with moderate to severe hypothyroidism may experience severe emotionally actions to changes in appearance and body image and the frequent delay in diagnosis. As hypothyroidism is treated  successfully and symptoms subside, the patient  may experience depression and guilt as a result  of the progression and severity of symptoms that  occurred. The nurse informs the patient and family that  the symptoms and inability to recognize them are common and part of the disorder itself.

 Because

most hypothyroidism treatment  takes place at home, the patient and family require information and instruction that will  enable them to monitor the patients condition and response to therapy. The nurse instructs the patient about the desired actions and side effects of  meditations about how and when to take  prescribe medications. The nurse provides written instructions and  guidelines for the patient and family. 



The

patient with hypothyroidism and  myxedema need considerable follow-up and healthcare.  Assistance the nurse reinforces the importance of continued thyroid hormone replacement and periodic follow-up and  instructs the patient and family members about the signs of over medication and  under medication.

V. MEDICATIONS

 Hypothyroidism

is traditionally treated with thyroid  hormone replacement therapy (either synthetic or natural). Thyroid replacement therapy could include taking levothyroxine (T 4 ), liothyronine (T  3 ), or a combination product that contains both T 4 and T  3. All o these treatments work in the body like thyroxine, the human hormone that is normally produced by the thyroid gland, and subsequently converted to T  3, the active hormone.

The purpose of treatment is to replace the thyroid hormone that is lacking. Levothyroxine is the most commonly used  medication. Doctors will prescribe the lowest dose that  effectively relieves symptoms and brings the TSH level to a normal range. If you have heart disease or you are older, your doctor may start with a very small dose.  Lifelong therapy is required unless you have a condition called transient viral thyroiditis.  You must continue taking your medication even when your symptoms go away. When starting your medication, your doctor may check your hormone levels every 2 - 3 months.  After that, your thyroid hormone levels should be monitored at least every year. 

  Do

NOT stop taking the medication when you feel better. Continue taking the medication exactly as directed by your doctor.   If you change brands of thyroid medicine, let your doctor know. Your levels may need to be checked.   Some dietary changes can change the way your body absorbs the thryoid medicine. Talk with your doctor if you are eating a lot of soy products or a high-fiber diet.  Thryoid medicine works best on an empty stomach and  when taken 1 hour before any other medications. Do NOT  take thyroid hormone with calcium, iron, multivitamins, alumin hydroxide antacids, colestipol, or other medicines that bind bile acids, or fiber supplements.

MEDICAL MANAGEMENT (HYPOTHYROIDISM)

Treatment  Treating Overt

Hypothyroidism.  Patients with overt hypothyroidism, indicated by clear symptoms and blood tests that show high TSH (generally 10 mU/L and above) and low thyroxine (T4) levels, must  have thyroid replacement therapy.

Treating Subclinical or Mild

Hypothyroidism.

Considerable debate exists about whether to treat   patients with subclinical hypothyroidism (slightly higher than normal TSH levels, normal thyroxine levels, and no obvious symptoms). Some doctors opt for treatment and  others opt for simply monitoring patients.

 It

is not clear if the benefits of treating subclinical hypothyroidism outweigh the risks and potential complications. Doctors who do not  advocate treatment argue that thyroid levels can vary widely, and  subclinical hypothyroidism may not persist. In such cases, overtreatment leading to hyperthyroidism is a real risk. There

is reasonable evidence and consensus to recommend  treatment for subclinical hypothyroidism in the presence of other  factors, including:  High

total or LDL cholesterol levels  Blood tests that show autoantibodies indicating a future risk  for Hashimoto's thyroiditis or other forms of other  autoimmune hypothyroidism  Blood tests that show TSH levels greater than 10 mU/L Goiter  Pregnancy  Female infertility associated with subclinical hypothyroidism

Treatment

is optional in patients with subclinical  hypothyroidism who have no obvious symptoms and  normal cholesterol levels. Some doctors feel that treating this group of patients will prevent progression to overt  hypothyroidism and future heart disease, as well as increase a patient's sense of well-being. However, the evidence to support treatment of this patient group is not  nearly as strong. Many doctors recommend against  treatment and suggest that these patients should simply have lab tests every 6 - 12 months.  Suppressive

Thyroid Therapy.  Suppressive thyroid therapy involves taking levothyroxine in doses that are high enough to block the production of natural TSH but too low to cause hyperthyroid symptoms. It may be used for patients with large goiters or thyroid cancer.

