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Be Aware, Increased Heart Rate after Returning from a Japan Trip Could Be a Sign of Hyperthyroidism!

       A few days ago, 2 sisters around 30 years of age took a trip to Japan. During the trip, they had been eating a large amount of Japanese hot pots, ramen and udon noodles. Both of them experienced palpitations, sensitivity to heat, hand tremors, insomnia and other symptoms 2 weeks after returning to Taiwan. It was not until they went to the hospital for a check-up and discovered it was “hyperthyroidism” playing the trick. Fortunately, after 2 months of drug therapy, all the symptoms resolved and their lives got back to normal. Despite the “Japan trip” not actually being a risk factor for hyperthyroidism, however, due to the increase of travelers visiting Japan over recent years, there are more associated cases being discovered clinically.

       Dr. Wang Shun-He from the Endocrinology Department in Taipei City Hospital Renai branch has pointed out that “hyperthyroidism” means that there are excessive thyroid hormones circulating in the blood. Patients are generally presented with swelling of the thyroid gland (neck engorgement), palpitations, increased heart rate, weight loss, hand tremors, anxiety, insomnia, sensitivity to heat, as well as increased sweating, hair loss, passing bowel movements and other symptoms. In Taiwan, the most common disease caused by hyperthyroidism is “Graves’ disease”. According to the data from National Health Insurance, approximately 8,000 new patients are produced in Taiwan each year. The disease is more common in females, with a ratio of female to male patients of 3:1.

       Graves’ disease is an inflammatory disease as a result of excessive autoimmune antibodies that are produced by the body, stimulate the gland, and lead to thyroid hormone overproduction. Its occurrence is related to “genetic inheritance”. If someone in the family has a thyroid gland autoimmune disease or history related to such problem, then the likelihood of other family members developing the disease is greater compared to the general public. The “environment” plays another important factor as well. Food containing large quantities of iodine (such as kelp, nori and seaweed), drugs or contrast containing iodine may also induce Graves’ disease. Furthermore, psychological stress, major life changes, the postpartum period and smoking are also risk factors.

       The sisters perhaps already have the health predispositions for Graves’ disease without being aware themselves. Additionally, they may not have been ingesting much iodine containing food; therefore, this problem had remained at bay. It was not until their trip to Japan that they consumed a large quantity of food containing seaweed soup base, which thus induced the condition.

       If patients with Graves’ disease are not under excellent control, then the condition is likely to result in eye protrusions, eye pathological changes, hypertension and arrhythmia. In severe cases, it may lead to heart failure that requires ECMO as emergency management. Fortunately, the treatment for this condition is fairly simple. Under the management of experienced physicians, patients’ compliance in taking regular medication and restricted iodine diet, the majority of acute symptoms can be resolved within 3 months from taking the medication. Additionally, attempts in drug weaning can be initiated around 1.5 years. Only a few patients with poor control acquire further radioactive iodine treatment or thyroidectomy as management.