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Practice Essentials. In countries where iodine deficiency is common (not the US), the reference range may be higher [ 5, 6, 7 ]. It is caused by antibodies that attack the thyroid and destroy it. If you have Graves disease, your doctor might also order a thyrotropin receptor antibody test (TSHR or TRAb), which detects both stimulating and blocking antibodies. Unlike thyroglobulin antibodies, TPO antibodies can stimulate the immune system and cause inflammation in thyroid tissue, leading to the development of thyroid disease [ 2 ]. Patients were stratified by TgAb status (positive or negative) and recurrence (defined as biopsy proven disease or unplanned second surgery). 2018 Nov;33(6):1050-1057. doi: 10.3904/kjim.2018.289. This study examines the effect of thyroidectomy (to decrease thyroid . The best way to initially test thyroid function is to measure the TSH level in a blood sample. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Xu J, Bergren R, Schneider D, Chen H, Sippel RS. Thanks for replying. Didn't find the answer you were looking for? government site. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Background: To investigate whether high thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels are associated with increased risk of lymph node metastasis (LNM) of thyroid cancer. Anti thyroid peroxidase antibody - <28 U/ml (range <60) Rubella . 2 Like Hashimoto thyroiditis, post-partum thyroiditis is characterized by an elevated TPO antibody level, but the clinical presentation is more variable. The presence of TPO antibodies in your blood suggests that the cause of thyroid disease is an autoimmune disorder, such as Hashimoto's disease or Graves' disease. The finding of an elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to disease in the thyroid gland. The free T4 or T3 is the hormone that is unbound and able to enter and affect the body tissues. T3 testing rarely is helpful in the hypothyroid patient, since it is the last test to become abnormal. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. It occurs when your body makes antibodies that attack the cells in your thyroid. Postpartum thyroiditis. Thyroid. Thyroglobulin Antibodies (TgAb) Although thyroglobulin antibodies interfere with the measure of Approximately 50% of women who are TPOAb positive early in pregnancy go on to develop some form of post-partum thyroid dysfunction, usually of a transient nature. Many thanks for replying so quickly Stella5349 and Barb135. The mere presence of detectable TPO antibodies does not, however, necessitate empiric treatment with thyroid hormone. Answer From Todd B. Nippoldt, M.D. Persistently elevated levels after thyroidectomy were not associated with disease recurrence in our series. Antibodies that attack the thyroid gland cause swelling, rarely tenderness and reduced function of the thyroid. When hyperthyroidism does not match the clinical picture, several steps should be taken. Radioactive iodine uptake during the hyperthyroid phase of postpartum thyroiditis will be low (1% to 2% at 24 hours), as opposed to Graves disease, in which uptake is high. The body's immune system makes antibodies in response to non-self proteins. Maggie0652 in reply to Clutter 6 years ago. Patients with elevated TPO antibodies but normal thyroid function tests (TSH and Free T4) do not necessarily require . An elevated TPO antibody level may influence the decision to treat patients with subclinical hypothyroidism. A diagnosis of subclinical hypothyroidism is suspected positive TPOAb can predict progression to overt hypothyroidism. It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. 2008 Jan;158(1):77-83. doi: 10.1530/EJE-07-0399. 1 In another study, the prevalence of autoimmune disorders, including thyroid disease, was more common than that of the general population. Unable to load your collection due to an error, Unable to load your delegates due to an error. The TSH of 0.29 is actually not a bad place to be in the first 5 years after Thyroidectomy. Changes in serum thyroglobulin antibody levels as a dynamic prognostic factor for early-phase recurrence of thyroglobulin antibody-positive papillary thyroid carcinoma after total thyroidectomy. Thyroid hormones regulate body temperature, heart rate and metabolism. T3 tests are often useful to diagnosis hyperthyroidism or to determine the severity of the hyperthyroidism. Epub 2017 Nov 8. About 10 percent of patients with chronic autoimmune hypothyroidism have atrophic thyroid glands (rather than goiter), which may represent the final stage of thyroid failure in Hashimoto's thyroiditis. 7. The thyroid has developed a very active mechanism for doing this. The major thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four iodine atoms. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. The range is usually somewhere between 0 and 34 IU/mL (6). The opposite situation, in which the TSH level is low, usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism). TSI - Thyroid-Stimulating . To avoid unnecessary surgery, PET/CT scan is a possible alternative to help differentiate between benign and malignant ITN. Tg is included in this brochure of thyroid function tests to communicate that, although measured frequently in certain scenarios and individuals, Tg is not a primary measure of thyroid hormone function. 