How can I prevent rhinitis?

What is rhinitis?

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Rhinitis is inflammation of the nose. It may, or may not, be caused by an allergy. Hay fever, the most common of the allergic diseases, is also known as seasonal allergic rhinitis.  People with hay fever generally have symptoms throughout the pollen season (spring, summer, autumn), the exact period depending on the type of pollen (tree, grass, weed) that triggers the symptoms. Then there is perennial allergic rhinitis, where symptoms are present year round, irrespective of season, because the allergen is something other than pollen, like house dust mite or pet dander. However, some people have rhinitis year round, but find their symptoms are worse during the pollen season. Also, in some countries the pollen season is very long. So you may hear the term persistent rhinitis or intermittent rhinitis used to describe such cases. 

Types of non-allergic rhinitis include triad and NARES. The name triad comes from the presence of three distinct symptoms: asthma, nasal polyps, and perennial rhinitis. Although triad does involve the immune system, it is not considered to be a classic allergy.  Triad is strongly associated with a sensitivity to aspirin and related drugs. NARES stands for Non-Allergic Rhinitis with Eosinophilia and is marked by the presence of immune cells called eosinophils in the nose, where they cause severe inflammation.  Then there is vasomotor rhinitis, whose exact cause is unknown. Triggers (not allergens) like spicy food, alcohol, stress, and air pollution can produce symptoms in vasomotor rhinitis.  The presence of nasal polyps may also contribute to non-allergic rhinitis.

 

What are the symptoms of rhinitis?

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They are similar to those of hay fever, namely:

• Red, watering eyes
• Sneezing
• Streaming nose
• Blocked nose/nasal congestion
• Itching of the nose, mouth, throat, eyes
• Dry throat
• Earache
• Loss of sense of smell.

Rhinitis may also be complicated by sinusitis, an inflammation of the sinuses, which are hollow cavities in the skull.  Fluid from the sinuses normally drains into the nasal cavity but if this area is congested, then mucus will build up in the sinuses and this may become inflamed and infected. Another complication of perennial allergic rhinitis is post-nasal drip where mucus runs down the back of the nose, and then into the throat and the airways, producing a persistent phlegm cough. 

What causes rhinitis?

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Allergic rhinitis is caused by exposure to an airborne allergen. Common allergens include:

• House dust mite droppings
• Particles from insects such as midges, mosquitoes, cockroaches, carpet beetles, house flies
• Mould spores, indoors and outdoors
• Pet dander, especially from dogs, cats and horses
• Workplace allergens, such as flour, wood dust and chemicals.

Sometimes a food allergen can cause rhinitis. Yeast is probably the most common food allergen to produce nasal symptoms.

How common is rhinitis?

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Allergic rhinitis (either seasonal or perennial) is common, affecting around 20% of the UK population. Around 50% of perennial rhinitis is thought to have an allergic cause.  

What causes the symptoms of rhinitis?

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What causes the symptoms of rhinitis?

The nose is a remarkable organ. It acts both as a heat exchanger and a filter. The nose is also well supplied with blood vessels (which is why a nose bleed produces so much blood). Cold air entering the nose flows past the turbinates, which are small bony projections on the breathing passages covered by mucous membrane. Particles and bacteria are trapped by the membranes, while the air is warmed by being drawn across the network of blood vessels that lies beneath the membranes. 

In vasomotor rhinitis, the blood vessels may swell in response to small changes in environmental conditions, including irritants, which leads to congestion. Tiny abnormalities in the anatomy of the nose – in the turbinates, or the septum, which divides the nostrils, may contribute to this, In allergic rhinitis, blood flow is increased, the mucous membranes swell and there is increased mucus production, all occurring in response to histamine production on exposure to the allergen. The result is nasal congestion, nasal blockage, and a runny nose. 

How is rhinitis diagnosed?

