Hyperthyroidism is a disorder of the activity of the thyroid gland, accompanied by the uncontrolled production of the main thyroid hormones, triiodothyronine (T3) and thyroxin (T4).
In parallel, the synthesis of thyroid-stimulating hormone (TSH), a pituitary element responsible for the levels of the above biologically active substances, is inhibited. Hyperfunction of the thyroid gland may be associated both with the disorder of the activity of the endocrine organ itself, and with the disruption of the functioning of other organs or systems. Hyperthyroidism, like hypothyroidism, can be primary and secondary. In the first case, the deviation is manifested against the background of thyroid disease, in the second - with the defeat of the pituitary gland. There is also tertiary thyrotoxicosis, which develops with a disorder in the work of the hypothalamus.
Most often, this hormonal disorder develops in females (18–20 cases per 1000 women). In men, the frequency of hyperthyroidism is 2 cases out of 1 thousand. The age limits during which such a deviation may occur vary in the range from 20 to 50 years.
What it is?
Hyperthyroidism (thyrotoxicosis) is a clinical syndrome accompanied by an increase in plasma T3 and T4 levels. The consequence of this hormonal surge is the acceleration of all metabolic processes occurring in the patient's body.
The opposite process is hypothyroidism. When it levels of thyroid hormones are reduced, and the metabolism slows down. Thyrotoxicosis is most often diagnosed in young women.
Causes of the disease
Thyrotoxicosis can be a consequence of:
- Diffuse toxic goiter (Perry disease, Grave disease). It is an autoimmune disease, mainly due to genetic transmission. Accompanied by a uniform increase in the tissues of the thyroid gland, and the production of antibodies to TSH. In 70–80% of cases, thyrotoxicosis is diagnosed in patients with this pathology.
- Inflammatory lesions of the thyroid gland. This may be subacute or chronic thyroiditis (Hashimoto disease). In the latter case, the cause of increased levels of thyroid hormones is the destruction of the structure of the follicular cells of the thyroid gland. Typically, such a hormonal disorder is reversible, and completely disappears after a course of therapy. It is directed primarily to the elimination of inflammation, and not the accompanying symptoms.
- Nodular goiter, which is characterized by the formation of seals in the structure of the tissues of the thyroid gland. As a result, it begins to work hard, throwing elevated concentrations of thyroxine into the bloodstream, which, during its decomposition, loses one iodine unit, and is transformed into triiodothyronine.
- Pituitary tumors. In most cases, these tumors are hormonally active. That is, they produce an additional amount of biologically active components.
- Thyroid adenomas. This is another hormone-producing tumor, having a benign nature. At the same time, the neoplasm itself releases biologically active substances, therefore the pituitary gland does not affect this process.
- Polycystic ovary syndrome and some other pathologies of the paired organ of the female reproductive system.
- Unfavorable heredity.
- Autoimmune pathologies of various origins.
Thyrotoxicosis is often caused by other pathological tissues of the thyroid gland, as well as violations of its activities of different etiologies.
According to modern classification, hyperthyroidism is:
- Primary. This syndrome develops against the background of pathological lesions of the thyroid gland.
- Secondary. Thyrotoxicosis of a secondary nature occurs in violation of the activity of the pituitary gland.
- Tertiary. Such hyperthyroidism is a consequence of malfunction of the hypothalamus.
Primary thyrotoxicosis goes through several stages of its development:
- Subclinical stage. At this stage, hyperthyroidism has no pronounced clinical manifestations. In the analysis of venous blood, there is a decrease in the level of thyrotropin on the background of normal thyroxin values.
- Manifest (explicit) stage. At this stage, the clinical manifestations of hyperthyroidism are already pronounced. In the serum, the level of T4 is steadily increasing, and the concentration of TSH continues to decline.
- Phase of complications. During this period, neurosis, psychosis, drastic weight loss, unreasonable aggression, cardiac and adrenal insufficiency join the general symptoms. The development of dystrophy of internal organs, formed and a large number of parenchymal tissues, arrhythmias and other complications.
Symptoms of hyperthyroidism
Manifestations of hyperthyroidism in women largely depend on the background of which pathology it originated. Equally important is the duration and severity of the disease, and the presence of complications from other organs or systems.
