The Overactive Thyroid Checklist: What to Do and What to Skip

Hyperthyroidism: the thyroid producing too much hormone, speeding many body processes. It causes weight loss, palpitations and anxiety that are often attributed to stress, and it carries real cardiac and bone risk if untreated.

Key takeaways

• Main test: TSH, suppressed, with raised T4 or T3
• Commonest cause: Graves' disease
• Most useful single change: Seek assessment for unexplained weight loss with palpitations or tremor.
• Commonest mistake: Attributing palpitations and anxiety to stress without a thyroid test.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

Do

• Seek assessment for unexplained weight loss with palpitations or tremor
• Report eye symptoms, which need specialist assessment in Graves' disease
• Take antithyroid medication exactly as prescribed
• Stop smoking, which worsens thyroid eye disease considerably

Do not

• Attributing palpitations and anxiety to stress without a thyroid test
• Ignoring a sore throat or fever while on carbimazole
• Stopping treatment when symptoms improve

The numbers behind the list

Here are the figures the checklist is drawn from.

If you change one thing

Seek assessment for unexplained weight loss with palpitations or tremor. That one first, and the others when you get to them.

Where to go next

• Overactive Thyroid: The Quick Reference
• Overactive Thyroid: Sorting the Evidence From the Noise
• Overactive Thyroid — the reference entry
• What the Guidance Really Says About Thyroid Function Tests
• Thyroid Lumps: What Published Guidance Supports

When to speak to a doctor

Seek urgent medical advice for a sore throat, mouth ulcers, fever or bruising while taking carbimazole or propylthiouracil — these can indicate a dangerous fall in white cells and need an immediate blood count. Call 999 for fever with agitation, a very rapid heart rate, vomiting and confusion, which can indicate thyroid storm. Report double vision or eye pain urgently.

Where this comes from

• NICE — Thyroid disease: assessment and management
• NHS — Overactive thyroid

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.