Thyrotoxicosis( hyperthyroidism) - Causes, symptoms and treatment. MF.
Thyrotoxicosis is a condition associated with an excess of thyroid hormones in the body. Also this condition is called hyperthyroidism. This is not a diagnosis, but a consequence of some diseases of the thyroid gland or exposure to external factors.
The root of "toxicosis" characterizes these changes well. With thyrotoxicosis, intoxication occurs with an excess of thyroid hormones. Excessive amount of hormones in the body leads to various physical changes and changes in the emotional sphere.
Causes of thyrotoxicosis
There are many causes of thyrotoxicosis. Conventionally, they can be divided into several groups:
1. Diseases accompanied by excessive production of thyroid hormones.
These include:
A) Diffuse toxic goiter( Graves' disease, Based's disease).This disease in 80-85% of cases is the cause of thyrotoxicosis.
For some reason, the immune system fails. Leukocytes( white blood cells) begin to develop so-called antibodies - proteins, which bind to the cells of the thyroid gland and cause it to produce more hormones. Often these antibodies also attack the cells of the orbit - there is, so-called, endocrine ophthalmopathy. Such diseases, when the cells of the immune system begin to produce substances that attack their own organs are called autoimmune. Graves' disease is an autoimmune disease.
The disease can occur at any age, but most often occurs in young people from 20-40 years.
B) Toxic adenoma and multinodular toxic goiter.
The presence of the thyroid gland node( s), which in excess produces thyroid hormones. In normal excess production of thyroid hormones is suppressed hormones of the pituitary( TTG).Toxic adenoma and multinodular toxic goiter function autonomously, that is, an excess of thyroid hormones is not suppressed by the pituitary hormone( TTG).This disease is more common in the elderly.
B) Thyrotropinoma is the formation of the pituitary gland, which in excess generates thyroid-stimulating hormone( TSH), which stimulates the thyroid gland. Very rare disease. It flows with the clinic of thyrotoxicosis.
2. Diseases associated with the destruction( destruction) of thyroid tissue and the release of thyroid hormones into the blood.
These diseases include destructive thyroiditis( subacute thyroiditis, thyrotoxicosis in autoimmune thyroiditis, postpartum thyroiditis, painless thyroiditis).
To this group of diseases can also be attributed kordaron-induced( amiodarone-induced) thyrotoxicosis. This is a thyrotoxicosis that occurs as a result of treatment with iodine-containing antiarrhythmic drugs( Amiodarone, Cordarone).Taking drugs causes destruction( destruction) of thyroid cells and the release of hormones into the blood.
3. Iatrogenic thyrotoxicosis - thyrotoxicosis caused by overdose of thyroid hormone preparations( L-thyroxine, Eutirox - drugs for the treatment of hypothyroidism - a condition associated with a decrease in the production of thyroid hormones).
These are the main causes of thyrotoxicosis.
Symptoms of thyrotoxicosis
If you feel lately irritable, emotional, notice a frequent change of mood, tearfulness, increased sweating, a feeling of heat, a heartbeat, a feeling of disruption in the heart, lost weight - this is an excuse to see a doctor and take tests for hormones of the thyroid gland. These are the symptoms of thyrotoxicosis.
Symptoms of thyrotoxicosis
Also symptoms of thyrotoxicosis include: increased blood pressure, loose stools, weakness, fractures, intolerance of hot climate, increased hair loss, menstrual irregularity, decreased libido( sexual desire), erectile dysfunction.
With an increase in the size of the thyroid gland, there may be complaints of swallowing disorders, an increase in the volume of the neck.
For diffuse toxic goiter( Graves' disease) is also characterized by the presence of infiltrative ophthalmopathy - lacrimation, photophobia, a feeling of pressure and "sand" in the eyes, there may be double vision, possibly a decrease in vision. Attracts attention exophthalmos - "protrusion" of eyeballs.
Exophthalmos
Diagnosis of thyrotoxicosis
If you notice similar symptoms, you need to take hormonal tests to exclude or confirm the presence of thyrotoxicosis.
Diagnosis of thyrotoxicosis:
1. Hormonal blood test:
- blood on TTG, T3 free, T4 free.
The main study proving the presence of thyrotoxicosis.
For thyrotoxicosis, a decrease in blood TSH( a pituitary hormone that reduces the production of hormones by the thyroid gland), an increase in T3 and T4 of thyroid hormones, is characteristic of thyrotoxicosis.
2. Definition of antibodies - confirmation of the autoimmune nature of the disease.
Definition of
is required. - Antibodies to TSH receptors( increase of AT to TSH receptor - proves the presence of Graves 'disease)
- Antibodies to TPO( increased with Graves' disease, autoimmune thyroiditis).
3. Perform ultrasound of the thyroid gland.
For diffuse toxic goiter( Graves' disease), as the most common cause of thyrotoxicosis, it is characteristic:
- an increase in the size, volume of the thyroid gland( an increase in the thyroid gland over 18 cm in women and more than 25 cm in a cube in men is called goiter),
-acceleration, increased blood flow in the thyroid gland.
For other causes of thyrotoxicosis, these signs are not characteristic. In destructive processes, a decrease in blood flow in the thyroid gland is determined.
4. In some cases, the doctor may prescribe a study - thyroid scintigraphy. This study shows how much the thyroid gland can capture iodine and other substances( technetium).This study allows you to clarify the cause of thyrotoxicosis.
Graves' disease is characterized by intensified seizure of the radiopharmaceutical.
For thyrotoxicosis due to destruction( destruction) of thyroid tissue, a decrease in capture or lack of capture of iodine( technetium) is characteristic.