In violation of the activity of the central nervous system hyperthyroidism is accompanied by the following symptoms:
- increased irritability;
- sense of gratuitous anxiety and fear;
- the acceleration of mental processes and speech;
- concentration disorder;
- fine tremor of the limbs;
- sleep disorders.
For hyperthyroidism, accompanied by a violation of the cardiovascular system, characterized by the appearance of:
- tachycardia that is difficult to treat;
- atrial flutter;
- atrial fibrillation;
- isolated systolic arterial hypertension (when the "upper" pressure is increased, and the "lower" remains within the normal range or decreases);
- accelerate blood flow;
- heart failure.
Hyperthyroidism may be accompanied by disorders of the functioning of the visual apparatus, which manifests itself:
- protrusion of the eyeballs;
- increase in the palpebral fissure;
- rare blinking;
- eyelid edema;
- limiting the mobility of the eyeball;
- double vision;
- dry cornea;
- rezu in the eyes;
Sooner or later, all this leads to blindness, which also develops due to squeezing of the optic nerves.
Characteristic of thyrotoxicosis is the acceleration of metabolism. The consequence of this is:
- sudden weight loss;
- development of thyroid diabetes;
- violation of body thermoregulation (subfebrile condition);
- intolerance to heat exposure.
In parallel with this, adrenal insufficiency develops, since an increased activity of thyroid hormones causes an active breakdown of cortisol.
Hyperthyroidism also negatively affects the condition of the skin - it becomes thin, moist, warmer. Due to increased levels of thyroid hormones, hair becomes brittle and brittle, and nails begin to exfoliate.
Other symptoms of this condition manifest themselves:
- shortness of breath;
- decreased lung capacity;
- digestive disorders;
- increased appetite;
- stool disorders;
- obstructive jaundice caused by enlarged liver.
Hyperthyroidism may be accompanied by symptoms of thyrotoxic myopathy:
- general poor health;
- muscle weakness;
- muscle hypotrophy;
- weakness in the body, especially in the limbs;
- fatigue when walking and lifting weights.
Hyperthyroidism can lead to thyrotoxic muscular paralysis. Disruption of water metabolism occurs, which entails a strong thirst and polyuria.
This syndrome has a negative effect on the production of sex hormones. In women, this is manifested by a failure of the menstrual cycle with painful, scanty and irregular menstrual periods. In patients of both sexes, such a violation provokes the development of pre-unconscious conditions, dizziness, fainting, cephalgia, weakness. In men, potency is disturbed and gynecomastia occurs.
External signs of hyperthyroidism are manifested, above all, an enlarged thyroid gland. Sometimes during palpation, the doctor can determine the cause of the disorder. It may be in the development of diffuse-toxic or nodular goiter. At the same time, the Basedow's disease is accompanied by a symmetric increase in the organ, while the presence of nodes indicates the course of the tumor process.
It is noteworthy that the previously described symptoms do not always manifest themselves in elderly patients, therefore, they have latent hyperthyroidism. In this group of patients, general weakness, depressive states, drowsiness, inhibition of thinking and movements come to the fore. Also, elderly patients are most susceptible to cardiovascular complications of hyperthyroidism.
Thyrotoxic (hyperthyroid) crisis
This condition is a complication of untreated hyperthyroidism, or a consequence of improperly prescribed therapy. Certain mechanical manipulations can also lead to a crisis, which are carried out by the doctor during the examination of the patient or the operation on the thyroid gland. Sometimes the occurrence of such a violation is associated with stress factors.
The symptoms of a thyrotoxic crisis are the same as in hyperthyroidism, but are more pronounced and more intense. Start acute, lightning. The attack is accompanied by pronounced psychomotor agitation and strong tremor of the hands, which then spreads throughout the body.
In hyperthyroid crises, a decrease in blood pressure, muscle weakness and general inhibition is observed. In parallel, symptoms of indigestion (diarrhea, nausea and uncontrollable vomiting) with a concomitant increase in body temperature and tachycardia (up to 200 units of pulse per minute) appear. Signs of infectious lesions of the body are absent.
During urination, urine may acquire an acetone odor. Body temperature can reach 41 degrees.
Thyrotoxic coma can cause acute fatty liver dystrophy. Such a violation is manifested primarily by the development of obstructive jaundice. In parallel with this, adrenal insufficiency is possible with the suppression of the production of important hormones of this paired endocrine organ.
