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Hyperthyroidism in Nigeria

An overactive thyroid — causes of weight loss, racing heart, and anxiety

Hyperthyroidism — an overactive thyroid — causes too much thyroid hormone, speeding up metabolism and virtually every body function. In Nigeria, it is often misdiagnosed as anxiety, cardiac disease, or malnutrition. Graves' disease (an autoimmune condition) is the most common cause worldwide. Untreated hyperthyroidism causes serious complications: atrial fibrillation, heart failure, osteoporosis, and thyroid storm (a life-threatening emergency).

Signs and Symptoms

✓ Unexplained weight loss despite good appetite
✓ Palpitations — rapid, irregular, or forceful heartbeat
✓ Anxiety, nervousness, irritability, and tremor of the hands
✓ Heat intolerance and excessive sweating
✓ Diarrhoea or frequent bowel movements
✓ Fatigue and muscle weakness
✓ Difficulty sleeping
✓ In women: lighter, less frequent periods or absent periods
✓ In Graves' disease: goitre (visible neck swelling); eye changes (exophthalmos — protruding eyes, grittiness, double vision); pretibial myxoedema (skin changes on the shins)
✓ Thyroid storm (crisis): fever, extreme agitation, confusion, rapid heartbeat — medical emergency

Risk Factors

When to Seek Help

Unexplained weight loss with palpitationsThese two together should always prompt TSH testing — hyperthyroidism is an easily missed and serious diagnosis.
Rapid or irregular heartbeat in a person who appears unwell or thinAtrial fibrillation from hyperthyroidism — needs ECG and TSH.
Eye protrusion or eye pain in someone with other thyroid symptomsGraves' ophthalmopathy — requires endocrinology and ophthalmology co-management.
Extremely unwell, fever, confusion, rapid heart rateThyroid storm — emergency. Go to hospital immediately.

Tests & Diagnosis

🧪 TSH
The first test — suppressed TSH (below 0.1 mIU/L) in an unwell patient is highly suggestive of hyperthyroidism.
🧪 Free T3 and Free T4
Elevated in hyperthyroidism. T3 toxicosis (elevated T3, normal T4) occurs in some patients.
🧪 TSH receptor antibodies (TRAb)
Confirms Graves' disease — present in 90%+. Useful to distinguish from toxic nodular goitre.
🧪 Thyroid ultrasound
Shows gland size, nodules, and vascularity — helpful in distinguishing Graves' from toxic nodule or thyroiditis.
🧪 ECG
Atrial fibrillation and sinus tachycardia are common findings in hyperthyroidism.
🧪 Thyroid isotope scan (Tc99m)
Distinguishes Graves' (diffuse uptake) from toxic nodule (focal uptake) or thyroiditis (reduced uptake).

Treatment Options

1
Beta-blockers (immediate symptom control)
Propranolol 40 mg three times daily reduces palpitations, tremor, sweating, and anxiety rapidly. Used while awaiting definitive treatment. Does not treat the underlying cause.
2
Antithyroid drugs (carbimazole or propylthiouracil)
Carbimazole 15–40 mg daily — the preferred drug in Nigeria. Reduces thyroid hormone synthesis. Most patients have good symptom control within 4–8 weeks. Given for 12–18 months (titration regimen) then stopped to assess for remission. Propylthiouracil preferred in pregnancy (first trimester).
3
Radioactive iodine (RAI)
A single oral dose — the iodine is taken up by the thyroid and destroys overactive tissue. Safe, effective, and permanent. Most people become hypothyroid after treatment (requiring lifelong levothyroxine). Avoid in pregnancy and in Graves' ophthalmopathy.
4
Thyroidectomy (surgery)
Removes all or most of the thyroid gland — definitive treatment. For: large goitre causing compression, patient preference, severe or drug-resistant disease, or when ophthalmopathy requires thyroid ablation. Results in hypothyroidism requiring levothyroxine.
5
Graves' ophthalmopathy
Sunglasses, lubricating eye drops. IV methylprednisolone for moderate-severe eye disease. Orbital decompression surgery for severe proptosis. Requires ophthalmology and endocrinology co-management.

Frequently Asked Questions

Can I cure hyperthyroidism?
Antithyroid drugs achieve long-term remission in 40–50% of Graves' disease patients — in those, treatment can be stopped. Radioactive iodine and surgery are permanent solutions but result in hypothyroidism (requiring lifelong levothyroxine). Toxic nodular goitre rarely remits with drugs — definitive treatment is usually needed.
Is carbimazole safe?
Yes for most people. Important side effects: agranulocytosis (rare but serious — low white blood cell count causing severe infection). If you develop a fever or sore throat while on carbimazole, stop the drug immediately and go to hospital for a full blood count. Liver toxicity is rare. Monthly FBC monitoring is recommended during high-dose treatment.
Can hyperthyroidism affect my heart permanently?
Prolonged uncontrolled hyperthyroidism can cause permanent atrial fibrillation, cardiomyopathy, and heart failure. Treating the thyroid usually restores normal heart rhythm, but established atrial fibrillation may persist and require anticoagulation. Early diagnosis and treatment prevents cardiac damage.
Is it safe to get pregnant with hyperthyroidism?
Hyperthyroidism must be well-controlled before conception and during pregnancy. Uncontrolled hyperthyroidism causes miscarriage, preterm birth, and foetal growth restriction. Propylthiouracil (not carbimazole) is used in the first trimester — discuss with your endocrinologist before trying to conceive.
What is thyroid storm?
A life-threatening exacerbation of hyperthyroidism — usually triggered by infection, surgery, or trauma in someone with undertreated disease. Features: fever, extreme agitation, confusion, rapid heart rate above 150 bpm, and organ failure. Mortality is 10–20% even with treatment. Requires intensive care admission, IV propylthiouracil or carbimazole, high-dose propranolol, steroids, and treatment of the trigger.

Related Pages

Thyroid Tests ExplainedHypothyroidism in NigeriaGoitre in Nigeria

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