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Hyperthyroidism (Overactive Thyroid) in Nigeria

Understanding and treating a fast thyroid in Nigeria

Hyperthyroidism — excess production of thyroid hormone — causes symptoms of metabolic overactivity: unexplained weight loss despite good appetite, heat intolerance, palpitations, anxiety, and tremor. Graves' disease (autoimmune) is the most common cause in Nigeria, particularly in young women. Toxic multinodular goitre becomes more common in older adults. Hyperthyroidism can cause atrial fibrillation, cardiac failure, and bone thinning if untreated. Fortunately, effective treatments are available in Nigeria.

Signs and Symptoms

✓ Unexplained weight loss despite normal or increased appetite
✓ Palpitations: fast or irregular heartbeat, awareness of heartbeat at rest
✓ Heat intolerance and sweating — feeling hot when others are comfortable
✓ Tremor: fine trembling of the outstretched hands
✓ Anxiety, irritability, emotional lability
✓ Diarrhoea or increased frequency of bowel movements
✓ Menstrual irregularity and reduced fertility in women
✓ Graves' disease: bulging or prominent eyes (exophthalmos/proptosis) — unique to Graves'
✓ Thyroid storm: extreme hyperthyroidism — high fever, severe tachycardia, agitation, confusion — life-threatening emergency

Risk Factors

When to Seek Help

UrgentNew rapid or irregular heartbeat with weight loss and heat intolerance — cardiac manifestations of hyperthyroidism (AF, heart failure) need prompt diagnosis and treatment
Emergency — Thyroid StormExtremely high fever (>40°C) with rapid heart rate, agitation, and confusion in a patient with known or suspected hyperthyroidism — this is a life-threatening emergency; go to A&E immediately
Graves' eye diseaseAny eye prominence, redness, pain, double vision, or vision loss in a patient with hyperthyroidism — urgent ophthalmology and endocrinology review; Graves' ophthalmopathy can be sight-threatening

Tests & Diagnosis

🧪 TSH
Suppressed (<0.1 mIU/L) in hyperthyroidism — the most sensitive initial test
🧪 Free T4 and free T3
Both elevated in overt hyperthyroidism; T3 may be disproportionately elevated in toxic nodule
🧪 TSH receptor antibodies (TRAb)
Positive in Graves' disease — confirms the autoimmune cause and is a prognostic marker
🧪 Thyroid ultrasound with Doppler
Assesses gland size, nodularity, and blood flow — increased flow in Graves'; guides radioactive iodine dose calculation
🧪 Radioactive iodine uptake scan
Distinguishes Graves' from toxic nodule and from thyroiditis (low uptake in thyroiditis); available at nuclear medicine departments in LUTH, UCH

Treatment Options

1
Carbimazole (first-line antithyroid drug)
5-20mg twice daily; blocks thyroid hormone production; TSH and FT4 checked at 4-6 weeks; maintenance dose continued for 12-18 months; 50% remission rate after stopping in Graves' disease
2
Propylthiouracil (PTU)
Alternative to carbimazole; preferred in first trimester of pregnancy and thyroid storm; monitoring for rare but serious agranulocytosis — check FBC if fever or sore throat develops on treatment
3
Beta-blocker (propranolol)
Rapidly controls palpitations, tremor, and heat intolerance while waiting for antithyroid drugs to work — does not reduce thyroid hormone levels but blocks its effects
4
Radioactive iodine (I-131)
Definitive treatment — single oral dose permanently reduces thyroid size and output; available at LUTH, UCH nuclear medicine departments; most patients become hypothyroid after treatment (requiring lifelong levothyroxine); contraindicated in pregnancy and while breastfeeding
5
Thyroid surgery (total thyroidectomy)
For large goitre, suspicious nodule, poor antithyroid drug compliance, or patient preference; requires pre-operative euthyroid state (normal thyroid function) with antithyroid drugs; immediate levothyroxine started post-op

Frequently Asked Questions

Can hyperthyroidism go away on its own?
Graves' disease occasionally enters spontaneous remission but this is unpredictable. Toxic multinodular goitre and toxic adenoma do not resolve spontaneously — they require definitive treatment (radioactive iodine or surgery). Postpartum thyroiditis is often transient, with hyperthyroidism followed by hypothyroidism then recovery.
Is radioactive iodine available in Nigeria?
Yes — I-131 radioactive iodine treatment for hyperthyroidism and thyroid cancer is available at the Nuclear Medicine departments of LUTH Lagos and UCH Ibadan, and at some other centres. Referral from an endocrinologist is required.
Does hyperthyroidism cause infertility?
Yes — hyperthyroidism disrupts the menstrual cycle and reduces fertility. Treating hyperthyroidism typically restores menstrual regularity and fertility. Conception should be delayed until thyroid function is normalised and stable.
Can I take carbimazole in pregnancy?
Carbimazole is associated with a small risk of foetal abnormalities — PTU is preferred in the first trimester; carbimazole can be used in the second and third trimesters if PTU is not tolerated. The lowest effective dose should be used. Untreated hyperthyroidism in pregnancy is more dangerous than treated.
What is thyroid storm?
Thyroid storm is a rare, life-threatening extreme hyperthyroidism, often triggered by infection, surgery, or iodine contrast in an incompletely treated hyperthyroid patient. Treatment requires IV PTU, Lugol's iodine, high-dose propranolol, and steroids in ICU. Mortality is 10-25% even with treatment.

Related Pages

Hypothyroidism (Underactive Thyroid) in NigeriaPCOS: Polycystic Ovary Syndrome In-DepthGoitre & Iodine Deficiency in NigeriaAdrenal Insufficiency in Nigeria

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