Hyperthyroidism: Symptoms and Treatment
Hyperthyroidism (or thyrotoxicosis) is a clinical condition in which excessively active thyroid gland secretion of thyroid hormones — triiodothyronine and thyroxine — is noted. Hyperthyroidism, the symptoms of which are manifested as a result of supersaturation of blood by these hormones and the spreading of blood by them throughout the body, including tissues, organs and systems, leads to acceleration of all processes in it, which affects the general state of the patient in a number of ways.
Hyperthyroidism is the result of various types of pathologies that are relevant to the thyroid gland, and these pathologies can be triggered both directly by disorders in it itself, and by disturbances that arise in those processes regulated by it. Similarly to hypothyroidism, hyperthyroidism, depending on the degree of thyroid damage, can manifest itself in the primary form (which implies the actual pathology of the thyroid gland), in the form of a secondary pathology (in the pathology of the pituitary gland), and also in the form of a tertiary (which implies the pathology of the hypothalamus).
As initially noted, hyperthyroidism leads to stimulation of the activity of all systems, tissues and organs in the body, and in particular, the cardiovascular system suffers from such changes. The fact is that against the background of the disease under consideration, and those processes that it entails, tissues and organs begin to need more oxygen, which in turn is accompanied by an increase in the frequency of heart contractions, at the expense of which such needs are met. Naturally, this affects the heart appropriately, it is defined as hyperthyroidism as a «thyrotoxic heart». Undoubtedly, the work of other organs is accompanied by tension. It should be noted that patients with hyperthyroidism without the necessary treatment for this disease may face the development of such a state as a thyrotoxic crisis, which, in turn, without proper medical care, can lead to the development of coma.
Women are predominantly prone to hyperthyroidism. So, for 1000 women there are about 18-20 cases of this disease, while in men for a similar number (1000) hyperthyroidism occurs in no more than two cases. As for the age range, here for hyperthyroidism a period of 20-50 years is assigned.
As we have already noted, hyperthyroidism develops as a result of pathological processes in the gland itself, as well as as a result of violations of its regulation. Primarily, hyperthyroidism develops as a result of the following diseases:
- Diffuse toxic goiter (or Basedova’s disease) — this causes most often leads to the development of hyperthyroidism, with a disproportionate increase in the thyroid gland, while concurrently producing hormones on its part.
- Nodal / multinodular toxic goiter (Plummer’s disease) — is diagnosed significantly less often, and mainly in older people. The peculiarity of the pathology in this case lies in the fact that, in its thyroid gland, seals of unknown origin are formed, which, as can be understood from the definition of this pathology, look like nodules. The impact they exert, leads to an even greater activity of the thyroid gland.
- In some cases, hyperthyroidism develops against a background of subacute thyroiditis, which implies an inflammatory process that develops as a result of the transfer of viral infections. Similar viral inflammations lead to destructive processes in the follicular cells of the thyroid gland, as well as to excessive intake of thyroid hormones into the blood. The course of hyperthyroidism in this variant is of a minor and short-term nature (its duration may be on the order of several weeks to several months).
- There is also a form of the disease, like artificial hyperthyroidism. It develops against the backdrop of uncontrolled use of thyroid hormones. In addition, it can also develop with the use of these hormones due to the current tissue immunity from the pituitary gland to them.
- There are also more rare causes that contribute to the development of hyperthyroidism:
- Ovarian teratomas accompanied by the production of thyroid hormones (otherwise the pathology is defined as the ovarian string, which implies the formation of tumor formations, the basis of which are thyroid cells in combination with these hormones produced)
- tumors of the pituitary gland, in which there is an increased production of thyroid-stimulating hormone (TSH) (for example, it can be acromegaloid hyperthyroidism with hyperostosis, which implies a combination of signs of hyperactivity on the part of the thyroid gland due to increased production of TSH with acromegaly and diffuse hyperostosis of the arch Skull)
- increased production of thyroid hormones against the background of the introduction of excessive amounts of iodine into the body.
Features of the course of hyperthyroidism
Highlight some of the features that are characteristic of the course of hyperthyroidism. So, for example, we have already noted that due to thyroid hormones, the consumption of oxygen increases, in particular from the tissues this causes an increase in the formation of tissues with a simultaneous increase in energy metabolism.