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A simple account of your symptoms and their seasonality may be all that is required to diagnose rhinitis. If confirmation and/or identification of an allergic cause is needed, then a skin prick test can be used.  A tiny drop of allergen extract is placed on the skin (either the arm or the back). If you are allergic to this substance, a small red weal will appear, usually within 15 minutes. Referral to a specialist is rarely necessary in simple cases of rhinitis, but should be done if you don’t respond to treatment (see below) or if there is doubt over the diagnosis. 

Can rhinitis be confused with other conditions?

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Nasal polyps and vasomotor rhinitis lead to similar symptoms to allergic rhinitis. It may be important to distinguish between an allergic and non-allergic cause for your nasal symptoms, as this will affect treatment. 

Facial pain is not usual in allergic rhinitis and a referral to an Ear Nose and Throat Specialist should be made for further investigation.

What is the outlook in rhinitis?

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Post-nasal drip can lead to a chronic cough, which is a symptom that always needs investigating. A cough that does not clear up within three weeks can indicate lung cancer. This is not to say there is any link between rhinitis and lung cancer – there isn't. But if you have a chronic cough, do not assume it is your rhinitis and ignore it. It may have a different cause.

Research has also suggested that about 40% of people with allergic rhinitis go on to develop asthma.  

How can I prevent rhinitis?

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Allergic rhinitis can be prevented by avoiding exposure to allergic triggers. Here are some pointers:

House dust mite

• Minimize allergen ‘reservoirs’ like carpets, sofas and curtains. 
• Keep your home dry, which reduces mould as well as HDM. 
• Invest in mite-proof covers for bedding.

Pet dander

• Confine your pet to one room in the house, or keep it outside.
• Wash the pet regularly with special shampoo and always wash your own hands after touching it.
• Pet dander gets airborne but also settles on carpets and soft furnishings. Keep the house ventilated and also vacuum regularly to suck up the allergen, using a vacuum with a HEPA filter to trap the particles. 

Mould spores

• Keep your home dry by dealing with any cracks, leaks, or rising damp, and remove any visible patches of mould. 
• When you are cooking, close the kitchen door and open a window. Do the same in the bathroom after taking a bath or shower.  Don't have a carpet in the bathroom.
• Dry clothes outside wherever possible.

A HEPA air purifier may help reduce the allergen burden by improving the quality of your indoor air. The filter traps allergen particles with very high efficiency. 

What medical treatments are there for rhinitis?

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If your symptoms are mild, use a long-acting non-sedating antihistamine such as:

• Claritin (loratadine) 
• NeoClaritin (desloratadine)
• Zyrtec (cetirizine)
• Xyzal (levocetirizine)
• Allegra (fexofenadine)

These are available over-the-counter (ask the pharmacist if you have questions about any of these medications). The older antihistamines like chlorpheniramine (Piriton) and hydroxyzine (Atarax) have a significant sedating effect and should not be used if you are driving, operating machinery, or studying. These older drugs also interact with alcohol so having even a small amount to drink may significantly affect performance.  If rhinitis mainly affects your eyes, antihistamine eye drops, such as Otrivine (antazoline) (also available over the counter) may help

A nasal decongestant (drops or a spray) may also be helpful, in addition to your antihistamine, to clear a blocked nose. Some of these are corticosteroids, which act by reducing inflammation. These include Beconase (beclomethasone) and Flixonase (fluticasone).  Meanwhile, Otrivine/Sudafed (xylometazoline) is a non-corticosteroid nasal decongestant. All of these can be bought without prescription.  But only use a decongestant for as short a time as possible, because the nose tends to develop 'rebound' vascular congestion and will stop responding to the medication.  

If antihistamines and nasal steroids do not do the job, then there is also Singulair (montelukast) which is a prescription medicine used for asthma and allergies. An antibody drug called Xolair (omalizumab) which targets the IgE antibody produced by the allergen has also been introduced recently. This approach gets to the root cause of allergic rhinitis, because IgE activates mast cells, making them produce histamine which triggers the allergic symptoms. 