Hyperthyroid crisis is able to turn into a comatose state in the absence of timely treatment. Self-therapy can also lead to similar consequences, since the patient without medical education is not able to choose the right medications. Coma may be fatal to the patient.
Death can also occur due to fatty hepatic dystrophy. An acute form of adrenal insufficiency can also cause the death of a patient.
Diagnosis of hyperthyroidism includes oral questioning of the patient, palpation of the neck in the area of the thyroid gland, and also:
- Analysis of venous blood for TSH, T4 and T3. In hyperthyroidism, the level of thyrotropin is reduced, and the indicators of thyroxine and triiodothyronine, by contrast, are increased.
- Ultrasound and CT of the thyroid gland. They are necessary to determine the size of the body, assess its structure and identify foci of inflammatory or neoplastic processes.
- Scintigraphy This is a hardware diagnostic procedure to evaluate the activity of different areas of the thyroid gland.
- Biopsy. The collection of tissue "thyroid gland" is carried out only when necessary. Usually this is the detection during palpation of seals and nodes in the tissues of the endocrine organ.
- ECG, which is necessary to assess the activity of the cardiovascular system.
It is extremely important to conduct a thorough and thorough examination in order to differentiate hyperthyroidism from other pathologies, which may also be accompanied by previously considered symptoms.
How to treat hyperthyroidism
The treatment regimen for hyperthyroidism is developed by an endocrinologist individually for each patient. When choosing a method of treatment and the appointment of specific drugs necessarily taken into account the severity and etiology of the syndrome.
The most common therapeutic methods are:
- Conservative therapy. It is based on the use of medications that suppress the production of thyroid hormones. Long-term treatment, monitoring of T3 and T4 indicators is carried out during the entire course. After eliminating the acute thyrotoxic state, patients continue to receive a maintenance dose of the drug. Pharmacotherapy can be an independent method, as well as a preparatory stage before RIT or surgery on the thyroid gland.
- Radioiodine therapy (RET). The method consists in a single dose of radioactive iodine. Under their influence the death of hormone-producing cells occurs, so that the levels of T3 and T4 are normalized. This is an irreversible process, so after HRT patients are usually prescribed hormone replacement therapy.
- Operation. It is performed with the ineffectiveness of conservative treatment, large nodes or a significant increase in the thyroid gland. The essence of surgical intervention is the partial or complete removal of the organ. After this procedure, thyrotoxicosis is replaced by hypothyroidism - a lack of thyroid hormones. As a result, the need for HRT will still not be avoided.
Beta-blockers can be used to treat hyperthyroidism (Propranolol, Atenolol, Bisoprolol, Metoprolol, etc.), however, only to eliminate symptoms. They act only a few hours, after which the sickness returns. The use of such funds is also possible with thyrotoxicosis accompanying thyroiditis. Beta blockers can be combined with other medicines and therapeutic techniques.
Often, in hyperthyroidism, treatment is supplemented by means of lowering the pulse, antihypertensive drugs, sedatives, etc.
Patients with hyperthyroidism should be at a dispensary account with an endocrinologist, and annually be tested for hormone levels. In general, the prognoses for this syndrome are favorable - both for life and for the patient’s work activity. But only if the person with thyrotoxicosis exactly follows the recommendations of his doctor.
Equally important in terms of later life with a similar violation is treatment. If it was started in time and assigned correctly, the forecasts will be as positive as possible.
It is important to remember that taking thyrostatics is prohibited during pregnancy and breastfeeding. If a woman is only planning a pregnancy, then this can be done not earlier than one year after undergoing a course of therapy for thyrotoxicosis.
In order to avoid the development of hyperthyroidism, it is necessary to:
- maintain iodine balance in the body;
- lead a healthy lifestyle and do not give up sports;
- walking in the open air more often;
- avoid stress and psycho-emotional disorders;
- monitor the normal functioning of the immune system;
- take multivitamin complexes in the autumn-spring period;
- annually visit the endocrinologist when living in endemic conditions.
When the first disturbing symptoms appear that may indicate hyperthyroidism, you should immediately contact an endocrinologist. If a patient has been diagnosed with a nodular goiter, he can be referred for examination by an endocrinologist.