Specialist thyroid care, Johannesburg
Hyperthyroidism and Graves' disease in Johannesburg.
Specialist assessment of an overactive thyroid, including Graves' disease, toxic nodules and thyroiditis, with treatment matched to the underlying cause.
In short
Hyperthyroidism means the thyroid gland is producing excess thyroid hormone. Graves' disease is the most common autoimmune cause, but toxic nodules and thyroiditis can produce a similar biochemical picture and require different treatment. Diagnosis begins with suppressed TSH and elevated free T4 and/or free T3, followed by tests such as TSH-receptor antibodies and, in selected cases, radionuclide imaging to establish the cause. Treatment may include antithyroid medication, radioactive iodine or surgery depending on the diagnosis, severity, pregnancy plans, eye disease and patient preference.
Medically reviewed by Dr Arnav Kapur, MBBCh Cum Laude
The approach
Understand first. Then treat.
Symptoms such as palpitations, tremor, heat intolerance, sweating, weight loss, anxiety, frequent bowel motions and menstrual change can suggest hyperthyroidism, but the biochemical pattern and underlying cause must be established before treatment is chosen.
This is particularly important because Graves' disease, toxic nodular disease and transient thyroiditis are not managed identically. At MLI, confirmed or complex hyperthyroidism is appropriate for specialist endocrinology with Dr Sindeep Bhana.
What specialist assessment may include
- TSH, free T4 and free T3
- TSH-receptor antibodies (TRAb) when Graves' disease is suspected
- TPO antibodies where they add diagnostic context
- Medication, supplement and iodine exposure review
- Pulse, blood pressure and rhythm assessment
- Eye symptoms and thyroid eye disease risk
- Pregnancy or fertility plans where relevant
- Radionuclide thyroid imaging where the cause remains unclear and it is clinically appropriate
- Ultrasound only where there is a palpable nodule or another specific structural indication
- Discussion of antithyroid medication, radioactive iodine and surgery where relevant
Hyperthyroidism is a biochemical diagnosis with different causes
A low TSH with elevated free thyroid hormones confirms thyrotoxicosis, but the next question is whether the thyroid is actively overproducing hormone or whether hormone is being released transiently from an inflamed gland. Graves' disease, toxic nodules and thyroiditis require different management, so cause matters.
Graves' disease is autoimmune
Graves' disease is caused by TSH-receptor antibodies that stimulate the thyroid. Measuring TRAb can confirm the diagnosis in many patients. Eye disease can occur independently of the degree of biochemical hyperthyroidism, which is one reason treatment choice and smoking status matter.
Treatment is individual
Antithyroid medication, radioactive iodine and surgery are all established options for Graves' disease and some forms of toxic nodular hyperthyroidism. The best choice depends on disease severity, gland size, nodules, likelihood of remission, pregnancy plans, thyroid eye disease, comorbidity and patient preference.
Monitoring matters after control is achieved
Thyroid function is checked repeatedly during treatment and after definitive therapy. Hypothyroidism can develop after radioactive iodine or surgery and can also occur later after autoimmune thyroid disease, so long-term follow-up is part of treatment rather than an afterthought.
Common questions
Answers before you book.
Is Graves' disease the same as hyperthyroidism?
No. Graves' disease is one cause of hyperthyroidism. Toxic thyroid nodules and thyroiditis can also produce excess circulating thyroid hormone, and treatment differs according to the cause.
Do I need a thyroid ultrasound for hyperthyroidism?
Not routinely. Current guidance recommends ultrasound mainly when a thyroid nodule is palpable or there is another structural reason to image the gland. TRAb testing and, where needed, radionuclide imaging are often more useful for identifying the cause of thyrotoxicosis.
Can Graves' disease affect the eyes?
Yes. Thyroid eye disease can cause dryness, irritation, swelling, double vision or more severe orbital symptoms. Eye involvement should be assessed separately because it can influence treatment decisions, particularly around radioactive iodine.
Can hyperthyroidism be cured?
Some causes are transient, some Graves' disease remits after a course of antithyroid medication, and radioactive iodine or surgery can definitively treat thyroid overactivity. Definitive treatment often results in hypothyroidism that then requires levothyroxine replacement.
This page provides general health information and does not replace individual endocrine assessment. Hyperthyroidism can affect heart rhythm, bone health and pregnancy, and treatment should be medically supervised.
Ready to start properly?
- Specialist Endocrinology
- Specialist Endocrinology Consultation
- Hypothyroidism
- Thyroid Nodules
- Meet Dr Sindeep Bhana
Centre of Advanced Medicine · 13 Scott Street, Waverley, Johannesburg
Monday to Friday, 07:40 to 17:00
011 440 8721