In general, antihistamines and topical nasal steroids do give some relief in perennial allergic rhinitis but tend to be less effective than in seasonal allergic rhinitis/hay fever. These drugs may also be effective in non-allergic rhinitis, where Singulair and related drugs may also be tried with some success. 

Can rhinitis be cured?

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Immunotherapy (also known as densensitisation or allergy shots) offers a way of overcoming allergic rhinitis for good. In the desensitisation approach, the system is ‘flooded’ with a known allergen so that the body will eventually learn to ‘ignore’ it.  Patients for immunotherapy need to be carefully selected, and treated in a specialist centre.   The procedure now involves only four injections and has been shown to give lasting benefit. There is also a home version known as sublingual immunotherapy, in which the patient places medication under the tongue (currently only available for grass pollen allergy). People with allergic rhinitis are more likely to have asthma, which fits in with the ‘united airway’ concepts which many allergy experts have noted. The significance of treating your allergic rhinitis for long-term results with immunotherapy is that it may prevent asthma in the future.  

Weight Loss With Green Coffee Beans

Scientists report striking new evidence that green, or unroasted, coffee beans can produce a substantial decrease in body weight in a relatively short period of time. 

In a study presented at the 243rd National Meeting & Exposition of the American Chemical Society (ACS), the world's largest scientific society, Joe Vinson, Ph.D., and colleagues described how a group of overweight or obese people who consumed a fraction of an ounce of ground green coffee beans each day lost about 10 percent of their body weight. 

"Based on our results, taking multiple capsules of green coffee extract a day - while eating a low-fat, healthful diet and exercising regularly - appears to be a safe, effective, inexpensive way to lose weight," Vinson said at the ACS meeting, being held here this week. He is with the University of Scranton in Pennsylvania. 

The study involved 16 overweight or obese people aged 22-26 years who took capsules of the extract or capsules containing a placebo, an inactive powder, for a total of 22 weeks. The subjects alternated between a low dose and a higher dose of the extract. The low dose consisted of 700 mg of the coffee extract, and the high dose was 1,050 mg. It was a so-called "cross-over" study in which people cycled through the two doses and the placebo, each for six weeks. Such studies have advantages because each person serves as his or her own "control," improving the chances of getting an accurate result. 

All of the participants were monitored for their overall diet (calories, food eaten, etc.) and exercise over the study period. "Their calories, carbohydrates, fats and protein intake did not change during the study, nor did their exercise regimen change," Vinson said. 

Participants lost an average of 17 pounds during the 22 weeks of the study. It included an average of a 10.5 percent decrease in overall body weight and a 16 percent decrease in body fat. Vinson noted that weight loss might have been significantly faster, except that participants received the placebo and the lower dose of green coffee extract for part of the study period. 

Vinson pointed out that previous studies have shown weight loss with green coffee. But this was the first to use higher amounts of the coffee extract and the first to measure the response to various doses. Based on those studies, Vinson believes that green coffee beans' effects likely are due to a substance called chlorogenic acid that is present in unroasted coffee beans. Chlorogenic acid breaks down when coffee beans are roasted (usually at a temperature of 464-482 degrees Fahrenheit). Roasting gives coffee beans their distinctive color, aroma and flavor. Green coffee beans, in contrast, have little aroma and a slightly bitter taste. 

Abstract 

Obesity is a growing epidemic in industrialized societies. Overweight and obese subjects in the US are now 68% of the population. There are prescription drugs for weight loss but efficacy is low and side effects cause a large dropout rate in clinical studies. We have investigated an extract of green (unroasted) coffee beans high in coffee polyphenols. A 22-week cross-over study was conducted in 16 sub-obese adults to examine the efficacy and safety of a commercial product GCA™. Subjects receive a high-dose (1050 mg), low-dose (700 mg), and placebo in separate six-week treatment periods followed by two-week washouts. Primary measurements were body weight, body mass index (BMI) and fat mass (BIA). Heart rate and blood pressure were measured. There was a significant decrease (improvement) in all parameters except blood pressure. Weight loss averaged 8 kg without side effects. This product is a safe, effective, and inexpensive nutraceutical for weight loss. 