174 views Reviewed >2 years ago. A family or personal history of autoimmune thyroid disease confers increased risk, and there is a strong female predominance in this disorder. Hypothyroidism, or an underactive thyroid, is a common problem. Also, patients had quite high levels of the TPO Antibody which may not be the case in all patients with Hashimotos thyroiditis. Mayo Clinic does not endorse any of the third party products and services advertised. Thank. It is an autoimmune disease. Advertising and sponsorship opportunities. Follow up visits were done every 3 months for 18 months and the thyroid hormone therapy was adjusted as needed. Bethesda, MD 20894, Web Policies Treatments can help. Antithyroid peroxidase antibodies in patients with high normal range thyroid stimulating hormone. Patients and Methods: This is a retrospective work of 112 cases managed with total thyroidectomy with positive antithyroid peroxidase antibodies (TPO-Ab), anti-thyroglobulin . TgAb are common in patients with thyroid cancer but resolve after treatment at approximately -11% IU/mL per month from preoperative levels with median resolution at 11.0 mo. The range resembles what we normally see for TPOab; it means that anything < 30 is negative for antibodies. Graves disease may be differentiated from postpartum thyroiditis by the presence of exophthalmos, thyroid bruit, and positive TSH receptor antibody. See this image and copyright information in PMC. 4 Iatrogenic forms of hypothyroidism occur after thyroid surgery, radioiodine therapy, and neck . PMID: 30856652. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is made in the pituitary gland located at the base of the brain, called thyroid stimulating hormone (abbreviated TSH). The treatment goal is to restore and maintain adequate T-4 hormone levels and improve . The thyroid examination will commonly reveal a firm, bumpy gland with symmetric enlargement. This site needs JavaScript to work properly. The normal range for thyroglobulin is: 1.40 - 29.2 ng/mL (g/L) for men. Thus, the thyroid and the pituitary, like a heater and thermostat, turn on and off. Merck Manual Professional Version. The lab's "in range" is not "normal" for everyone. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. High antibodies indicate that a patient's symptoms are from too little thyroid hormone regulation when the TSH, T4, or T3 fail to do so. I had RAI Nov 1, 2012. Eskes SA, Endert E, Fliers E, Birnie E, Hollenbach B, Schomburg L, et al. You may opt-out of email communications at any time by clicking on In the case of postpartum, silent, or subacute thyroiditis, the radioactive iodine uptake during the hyperthyroid phase will be low. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Fam Med. The important thing is not what your results look like on paper, but how you feel with them at the current levels; if you don't feel well, there's something going on - either you thyroid levels are not optimal for you, or there's something else. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Image: Sebastian Kaulitzki/Science Photo Library/Getty Images. 3. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. information and will only use or disclose that information as set forth in our notice of My TSH level was .01. It can, however, present without a goiter (atrophic form). Women tend to have slightly higher thyroglobulin levels than men [ 8 ]. Thyroglobulin antibody resolution after total thyroidectomy for cancer. https://www.thyroid.org/thyroid-function-tests/. There is a problem with A high TSH is seen after thyroid removal if thyroxine replacement is not adequate or from injection of biosynthetic TSH. First, the laboratory test result should be confirmed, and free thyroxine (T4) and free triiodothyronine (T3) levels should be measured. Epub 2014 Jul 17. Method In a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy . During that time, the only intervention was the use of nigella extract. In contrast with postpartum thyroiditis, silent thyroiditis is less likely to result in permanent hypothyroidism (up to 11% of patients), and recurrence is less common.19 The considerations for initiation of therapy and the treatment approach are the same as for postpartum thyroiditis. Thank you for this information. What Do Herpes Sores Look Like at Different Stages. 36 This patient continued to be . 