5. In the presence of endocrine ophthalmopathy, exophthalmos is performed eye socket or magnetic resonance imaging or computed tomography of the eye sockets.
Treatment of thyrotoxicosis
To determine the tactics of treatment, you must first determine the cause of thyrotoxicosis. The most common cause of thyrotoxicosis is Graves' disease.
There are three methods for treating Graves' disease: medications, surgical treatment and radiotherapeutic iodine therapy. Medicamentous treatment consists in the appointment of thyreostatic drugs( drugs that reduce the formation of thyroid hormones).There are two such drugs: Thiamazole( Tirozol, Mercazolilum, Metizol) and propylthiouracil( Propitsil).Initially, the drug is prescribed in a dose of about 30 mg per day, after the normalization of the thyroid hormones pass to a maintenance dose of 5-15 mg per day. The duration of treatment with thyreostatics is usually 1-1.5 years.
Treatment of destructive processes in the thyroid gland( thyrotoxicosis associated with the destruction of thyroid cells and the release of excess thyroid hormones into the blood) is carried out by glucocorticosteroid hormones( Prednisolone).These drugs reduce the process of destruction of thyroid cells. Dosage and duration of treatment are chosen individually.
Operative treatment on the thyroid gland with thyrotoxicosis is performed only after treatment with thyreostatics when normalization of thyroid hormones is achieved.
What kind of lifestyle should be lead to promote recovery?
To help you recover, you need to take regular medications prescribed to you by your doctor and undergo hormonal control tests.
And also, it should be borne in mind that the probability of a stable remission is higher for non-smokers. If you smoke, the probability of a relapse of thyrotoxicosis after the end of thyroid therapy is higher for you. Therefore, if you smoke, quitting will increase your chances of recovery.
Treatment of thyrotoxicosis with folk remedies
It should be cautioned against treatment with folk remedies. Thyrotoxicosis is a serious condition that, without adequate timely treatment, can lead to serious complications, especially from the cardiovascular system( for example, severe arrhythmias).
Therefore, the identified thyrotoxicosis requires mandatory treatment with medications. Treatment with various folk remedies "from the thyroid gland", which neighbors advise you, most likely not only will not help, but will also harm, as thyrotoxicosis without treatment can lead to serious complications.
In addition to the main treatment, you can advise a full meal, there are plenty of vegetables and fruits. Perhaps the appointment of multivitamin complexes( Vitrum, Centrum and others) or an additional prescription for the main therapy of B vitamins( Milgamma, Neuromultivitis).
Complications of thyrotoxicosis
If untimely, inadequate treatment develops complications of thyrotoxicosis, such as ciliary arrhythmia, arterial hypertension( increased blood pressure), thyrotoxicosis contributes to the development and deterioration of the course of coronary heart disease, the defeat of the central nervous system in severe cases can lead to thyrotoxic psychosis. These complications are associated with the cardiotoxic effect of excess thyroid hormones( that is, an increased amount of thyroid hormones worsen the state of the cardiovascular system: leads to an accelerated metabolism in the cells of the myocardium, increases the heart rate, and as a result complications develop).
An acute complication is a thyrotoxic crisis - a serious complication that occurs after the transferred stress, with surgery on the thyroid gland against a background of thyrotoxicosis. This is a life-threatening condition. The main symptoms are fever up to 38-40 °, palpitations up to 120-200 beats per minute, heart rhythm disturbances, central nervous system disorders.
To prevent these complications, timely diagnosis and treatment of thyrotoxicosis is necessary. Therefore, it is necessary to see a doctor if there are signs of thyrotoxicosis and undergo a hormonal examination.
Prevention of thyrotoxicosis
It should be remembered that there is a genetic predisposition to diseases of the thyroid gland. If your close relatives have thyroid disorders, then you also are recommended to periodically perform ultrasound of the thyroid gland, hormonal studies.
If you notice symptoms of thyrotoxicosis, you need to do thyroid hormone research.
If hypothyroidism has already been identified, treatment should be started in time to prevent complications of thyrotoxicosis.
Consultation of a doctor for thyrotoxicosis
Question: When treating thyreostatics, how often do I need to undergo hormonal studies?
Answer: If a course of drug treatment of thyrotoxicosis is being conducted, the first study of thyroid hormones( T3 free, T4 free) after the start of thyreostatic therapy should be performed one month after the start of therapy. Further, against a background of a decrease in the dose of thyreostatics, several more times should be performed at intervals of 1 month. Research TTG should be performed no earlier than 3 months after the start of thyreostatic therapy, since it remains long lowered. After selecting a maintenance dose of thyrostatics, a hormonal study can be performed once every 2-3 months.
Question: What are the limitations of taking thyreostatics?
Answer: Until the level of thyroid hormones normalizes, it is recommended to reduce physical activity. After the normalization of hormones( the achievement of euthyroidism), it is possible to increase the level of physical activity.
Question: What is the probability of remission after a course of thyreostatic therapy?
Answer: The course of thyreostatic therapy usually lasts 12-18 months. After that, studies are conducted to ensure that remission is possible( thyroid ultrasound is performed, the antibodies to the TSH receptor are investigated).After that the therapy stops. However, the probability of recurrence of the disease sometimes exceeds 50%.Usually relapse occurs within the first year after the discontinuation of thyreostatic therapy. In case of ineffective treatment, operative thyroid removal or treatment with radioactive iodine is indicated.
More specific recommendations can be given to you by a doctor at a full-time consultation. Be healthy!
Doctor endocrinologist Artemyeva Marina Sergeevna