Air Pollution Tied to Behavior Issues in Kids.

Action Points

• A long-running Columbia University cohort of mothers and children found that exposure to polycyclic aromatic hydrocarbon (PAH) during pregnancy was associated with anxiety/depression and activity problems in the children at ages 6 to 7 years.
• Note that the women were all African American or Dominican, residing in three boroughs of New York City, were nonsmokers, and had PAH exposure assessed via both personal air monitoring in the third trimester and measurement in cord blood at delivery and maternal blood a day later.

Prenatal exposure to air pollution may have ill effects on a child's behavior in the early school years, researchers reported.

The latest report from a long-running child/mother cohort found that high levels of a polycyclic aromatic hydrocarbon in maternal or cord blood were associated with behavior problems in children at ages 6 and 7, according to Frederica Perera, DrPH, of Columbia University, and colleagues.

Two separate measures were associated with symptoms of anxiety, depression, and attention disorders, Perera and colleagues reported online in Environmental Health Perspectives.

The team had previously reported that prenatal exposure to polycyclic aromatic hydrocarbons (which are produced during incomplete combustion of organic substances) was associated with a reduced intelligence quotient when children reached age 5.

Environmental air pollution, including polycyclic aromatic hydrocarbons, is high in urban areas and is thought to have adverse effects in children, something that Perera and colleagues have been investigating in the Columbia Center for Children's Environmental Health cohort.

The cohort, consisting of 617 mother/child pairs, includes African-American and Dominican women who resided in Washington Heights, Harlem, or the South Bronx in New York City and were pregnant between 1998 and 2003.

They were recruited through local prenatal care clinics into a prospective cohort study, with enrollment restricted to nonsmokers, ages 18 through 35, who did not use other tobacco products or illicit drugs, and were free of diabetes, hypertension, or known HIV.

During the prenatal period, the women in the study carried personal air monitoring units that recorded levels of a representative polycyclic aromatic hydrocarbon, benzo[a]pyrene (B[a]P).

The researchers also measured DNA adducts of B[a]P -- biomarkers of exposure -- in cord blood collected at delivery and in maternal blood collected, in most cases, the day after delivery.

At ages 6 and 7, behavior of the children was assessed using the Child Behavior Checklist. At the time of this analysis, 294 children had had the checklist completed; the sample consisted of 253 children who also had available data on explanatory or potential confounding variables.

Maternal exposure, as assessed by the personal monitoring units, was broken down into high and low at the median exposure of 2.27 nanograms per cubic meter.

The cohort was also stratified by the presence or absence of the DNA biomarkers.

In multivariate analyses, Perera and colleagues found:

• High prenatal exposure, as measured by air monitoring, was associated with a significantly higher symptom score of Anxious/Depressed in the children -- 1.45 times that of the low exposure group (P<0.0001).
• High exposure was also associated with an elevated symptom score of Attention Problems -- 1.28 times that of the low exposure group (P=0.001).
• Similarly, detectable DNA biomarkers of exposure were associated with Anxious/Depressed symptoms -- 1.23 and 1.46 times that of the nondetectable group for maternal and cord blood, respectively. The associations were significant atP=0.019 and P<0.001.
• The same was true for Attention Problems – the risk increases were 1.25 and 1.32 times that of the nondetectable group for maternal and cord blood respectively. The associations were significant at P=0.003 and P=0.002.

The researchers concluded that the findings "provide additional evidence" that the environmental levels of polycyclic aromatic hydrocarbons encountered in New York City air can adversely affect child behavior.

They cautioned that such things as other pollutants and stress, which were not measured, might have contributed to residual confounding. Also, they noted, the personal air monitoring took place only once over a 48-hour period in the third trimester.