Treatment

of Special Cases

Treating the Elderly and Patients with Heart Disease. Thyroid dysfunction is common in elderly patients, with most  having subclinical hypothyroidism. There is no evidence that  this condition poses any great harm in this population, and  most doctors recommend treating only high-risk patients.  Elderly patients, particularly people with heart conditions, usually start with very low doses of thyroid replacement, since thyroid hormone may cause angina or even a heart  attack. Patients who have heart disease must take lowerthan-average maintenance doses. Doctors do not recommend  treatment for subclinical hypothyroidism in most elderly  patients with heart disease. Such patients should be closely monitored, however.

Treating

Newborns and Infants with Hypothyroidism.

 Babies born with hypothyroidism (congenital  hypothyroidism) should be treated with levothyroxine (T4) as soon as possible to prevent complications. Early treatment can help improve IQ and other developmental   factors. However, even with early treatment, mild   problems in mental functioning may last into adulthood.  In general, children born with milder forms of  hypothyroidism will fare better than those who have more severe forms.

Treatment Women

During Pregnancy and for Postpartum Thyroiditis.

who have hypothyroidism before becoming pregnant may need to increase their dose of levothyroxine during  pregnancy. Women who are first diagnosed with overt hypothyroidism during pregnancy should be treated  immediately, with quick acceleration to therapeutic levels.  Although not well proven, doctors often recommend treating  patients diagnosed with subclinical hypothyroidism while  pregnant. There are no risks to the developing baby when the  pregnant woman takes appropriate doses of thyroid hormones. The pregnant woman with hypothyroidism should be monitored  regularly and doses adjusted as necessary. If postpartum thyroiditis develops after delivery, any thyroid medication should be reduced or temporarily stopped during this period.

Treatment

of Hypothyroidism and Iodide Deficiency.

People

who are iodide deficient may be able to be treated for hypothyroidism simply by using iodized salt. In addition to iodized salt, seafood is a good source. Except for plants grown in iodine-rich soil, most other   foods do not contain iodine. The current RDA for iodide is 150 micrograms for both men and women, with an upper limit of 1,100 micrograms to avoid thyroid injury.

Hyperthyroidism

  Hyperthyroidism



is the term for overactive tissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine (T 4 ), triiodothyronine(T  3 ), or both. Thyroid hormone is important at a cellular level, affecting nearly every type of  tissue in the body. Thyroid hormone functions as a stimulus to metabolism and is critical to normal function of the cell. In excess, it  both overstimulates metabolism and exacerbates the effect  of the sympathetic nervous system, causing "speeding up"  of various body systems and symptoms resembling an overdose of epinephrine (adrenaline). These include fast  heart beat and symptoms of palpitations, nervous system tremor and anxiety symptoms, digestive system hypermotility (diarrhea), and weight loss.

weight loss (often accompanied by an increased  appetite)  anxiety  intolerance to heat   hair loss  muscle aches  weakness  fatigue  hyperactivity  Irritability  Apathy  depression  polyuria and sweating. 

The major causes in humans are:  Graves' disease (the most common etiology with 7080%)  

Toxic thyroid adenoma



Toxic multinodular goitre

 Hyperthyroidism

is generally treatable and carries a good prognosis. Most patients lead normal lives with proper treatment. Thyroid storm, however, can be life threatening and can lead to heart, liver, or kidney failure.

II. ANATOMY & PHYSIOLOGY





The thyroid glands are found on the trachea. The main hormone produced is called  thyroxine. This hormone controls the growth and development of animals. Iodine is required for its production.  Lack of  thyroxine causes deformation and  retardation. The glands swell if not enough hormone is produced  – this is called goitre in humans.

These are located on either side of the thyroid. They  produce two hormones: Parathormone and Calcitonin. These hormones control the level of calcium, magnesium and phosphate in the body.



Thymus   A

very small gland located on the neck. Has some involvement in the production of lymphocytes, which are involved in immune response.

 Normal Thyroid 

 Hypothyroidism

 Hyperthyroidism

III. PATHOPHYSIOLOGY

Hyperthyroidism Grave's Disease(most common cause)

multinodular goiter

adenoma of  thyroid

too much ingestion of  iodinecontaining agents

ingestion of  excessive thyroid hormone

-increase oxygen consumption -increase use of metabolic fuels

autoimmune condition

-increase sympathetic CNS activity

abnormal stimulation of  the thyroid gland by thyroid stimulating antibodies Goiter

hypermetabol ic state

cytokine-mediated activation of  fibroblasts in orbital tissue behind the eyeball

nervousness, irritability, restlessness, anxiety, wakefulness

weight loss

increased cardiac output

exopthalmos(opthalmopathy) paralysis of  extraocular muscle

optic nerve damage

visual loss

tachycardia, palpitation, shortness of  breath

inability to close lids corneal ulceration

excessive sweating, thin hair, silky skin

decrease muscle tone and reflexes muscle cramps

heat intolerance

incrased GI motility

diarrhea

IV. NURSING DIAGNOSIS

  Imbalanced

Nutrition: Less than Body Requirements related to accelerated metabolic rate resulting in weight  loss and decreased energy levels

