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Q&A: Thyroid Disease

What’s the difference between hypothyroidism and hyperthyroidism, and what are the main risk factors for these conditions?

Hypothyroidism and hyperthyroidism both refer to the amount of hormone excreted by the thyroid gland, which is located in the neck and regulates your metabolism.

Hypothyroidism means you have an “underactive” thyroid. The risk for this condition increases with age, and it is particularly prevalent in women age 60 and older and people with a family history of hypothyroidism. It also is possible for drugs to contribute to hypothyroidism—for example, amiodarone (Pacerone®, Corderone®), which is used to treat heart arrhythmias (it also can cause hyperthyroidism) and some biological therapies used to treat cancer, including sunitinib (Sutent®) and imatinib (Gleevec®). If left untreated, hypothyroidism can result in several complications, including an increased risk of depression, coronary artery disease, and stroke. Symptoms include dry skin, brittle nails, and memory problems. Hyperthyroidism occurs when the thyroid is “overactive.” The most common cause of hyperthyroidism is a condition called Grave’s disease, which occurs most often in middle-aged women. Other common causes include viral syndromes, and side effects of certain medications, including amiodarone, thyroid supplements, and iodine. One of the most identifiable physical signs of Grave’s disease is a “bulging” of the eyes. It also may cause a swelling in the neck (known as a goiter). Other symptoms include weight loss, anxiety, insomnia and palpitations. In older adults, hyperthyroidism can precipitate atrial fibrillation, a rapid and irregular heartbeat. In older adults, it also can present “apathetically,” with fatigue and depression rather than with anxiety and weight loss. Most of the symptoms of hypothyroidism and hyperthyroidism can be mistaken for normal changes that occur with aging, so people with symptoms that suggest a thyroid problem should ask their physician about getting tested for thyroid disease.

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