Finally, children born extremely preterm were excluded, as were mothers who smoked, used illicit drugs, or had preexisting disease, so that the findings might not apply to populations at higher risk.

World's Tallest Man Stops Growing.

The world's tallest man appears to have stopped growing following treatment at the University of Virginia Medical Center, earning the medical center a mention in the 2012 Guinness World Records. 

 In May 2010, 8-foot-3-inch Sultan Kosen of Turkey made his first visit to UVA for treatment by endocrinologist Mary Lee Vance, MD. Kosen suffers from acromegaly, which is usually caused by a tumor in the pituitary gland. The tumor causes a large amount of growth hormone to be produced, which can lead to gigantism if the excess growth hormone is produced before puberty begins.

The condition can cause a range of health problems, Dr. Vance says. "His skeleton just can't support him," she says.

Advanced Treatments

Dr. Vance placed Kosen on a new medication that could potentially help control the production of growth hormone and stop his continued growth. Because Kosen's pituitary tumor had spread to areas of his brain where doctors could not safely perform open surgery, UVA neurosurgeon Jason Sheehan, MD, then performed Gamma Knife radiosurgery in August 2010.

Gamma Knife radiosurgery is a noninvasive procedure that delivers focused beams of radiation guided by MRI to a specific spot in a patient's body -- in this case, Kosen's pituitary tumor.

About three months ago, Kosen's doctors in Turkey told Dr. Sheehan that Kosen has stopped growing. "The treatments that we provided at the University of Virginia have stopped the production of his excess growth hormone and stopped the growth of the tumor itself," Dr. Sheehan says.

Stopping Growth, Saving a Life

Kosen's listing in the 2012 edition of Guinness World Records cites his treatment at UVA, though Dr. Vance and Dr. Sheehan are happiest that they were able to provide effective care.

"Treating someone 8 feet 3 inches tall is no different from treating someone 5 feet 10 inches tall," Dr. Vance says. "The important thing is to stop the production of the excess growth hormone."

"I'm most pleased that we were able to help Sultan," Dr. Sheehan adds. "If he had continued to grow, it would have been life-threatening."

Latest Medical findings on Asthma.

Asthma has been very much on the medical research agenda in recent weeks, so we thought it was time to bring you an update on the latest news.

• New findings from the West Sweden Asthma Study suggest that severe asthma may disguise itself as nasal congestion. Dr Jan Lötvall and his team, from the University of Gothenburg, asked 30,000 people about symptoms like nasal congestion, runny nose, wheezing and breathlessness. He found that around 2% of the population of West Sweden actually had asthma, which was more than expected. The researchers noted that 60% of those with asthma also reported some kind of nasal disease and nasal symptoms were more common among those with severe asthma. 'These findings suggest that some parts of the immune system that are activated in connection with chronic nasal problems might be linked to severe asthma,' said Lötvall. 'This insight could lead to new forms of treatment in the long run.' He believes the new study could lead to the identification of new subgroups of asthma and the relationships between asthma and other chronic conditions like rhinitis. Take home message? If you're worried about a chronic stuffy nose, get it checked out thoroughly - could be you've actually got asthma.

• Wheezing and respiratory infections are more common among newborns with lower Vitamin D levels, according to a new study from the New Zealand Asthma and Allergy Cohort Study, which is following up more than 1,000 children in the cities of Wellington and Christchurch. During the first five years of life, the lower the vitamin D level at birth, the higher the risk of wheezing in the first five years. The wheezing generally came from chest infections. There was no link between low vitamin D and increased risk of asthma at age five. So, even though low vitamin D can does not cause asthma, it can certainly make it worse if it already exists. It may be that vitamin D supplements can help here (although further research would be needed to confirm this) by protecting a child from infection, particularly during the months when sunlight levels are low, since lack of sunlight exposure is a major factor in vitamin D deficiency.