20th ed. A different antibody that may be positive in a patient with hyperthyroidism is the stimulatory TSH receptor antibody (TSI). This study enrolled patients with hypothyroidism due to Hashimotos thyroiditis who received treatment with thyroidectomy and thyroid hormone replacement or thyroid hormone replacement alone. Thyroid cancer can also produce elevated thyroglobulin antibodies. Additionally, the thyroglobulin antibody test may be ordered in conjunction with other thyroid blood tests, including. Thyroid Antibodies like a title) Thyroid Peroxidase AB 24 H Thyroglobulin AB <1 Background: A very high RAIU is seen in individuals whose thyroid gland is overactive (, Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Complementary and Alternative Medicine in Thyroid Disease, Novel Coronavirus (COVID-19) and the Thyroid, Toxic Nodule and Toxic Multinodular Goiter, FNA Biopsy of Thyroid Nodules in Children & Adolescents, Hyperthyroidism in Children and Adolescents, Hypothyroidism in Children and Adolescents, Thyroid Nodules in Children and Adolescents, Clinical Thyroidology for the Public (CTFP). Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland. While detecting antibodies is helpful in the initial diagnosis of hypothyroidism due to autoimmune thyroiditis, following their levels over time is not helpful in detecting the . Thyroid. just because the thyroid is no longer present you still have sick autoimmune antibodies that can cause issues. We offer this Site AS IS and without any warranties. HHS Vulnerability Disclosure, Help When chronic autoimmune thyroiditis is suspected, the family physician should perform a careful thyroid examination and measure serum TSH and TPO antibody levels. Treatment with levothyroxine ameliorates the hypothyroidism and may reduce goiter size. THE FULL ARTICLE TITLE: Durante C, Tognini S, Montesano T, Orlandi F, Torlontano M, Puxeddu E, Attard M, Costante G, Tumino S, Meringolo D, Bruno R, Trulli F, Toteda M, Redler A, Ronga G, Filetti S, Monzani F; PTC Study Group. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/thyroid-disorders/overview-of-thyroid-function?query=overview thyroid function. T4 TESTS So, it's no surprise we frequently hear from patients who would like assistance with this. Given the known challenge of thyroidectomy in patients with HT, surgery has typically been reserved for cases of con-comitant malignancy or substernal goiter with compressive A low TSH and low FT4 or FTI indicates hypothyroidism due to a problem involving the pituitary gland. Because my daughter has Primary Biliary Cirrohisis our doctor ran an AMA and ANA which have all come back negitive. Dr. John Berryman and 6 doctors agree. However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. In the case of postpartum thyroiditis, immune-mediated thyroid destruction may result in the release of preformed thyroid hormone into the bloodstream, causing hyperthyroidism. In: Harrison's Principles of Internal Medicine. In the thyrotoxic phase, thyroid function tests show suppressed TSH and free T4 and free T3 levels that are within the normal range or frankly elevated. Patients with severe thyroid pain and systemic symptoms (e.g., high fever, leukocytosis, cervical lymphadenopathy) should undergo fine-needle aspiration to rule out infectious thyroiditis. A week later the test was done again along Redheadaussie hasn't been active on the forum for quite some time, so it's unlikely she will respond. American Thyroid Association. 8. Created for people with ongoing healthcare needs but benefits everyone. SUMMARY OF THE STUDY Background Basedow's disease and Hashimoto's thyroiditis are autoimmune thyroid disorders and usually diagnosed with elevation of serum autoimmune antibodies. high when your TSH level is below normal, but that is acceptable as long . The person is pregnant be aware that after the first trimester, thyroid autoantibodies may be negative due to immune suppression in pregnancy. Review/update the Laposata M. The endocrine system. However, if the thyroid antibodies remain elevated after following a natural treatment protocol, this means that either the autoimmune trigger hasn't been removed, the autoimmune response hasn't been suppressed, and/or other compromised areas of the body need to be healed. Thyroid peroxidase (TPO) is an enzyme normally found in the thyroid gland. All patients were stratified to TgAb+/- groups and then further divided into those, TgAb Resolution. You didn't mention how long ago you had the RAI, if only recently then that would explain your situation. sured by elevated thyroid peroxidase antibody (TPO Ab).6,7 To date, there is no algorithm for treatment in these refractory cases. Mayo Clinic; 2020. FT4 and FT3 levels did not differ in patients with a mild lymphocytic infiltration compared to those with a severe lymphocytic infiltration (21.1 vs 32 ng/L, P = 0.5 for FT4 and 8.1 vs 13.2, P = 0.18 for FT3). Graves' disease is an autoimmune disease of the thyroid . It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. AskMayoExpert. Hashimoto's thyroiditis can cause your thyroid to not make enough thyroid hormone. Some studies suggest that TPOAb may cross-react with tissues other than the thyroid and may contribute to inflammation and general symptoms. Epub 2014 May 21. Thyroiditis is a general term that refers to inflammation of the thyroid gland and encompasses several clinical disorders. Search terms included thyroiditis, thyroid inflammation, autoimmune thyroiditis, Hashimoto's thyroiditis, lymphocytic thyroiditis, acute thyroiditis, infectious thyroiditis, bacterial thyroiditis, postpartum thyroiditis, drug-induced