  Activity

Intolerance related to exhaustion secondary to accelerated metabolic rate resulting in inability to perform activity without shortness of breath and significant  increases in heart rate

  Hyperthermia

related to accelerated metabolic rate resulting in fever, diaphoresis, and reported heat  intolerance

  Impaired

Social Interaction related to extreme agitation, hyperactivity, and mood swings resulting in inability to relate effectively with others

V. NURSING INTERVENTIONS

 Rapid

movement of food through the gastrointestinal tract may result to nutritional imbalance and further weight loss.  Highly

seasoned foods and stimulants such as coffee, tea, cola, and alcohol are discouraged to reduce the area.  High calorie, high protein foods are encouraged.

 The

patient needs reassurance that the emotional  reactions being experience are a result of the disorder and that with effective treatment those symptoms will be controlled. Use a calm, unhurried approach with the  patient.  Stressful experiences are minimized; therefore, if hospitalized, the patient is not placed in a room with very ill or talkative patients. The environment is kept quite and uncluttered. The nurse encourages relaxing activities if they do not overestimate the patient.

 The

patient is likely to experience changes in appearance, appetite and weight. The nurse conveys and understanding of the  patients concern about these problems and assists the patient to develop effective coping strategies.  If changes in appearance are very disturbing to  patient, mirrors maybe covered or removed. The nurse reminds the family members and   personnel to avoid bringing these changes to the  patient’s attention. The nurse explains to the patient and family that  most of these changes are expected to disappear with effective treatment.

The

patient finds a normal room temperature too warm because of an exaggerated metabolic rate and increased  heat production. The nurse maintains the environment at a cool, comfortable temperature and  changes bedding and clothing as needed.

 The

nurse closely monitors the patient with hyperthyroidism for signs and symptoms that maybe indicative of thyroid storm.  Anti-thyroid medications maybe prescribe to reduce thyroid hormone levels.  Propranolol and digitalis maybe prescribe to treat cardiac symptoms.

The nurse teaches the patient how and when to take  prescribe medication, and provides instructions about the essential role of the medication and  broader therapeutic plan.  The nurse provides a written plan for the patient to use at home  The nurse identifies adverse effects that should be reported if they occur.  The nurse also advises the patient to avoid stressful  situations that may precipitate thyroid storm. 

 The

nurse reinforces to the patient and family the importance of long-term follow-up because of the risk for hypothyroidism after thyroidectomy or treatment with anti-thyroid  medications or radioactive iodine.  The nurse also assesses the patient for changes indicating return to normal thyroid function and  signs and symptoms of hyperthyroidism and  hypothyroidism.  The nurse reminds the patients and family about  the importance of health promotion activities and recommended health screening.

VI. MEDICAL MANAGEMENT

 Radioiodine

is considered the treatment of choice for hyperthyroidism, but in some situations, methimazole therapy is preferred, such as in cats with pre-existing renal insufficiency.  Methimazole

blocks thyroid hormone synthesis, and  controls hyperthyroidism in more than 90% of cats that  tolerate the drug. Unfavorable outcomes are usually due to side effects such as gastrointestinal (GI) upset, facial  excoriation, thrombocytopenia, neutropenia, or liver enzyme elevations; warfarin-like coagulopathy or myasthenia gravis have been reported but are rare.

Surgical Procedure  Surgery

- this involves surgically removing the thyroid gland (thyroidectomy). It may be an option for  patients who cannot tolerate anti-thyroid medications, or those who do not wish to receive radioactive iodine therapy. Patients will subsequently require thyroxine treatment to make sure their blood levels of thyroid  hormones are adequate. The operative procedure to treat

hyperthyroidism is known as a near total thyroidectomy  It

is performed under general anesthesia.

The surgeon makes an incision in the

skin lines across the front of the neck and carefully exposes the thyroid  gland.