• New research in the journal Pediatrics suggest that babies given antibiotics in the first year of life are 12% more likely to develop asthma than babies not receiving antibiotics. The risk increased with the number of courses of antibiotics received. So babies receiving more than four courses of antibiotics had a 30% increased risk of asthma. The study was carried out by Dr Fawziah Marra and colleagues at the University of British Columbia. Dr Marra says. 'While I do not think this study means your child should not take antibiotics if they really need them, it may make you think twice about asking for them if your doctor doesn't prescribe them.'

• Finally, could breast feeding increase the risk of your child developing an allergy? The World Health Organization recommends breastfeeding for six months before introducing solids. But researchers at University College London's Institute of Child Health now say this might not be the best approach. Put simply, they say the latest evidence suggests that earlier exposure to potential allergens, through solid foods, may be protective of allergy.

A Cure for Crime? Psycho-Pharmaceuticals and Crime Trends.

An estimated 12% of the decrease in crime since the early 1990s was due to psychiatric drugs that became newly available during that time, according to a study published by the National Bureau of Economic Research. Mental illness is a known risk factor for criminal behavior as well as for victimization, but the study was the first to quantify the impact of treatment on crime. The researchers found that crime dropped more quickly in the states where the new classes of drugs were distributed more widely. 
We examine limited international data, as well as more detailed American data to assess the relationship between crime rates and rates of prescriptions of the main categories of psychotropic drugs, while controlling for other factors which may explain trends in crime rates. The most-effective drugs at reducing crime were stimulants to treat ADHD and so-called "newer generation antidepressants," both of which appeared to reduce violent crime by 0.1% for every 1% increase in prescriptions.

Anti-Obesity Drug Now In Clinical Trials May Cause Rapid Bone Loss

An endocrine hormone used in clinical trials as an anti-obesity and anti-diabetes drug causes significant and rapid bone loss in mice, raising concerns about its safe use, UT Southwestern Medical Center researchers have shown. 

The hormone, fibroblast growth factor 21 (FGF21), promotes bone loss by enhancing the activity of a protein that stimulates fat cells but inhibits bone cells, researchers report in a study available online inProceedings of the National Academy of Sciences. 

"This hormone is a very potent regulator of bone mass," said Dr. Yihong Wan, assistant professor of pharmacology and senior author of the study. "When we oversupply FGF21 in mice, it results in substantial bone loss." 

UT Southwestern scientists had been investigating this hormone's properties since its discovery in 2005 as a potential drug. Bone loss was a side effect of another class of compounds that had been commonly used in the treatment of diabetes - activating the same protein in a manner similar to FGF21 - and leading the research team to investigate the bone effect of FGF21 in three kinds of mice. 

They found that rodents fed a drug form of the hormone over a two-week period lost 78 percent of their spongy bone. Mice engineered to produce excess FGF21 had similar effects. Conversely, researchers found mice completely lacking the hormone had comparable gains in bone mass. 

While the insulin-sensitizing effects of FGF21 make it a potentially powerful anti-obesity drug, that could be canceled out by risk of osteoporosis and fractures associated with bone loss, the investigators report. 

"The bone effect is clear," said Dr. David Mangelsdorf, chairman of pharmacology, a Howard Hughes Medical Institute investigator at UT Southwestern and one of the study's corresponding authors. "It's a tradeoff of benefits and risks, and the key will be to design the drug in such a way to leverage the two against each other, dialing out the side effects and dialing in the positive." 

In a related study online in Cell, researchers at the medical center identified how FGF21 regulates the activity of a diabetes-fighting compound in fat tissue, altering metabolism in response to starvation and resumed eating for survival-driven energy conservation. 

"FGF21 helps mobilize the fat in adipose tissue back to the liver and burn it. But when the animal is refed, it stops this process and immediately turns back to restoring fat. In one case, it turns this system on, and in the other, turns it off," said Dr. Steven Kliewer, professor of molecular biology and pharmacology and senior author of the Cell paper. 