thyroiditis, clinical presentation, clinical guidelines, and treatment. . Supporting laboratory data include an elevated erythrocyte sedimentation rate, C-reactive protein level, and thyroglobulin level. I don't believe it was a TPOab. Before When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed TSH, and low uptake of iodine 123 on thyroid scanning. Even though the results of this study indicate that surgical management of Hashimotos thyroiditis may be beneficial, it is not clear whether undergoing surgery for this relatively common disease is necessary to treat symptoms in all patients. Thyroid function tests. Disease-free survival was equivalent between TgAb-positive and TgAb-negative groups (P = 0.8). Mayo Clinic does not endorse companies or products. In many patients with hypothyroidism or hyperthyroidism, lymphocytes react against the thyroid (thyroid autoimmunity) and make antibodies against thyroid cell proteins. Higher rates of chronic autoimmune thyroiditis have been observed in patients with type 1 diabetes mellitus, Turner syndrome, Addison disease, and untreated hepatitis C.1012 The annual incidence of chronic autoimmune thyroiditis is estimated to be 0.3 to 1.5 cases per 1,000 persons.13 Presenting symptoms depend on the degree of associated thyroid dysfunction, but most commonly include a feeling of fullness in the neck, generalized fatigue, weight gain, cold intolerance, and diffuse muscle pain. Copyright 2014 by the American Academy of Family Physicians. I had a stroke about nine months ago and had an ultrasound to check the choriodid arteries, they found that my thyroid was enlarged and irregular texture. If you've been diagnosed with thyroid disease, your doctor may suggest a TPO antibody test and other thyroid . Im told its high. Once the T4 in the bloodstream goes above a certain level, the pituitarys production of TSH is shut off. A TPO test detects antibodies against TPO in the blood. All rights reserved. This is a paradox of sorts, but they do settle down. In some patients, symptoms may persist despite what appears to be adequate treatment based on blood tests of thyroid function, raising the possibility that some symptoms may be related to the autoimmune condition itself. At the Ca' Granda Main Polyclinic Hospital in Milan, it was feasible for them to investigate this because they . To exert its effects, T4 is converted to triiodothyronine (T3) by the removal of an iodine atom. Some endos rarely deal with post-thyroid cancer patients. In fact, the thyroid and pituitary act in many ways like a heater and a thermostat. include protected health information. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The timing likely reflects a rebound in immune function after a period of relative immune tolerance during pregnancy. Elevated TSH antibodies. the unsubscribe link in the e-mail. They all had a TPOAb titer >1000 IU/L and reported persistent symptoms despite having normal thyroid hormone levels based on blood tests. Patients with subacute thyroiditis should be started on high-dose acetylsalicylic acid or nonsteroidal anti-inflammatory drugs as first-line therapy. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Elevated thyroglobulin antibodies. Thyroid hormone therapy: patients with hypothyroidism are most often treated with Levothyroxine in order to return their thyroid hormone levels to normal. Hashimoto thyroiditis is part of the spectrum of autoimmune thyroid diseases (AITDs) and is characterized by the destruction of thyroid cells by various cell- and antibody-mediated immune processes. Thyrotropin receptor antibodies (TRAb) and/or thyroid-stimulating antibody (TSAb) are usually used for diagnosis of Basedow's disease, and thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) are for . Thyroglobulin antibodies (TgAb) are produced by 10%-25% of thyroid cancer patients and interfere with thyroglobulin measurement, a marker of residual or recurrent cancer after surgery. Silent thyroiditis is similar to postpartum thyroiditis, but its presentation is not limited to the postpartum state. It makes hormones that control the way the body uses energy. Accessed Aug. 5, 2020. information submitted for this request. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Thyroid peroxidase antibodies will usually go away if a radical thyroidectomy is done for thyCa but may not if a lot of thyroid tissue remains after thyroidectomy for goitre/nodule removal or hyperthyroidism. Hashimoto's thyroiditis is an autoimmune disorder where antibodies attack and destroy the thyroid. Several case reports and case series have also shown that COVID-19 can cause subacute thyroiditis. High concentrations of TPOAb identify those women who are at risk . Accessibility After surgery, serum TPOAb levels declined sharply and significantly from a baseline of 2232 IU/ml to 152 IU/ml at 18 months, while levels declined only slightly in the thyroid hormone replacement-only group. If thyroglobulin levels are low even in the presence of stimulation by a raised TSH, this is very reassuring and indicates absence of recurrence in papillary and follicular thyroid cancers (differentiated thyroid cancers). It is used most often in patients who have had surgery for thyroid cancer in order to monitor them after treatment. But the presence of TPO antibodies may increase the risk of future thyroid disorders. However, histopathologic examination of the surgical specimen often shows foci of lymphocytic thyroiditis synchronous with the primary . The aim of this systematic review is to examine all the data currently available in the literature on the effects of nutritional intervention on biochemical parameters (anti-thyroid antibody . 