 Precautions

are taken to identify, isolate, and protect  important structures in the area of the thyroid gland. Two are particularly important: 1. The laryngeal nerve, which is vital for the  proper function of the larynx or voice box, is carefully identified and protected from trauma during this procedure. 2. The four small parathyroid glands, which are embedded in thyroid tissue and produce a hormone necessary for maintenance of blood  calcium levels, are also identified and preserved.  Most The

of the thyroid gland is removed.

surgeon usually leaves about 3 to 8 grams, which is less the 0.3 ounces of thyroid tissue.

The

procedure generally takes several hours.

The

incision usually heals well and is usually not even noticeable

 Surgical Care

Thyroidectomy is no longer the

recommended first-line therapy for hyperthyroid Graves disease. However, a recent  retrospective cohort  studyjavascript:showcontent('active','references'); showed  that one-third of all patients electing surgery as definitive management did so without a specific indication, and the  patient satisfaction with the decision for surgery as definitive management of Graves disease was high. Surgery is a safe alternative therapeutic option in patients who are noncompliant with or cannot tolerate antithyroid drugs, have moderate-to-severe ophthalmopathy, have large goiters, or refuse or cannot undergo radioiodine therapy.

Thyroidectomy

may be appropriate in the presence of a thyroid nodule that is suggestive of carcinoma.  In

certain cases (eg, in pregnant patients with severe hyperthyroidism), thyroidectomy may be indicated because radioactive iodine and antithyroid medications may be contraindicated.  It generally is reserved for patients with large goiters with or without compressive symptoms.  It also may be indicated in patients who refuse radioiodine as definitive therapy or in those in whom the use of antithyroid drugs and/or radioiodine does not  control hyperthyroidism.  Surgery

provides rapid treatment of Graves disease and permanent cure of hyperthyroidism in most patients, and it has "negligible mortality and acceptable morbidity" by experienced surgeons.

Ophthalmopathy  Near-total

thyroidectomy has little, if any, effect on the course of  ophthalmopathy. If

ophthalmopathy is severe but inactive, orbital decompression may be performed. Reducing proptosis and decompressing the optic nerve can be achieved by transantral orbital decompression. The

major adverse effect is postoperative diplopia, which may necessitate a second surgery on the extraocular muscles to correct the problem. Rehabilitative

(extraocular muscle or eyelid) surgery is often needed. Eyelid surgery (eg, severance of the Müller muscle, scleral  or palatal graft insertion) can be performed to improve exposure keratitis.

VII. MEDICATIONS

 Hyperthyroidism

can be treated using medicine, radiation, or surgery. Many factors, such as the person's age and the severity and type of hyperthyroidism, are important in determining which treatment is best. The two main types of medicines used to treat  hyperthyroidism are antithyroid drugs and betablockers.

 Antithyroid

drugs, such as methimazole (MMI or Tapazole) and propylthiouracil (PTU), work by decreasing the production of thyroid hormone.  Both are very effective, but methimazole is generally preferred because of a rare risk of  serious side effects with PTU. The illustration shows that some hormone is made, but the thyroid  becomes much less efficient. When taken  faithfully, these drugs are usually very effective in controlling hyperthyroidism within a few weeks.

 For

pregnant women, PTU is the preferred  drug during the first trimester. After the first  trimester, methimazole is preferred.  For patients with sustained forms of  hyperthyroidism, such as Graves' disease or toxic nodular  goiter, anti-thyroid medications are often used. The goal with this form of drug therapy is to prevent the thyroid from producing hormones.

Cont’d  Very

rarely, patients treated with these medications can develop liver inflammation or a deficiency of  white blood cells therefore, patients taking antithyroid drugs should be aware that they must  stop their medication and call their doctor promptly if they develop yellowing of the skin, a high fever, or severe sore throat. The main shortcoming of  antithyroid drugs is that the underlying hyperthyroidism often comes back after they are discontinued. For this reason, many patients with hyperthyroidism are advised to consider a treatment that permanently prevents the thyroid  gland from producing too much thyroid hormone.

 Rash

itching or fever (but these are uncommon)



 MMI

is usually preferred over PTU because it  reverses hyperthyroidism more quickly and  has fewer side effects. MMI requires an average of 6 weeks to lower T4 levels to normal and is often given before radioactive iodine treatment. MMI can be taken once per day.

 PTU

blocks the conversion of T4 to T3 in nonthyroid tissue, but it does not reverse hyperthyroidism as rapidly as MMI. PTU must  be taken two to three times per the day.

 PTU

used to be the drug of choice during pregnancy because it is thought to have a lower risk of causing birth defects. But experts now recommend that PTU be given during the first trimester only. This is because there have been rare cases of liver damage in people taking PTU. After the first trimester, women should  switch to methimazole for the rest of the pregnancy.