What Is Hyperthyroidism? What Causes Hyperthyroidism?

Hyperthyroidism, also known as overactive thyroid, is a medical condition caused by an abnormally high level of thyroid hormone in the bloodstream. The thyroid gland produces an excessive amount of thyroid hormones. 

The thyroid gland is located in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism. Symptoms of hyperthyroidism may include a rapid heartbeat, hyperactivity, muscle weakness, sudden weight loss or gain, increased appetite and sensitivity to heat. The condition is more common in women than men. 

According to Medilexicon's medical dictionary, hyperthyroidism is:

"An abnormality of the thyroid gland in which secretion of thyroid hormone is usually increased and no longer under regulatory control of hypothalamic-pituitary centers; characterized by a hypermetabolic state, usually with weight loss, tremulousness, elevated plasma levels of thyroxin and/or triiodothyronine, and sometimes exophthalmos; may progress to severe weakness, wasting, hyperpyrexia, and other manifestations of thyroid storm; often associated with Graves disease."

There are several causes of hyperthyroidism. Hypertheyroidism can be effectively controlled with drugs that reduce the production of hormones from the thyroid gland. In some cases, radiotherapy and surgery are recommended. 



Hyperthyroidism, if not properly treated, can cause other health problems such as irregular heart rhythms and osteoporosis.

What are the signs and symptoms of hyperthyroidism?

What is the difference between a symptom and a sign? A symptom is something the patients feels and describes, such as pain or dizziness, while a sign is something others can detect, such as a rash or inflammation.

The incidence and severity of symptoms varies from person to person. Patients with mild disease are often not aware of their hyperthyroidism because they have no symptoms. Usually, the symptoms are related to the increased metabolic rate of the body.

Signs and symptoms linked to hyperthyroidism may include (patients rarely have all those listed below):

• a swelling in the neck caused by an enlarged thyroid gland (goiter)
• decreased concentration
• diarrhea
• difficulty breathing
• difficulty sleeping
• excessive sweating
• extreme tiredness
• hyperactivity
• oversensitivity to heat
• increased appetite
• increased bowel movements
• more frequent urination
• infertility
• moodiness, irritability
• itchy skin with raised itchy swellings (urticaria)
• nails become loose
• loss of interest in sex
• menstrual problems in women, especially lighter periods or absence of periods
• muscle weakness
• alopecia - usually, hair is lost in patches
• accelerated heartbeat, sometimes with palpitations
• redness on the palms of hands
• shakiness and muscle weakness
• sudden weight loss or gain
• trembling hands
• warm, damp skin

Patients with diabetes and hyperthyroidism may experience heightened diabetes symptoms, such as fatigue and increased thirst. In the majority of cases, the signs and symptoms of hyperthyroidism are not of concern. Patients with heart disease have a higher risk ofarrhythmia, heart failure, and other cardiovascular risks, which are of concern.

What are the causes of hyperthyroidism?

Graves' disease. It is the most common cause. Graves' disease is an autoimmune condition in which the body's immune system mistakenly targets the thyroid gland and causes it to produce too much thyroid hormone. It is unclear what triggers this condition. There is a genetic basis for Graves' disease, meaning that it can run in families. It is most common in women aged 20-40 years and has a higher incidence amongst smokers. Graves' disease may also affect the eyes, causing discomfort and double vision. Patients commonly having eyes that bulge out.


In Grave's disease, the eyes can bulge out

Nodular thyroid disease. Lumps can develop in the thyroid gland. They are known as nodules. It is unclear why they develop. They are usually benign (non-cancerous). The thyroid is usually enlarged, but there is no pain. Nodules may be felt with the fingertips. The nodules can contain abnormal thyroid tissue, affecting the regular function of the thyroid, causing overactive thyroid. Nodules that contain abnormal thyroid tissue are described as toxic. 