6 7 Thyroid Peroxidase Antibodies (TPO) Optimal range: 0 -9 IU/mL Thyroid peroxidase is an enzyme used in the synthesis of thyroid hormone. Chronic autoimmune thyroiditis (Hashimoto thyroiditis, chronic lymphocytic thyroiditis), Hypothyroidism; rarely thyrotoxicosis secondary to alternating stimulating and inhibiting thyroid autoantibodies, Infectious thyroiditis (suppurative thyroiditis), Thyroid pain, high fever, leukocytosis, and cervical lymphadenopathy; focal inflammation may result in compressive symptoms such as dysphonia or dysphagia; patients may assume a posture to limit neck extension; palpation may reveal focal or diffuse swelling of the thyroid gland and the overlying skin will be warm and erythematous; presence of fluctuance suggests abscess formation, Multiple infectious organisms, most commonly bacterial, Thyroid fine-needle aspiration with Gram stain and culture; blood cultures; neck magnetic resonance imaging or computed tomography with contrast media; plain radiography of the lateral neck may reveal gas in the soft tissues; thyroid autoantibodies are generally absent; serum thyroxine and triiodothyronine levels are usually normal, Acute complications may include septicemia and acute airway obstruction; later sequelae of the acute infection may include transient hypothyroidism or vocal cord paralysis, Hospitalization and treatment with intravenous antibiotics (nafcillin plus gentamicin or a third-generation cephalosporin); abscess formation may necessitate surgical drainage; euthyroidism is generally restored after treatment of infection, Hyperthyroidism alone; hyperthyroidism followed by hypothyroidism; or hypothyroidism alone within one year of parturition, Thyroid function tests; elevated TPO antibody levels; low radioactive iodine uptake in the hyperthyroid phase, Euthyroidism is generally achieved by 18 months, but up to 25% of women become permanently hypothyroid; high rate of recurrence with subsequent pregnancies, Beta blockers can be considered for significant hyperthyroid symptoms (in the hyperthyroid phase); levothyroxine for symptomatic hypothyroidism (in the hypothyroid phase) and for permanent hypothyroidism, Patients may present with thyroid pain and transient thyrotoxicosis, Clinical diagnosis made in the setting of recent previous radiation, Hyperthyroidism generally resolves within one month, Self-limited, but symptoms may be treated with beta blockers and nonsteroidal anti-inflammatory drugs, Very firm goiter or compressive symptoms (dyspnea, stridor, dysphagia), which appear disproportionate to the size of the thyroid; hypocalcemia may occur as a result of fibrotic transformation of the parathyroid glands, Autoimmunity may contribute to the pathogenesis, Most patients are euthyroid, approximately 30% are hypothyroid, Glucocorticoids and mycophenolate (Cellcept); tamoxifen may work by inhibiting fibroblast proliferation, Silent thyroiditis (silent sporadic thyroiditis, painless sporadic thyroiditis, subacute lymphocytic thyroiditis), Hyperthyroidism alone; hyperthyroidism followed by hypothyroidism; or hypothyroidism alone, Euthyroidism is generally achieved by 18 months, but up to 11% of patients become permanently hypothyroid; rarely recurs, Beta blockers can be considered for significant hyperthyroid symptoms (in the hyperthyroid phase); levothyroxine for symptomatic hypothyroidism (in the hypothyroid phase) and permanent hypothyroidism, Subacute thyroiditis (subacute granulomatous thyroiditis, giant cell thyroiditis, de Quervain thyroiditis), Thyroid pain; hyperthyroidism followed by transient hypothyroidism most commonly, Euthyroidism is generally achieved by 18 months, but up to 15% of patients become permanently hypothyroid; rarely recurs, Atrial fibrillation, ventricular arrhythmia, Persistent or recurrent cutaneous T cell lymphoma, psoriasis, graft-versus-host disease, chronic lymphocytic leukemia, Hairy cell leukemia, follicular lymphoma, malignant melanoma, AIDS-related Kaposi sarcoma, chronic hepatitis B and C, Hypothyroidism more often than hyperthyroidism, Gastrointestinal stromal tumors, renal cell carcinoma. Thyroid ultrasonography in subacute thyroiditis shows a nonuniform echotexture, hypoechoic areas, and decreased vascularity throughout the gland. Changes in TSH can serve as an early warning system often occurring before the actual level of thyroid hormones in the body becomes too high or too low. Back so soon? Hyperthyroidism, or overactive thyroid, happens when your thyroid gland makes more thyroid hormones than your body needs.