 Beta-blockers,

such as atenolol, are often started as soon as the diagnosis of  hyperthyroidism is made. While beta-blockers do not reduce thyroid hormone production, they can control many of the bothersome symptoms, such as rapid heart rate, tremors, anxiety, and heat intolerance. Once the hyperthyroidism is under control (by antithyroid drugs, surgery, or radioactive iodine), the beta-blocker is stopped.

 Destroying

the thyroid with radiation, called  radioiodine ablation, is a permanent way to resolve hyperthyroidism. The amount of radiation used is small and does not cause cancer. This is the most widely used treatment in the United States.  Radioiodine is given in liquid or capsule form, and  it works by attacking and destroying much of the thyroid tissue. This takes about 6 to 18 weeks.  People with severe symptoms, older adults, and   people with heart problems should first be treated  with an antithyroid drug to control symptoms.  Most patients who receive radioiodine develop hypothyroidism and need to take thyroid hormone supplements for the rest of their lives.

 Sometimes,

after apparently successful treatment, the condition returns and further treatment is needed.  About 20 percent of those who use radioiodine treatment require a second dose. These people usually have severe hyperthyroidism or a very large goiter.  Occasionally, people whose hyperthyroidism is caused by Graves' disease may find that their eye symptoms worsen after therapy.

 People

who undergo this therapy should avoid  close physical contact, especially with young children and pregnant women, for three to seven days after treatment because of the  possibility of exposing them to low doses of  radiation. This can be difficult for parents of  young children. Patients will need to see their clinician on a regular basis after treatment to have thyroid hormone levels checked and  monitor for hypothyroidism or recurrent  hyperthyroidism.

VIII. DIAGNOSTIC PROCEDURES

Hypothyroidism & Hyperthyroidism

 The

TSH (or Thyroid Stimulating  Hormone) assay has been recognized as an exquisitely sensitive indicator of  thyroid status.

 The

T4 (or Thyroxin) assay complements the TSH assay, and is used to confirm a thyroid disorder when suggested by an abnormal TSH.

T3 The

T3 (or Triiodothyronine) assay is another assay which is used in the diagnosis of thyroid disorders.

 The

T3 Resin Uptake assay is used in calculating the Free Thyroxin Index (FTI).

Other Tests  Autoantibodies

of clinical interest in thyroid  disease include thyroid-stimulating antibodies (TSAb), TSH receptor-binding inhibitory immunoglobulins (TBII), antithyroglobulin antibodies (Anti-Tg Ab) and the antithyroid   peroxidase antibody (Anti-TPO Ab).

 Similar

in its use for evaluating a breast  mass, ultrasound can be used to assess a thyroid nodule.

Fine Needle Aspiration  Fine

Needle Aspiration (FNA) has become the single-most important step in the evaluation of a thyroid nodule.

 The

thyroid glands' ability to concentrate iodine and certain radioactive isotopes has been exploited in a nuclear imaging technique known as the thyroid scan.

X. DIET

 No

foods have been shown in clinical studies to improve or worsen the symptoms of  hyperthyroidism. However, that doesn't mean you shouldn't pay attention to what you eat. A healthy, well-balanced diet is important for those with hyperthyroidism -- both during and  after treatment. It should include things like ruits, vegetables, and lean proteins, with limited  amounts of foods high in fat and cholesterol.

 Healthcare

providers generally advise their  patients to follow good dietary habits following treatment for hyperthyroidism. The reason is that considerable weight gain is common with this condition. One study showed an average weight gain of about 12 pounds (5.4 kg) in  people followed for up to two years after hyperthyroidism treatment.

Graves'

disease  Preexisting obesity result of   Previous weight loss as a result hyperthyroidism  Hypothyroidism following treatment.

 The

good news is that research has also shown that this weight gain can be minimized by  following sensible dietary habits. If you have an overactive thyroid, you should strive to eat a well-balanced diet and control your weight.  A well-balanced diet can help you feel better and can be a positive step in dealing with hyperthyroidism. It can also help decrease your chances of developing heart disease or certain types of cancer.

 Eat

a heart-healthy heart-healthy diet. This diet should include foods such as: vegetables, grains, and fat-free fat-free or low-fat   Fruits, vegetables, milk and milk products  Lean meats, poultry, poultry, fish, beans, eggs, and and nuts.  Limit foods with saturated fats, fats, trans fats, fats, cholesterol, sodium (salt), and added sugars.  Get regular physical activity for at least 30 minutes a day on most days of the week.  Limit your intake intake of alcohol.