Excessive iodine intake. The thyroid gland removes iodine from the blood which comes mostly from a diet of foods such as seafood, bread, and salt. Then, it uses it to produce thyroid hormones. The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3). Taking additional iodine in supplements can cause the thyroid gland to produce too much of the hormones.

Intake of thyroid hormones. Lack of patient follow-up can result in patients taking too many doses of their thyroid medications.

Medications. Certain medications used in the treatment of heart problems contain a large amount of iodine. They may be associated with thyroid function abnormalities. An example is amiodarone, which is sometimes prescribed for patients with atrial fibrillation; it can cause amiodarone-induced hyperthyroidism.

Thyroiditis. The inflammation of the thyroid. This can be the result of a viral infection. The signs and symptoms may include fever, sore throat, painful swallowing, generalized aches and pains in the neck.

Follicular thyroid cancer. In rare cases, overactive thyroid can be caused by thyroid cancer. The malignant cells may themselves start producing thyroxine or triiodothyronine.

How is hyperthyroidism diagnosed?

The doctor will ask the patient questions about symptoms, carry out a physical examination, and order a blood test. Cases of advanced hyperthyroidism are fairly straightforward to diagnose - however, early on in the condition, symptoms are not so obvious and clear-cut, and a significant number of patients are overlooked.

The blood test is known as a thyroid function test. It helps evaluate how well the thyroid gland is working. The thyroid function test checks for levels of thyroid-stimulating hormone (TSH) and thyroxine and triiodothyronine. 

In some cases of hyperthyroidism, a special diagnostic scan of the thyroid gland is made using radioactive iodine called radioactive iodine uptake (RAIU).

What are the treatment options for hyperthyroidism?

Some medications treat the consequences of hyperthyroidism, such as heart beat problems, while others target thyroid hormone productions.

Antithyroid Drugs. This type of medication stops the thyroid gland from producing excess amounts of thyroxine or triiodothyronine. 

Radioactive Iodine. Radioactive iodine is picked up by the active cells in the thyroid and destroys them. The destruction is local, and there are no widespread side effects with this therapy. The dose of radioactivity contained in the radioiodine is very low and is not harmful. 

Radioiodine treatment is not suitable for women who are pregnant or breastfeeding. Following radioiodine treatment, women should avoid getting pregnant for at least six months and men should not father a child for at least four months.

Surgery. If other treatments are not possible, as may be the case if the patient is pregnant, cannot tolerate other therapies, or has cancer, part of the thyroid gland is removed.

What are the complications related to hyperthyroidism?

Graves' ophthalmopathy. Patients may experience pain or discomfort in the eye, photophobia (light oversensitivity), and have some vision problems. Their eyes may also bulge out. For most people, the symptoms can be relieved using eye drops and wearing sunglasses. In severe cases, treatment with certain drugs such as steroids or immunosuppressive drugs can be used to decrease the swelling behind the eyes. 

Complications in pregnancy. Hyperthyroidism may affect a woman's ability to become pregnant. Pregnant women with the condition are more at risk of developing complications during pregnancy and birth, such as miscarriage and eclampsia (seizures during pregnancy), premature labor and low birth weight. In most cases, the pregnancy can be expected to progress normally if properly treated. 

Thyroid storm. This is an uncommon reaction that can be set off by an infection, injury or trauma. This condition can also occur in pregnant women with undiagnosed or poorly controlled hyperthyroidism, and can be triggered by childbirth or surgery. The signs and symptoms include rapid heartbeat, high fever, agitation, jaundice, vomiting, diarrhea, dehydration, hallucinations. This reaction is life threatening and requires immediate emergency medical treatment. 

The seriousness of hyperthyroidism depends on the body's capability to react to the changes resulting from excess thyroid hormones. Thyroid disease is common - with proper care it can be easily diagnosed and treated. Patient adherence to treatment guidelines (instructions by the doctor) are crucial for effective results.