Also a feature of hyperthyroidism is an increase in the sensitivity of the tissues to sympathetic stimulation (ie stimulation of the sympathetic nervous system, which is part of the autonomic nervous system) and to catecholamines (ie to physiologically active substances acting as a controlling type of molecules And chemical intermediates in the framework of intercellular interaction, in particular, neurotransmitters in the form of dopamine, noradrenaline and epinephrine).
Because of the increased level of androgen conversion to estrogens, the volume of circulating globulin content in the tissues increases, due to which the sex hormones are bound, which in turn leads to an increase in the ratio between estrogens and androgens. Against the backdrop of this kind of hormonal changes, the possibility of developing gynecomastia in men (a pathology implying an excessive increase in mammary glands in men (one-sided or bilateral type), which in some cases determines the female type) is not excluded.
Because of accelerating the process of destruction of cortisol against the background of the influence of thyroid hormones, a hypocorticism clinic develops, which determines the reversible form of renal failure.
Forms of hyperthyroidism
Hyperthyroidism can occur in mild or moderate form, and also in severe form.
The mild form of the disease course (subclinical form) is characterized by asymptomatic course, triiodothyronine (T4) is normal according to actual indices, TSH (thyrotropic hormone) values are slightly lowered.
The next form is a medium-gravity form (in other words, explicit or manifest). In this case, the T4 level is characterized by an increase, while the TSH values are significantly reduced, symptomatic symptomatology is manifested.
Finally, a severe (complicated) form of the severity of the course of the disease, in which adrenal or cardiac insufficiency is noted, atrial fibrillation, expressed body mass deficit, psychoses and other types of pathology, indicating, respectively, the defeat of specific specific systems, organs and Inherent in their functions.
Consider the main signs of hyperthyroidism, which correspond to the indicated degrees of severity of its manifestation:
- Easy form
In addition to the initially noted changes in the hormone levels in the blood (which is detected with an appropriate blood test), there is a decrease in weight in a moderate degree of manifestation (within 5 kg). Also there is a tachycardia, in which the heart rate is no more than 100 beats per minute, there is no change in the rhythm of the contractions. Signs from the endocrine glands that indicate a violation of their functions are also absent (except for the thyroid gland). In addition, patients have a certain degree of irritability, sweating (manifested even in conditions with normal temperature).
- Average form
Weight loss is pronounced (about 10 kg). In the myocardium, changes in the pathological scale are noted, tachycardia manifests itself with a heart rate of between 100 and 120 beats / min. In this case, tachycardia is characterized by the stability of its own manifestation, and this does not depend on the position of the person, the connection with the previous dream and the state of prolonged dormancy is also absent. Violations are subject to carbohydrate metabolism, cholesterol in the blood decreases, there are gastrointestinal disorders (which is characterized by a loose and frequent stool).
Gradually, the signs are growing, indicating the relevance of adrenal insufficiency. In patients, thyrotoxic tremor is noted — trembling of the fingers, marked in the state of the outstretched arm. In addition, patients become more irritable and excitable, there are disturbances in sleep, excessive anxiety and tearfulness. There are also such signs as exophthalmos (characteristic displacement of the eyeball forward, in other words — protrusion, bulging eyes), as well as hyperhidrosis (ie, increased sweating) of the general type of manifestation.
In this case, in addition to the general description originally proposed by us in the classification of forms of hyperthyroidism, we can note a sharp and pronounced weight loss. Tachycardia has a stable character of manifestation, the pulse at it is from 120-140 rpm, but the possibility of exceeding these limits is not ruled out. Arterial pressure is characterized by an increased systolic pressure with a simultaneous reduced diastolic pressure. Exophthalmos is even more pronounced in comparison with the previous form of the disease, as is the thyrotoxic tremor, which this time manifests itself in the form of spreading through the body (and not only with the defeat of the hands).
Given the peculiarity of the disease we are considering, which is to accelerate all the processes occurring in the body, it can be understood that the symptoms of hyperthyroidism are extremely multifaceted and, accordingly, they are determined based on the severity of the disease, its course and the degree of damage to specific organs, tissues and Systems. Excess hormone production, produced by the thyroid gland, determines the following effect on the patient’s body:
- CNS. The central nervous system reacts to the actual effects of the disease in the form of increased excitability, irritability, emotional imbalances, fears and unreasonable anxieties, fast speech, trembling of hands and sleep disorders.
- Ophthalmology. Ophthalmic symptoms consist of an earlier manifestation, which is exophthalmos (in which the eyeball is exposed to protrusion when it is displaced forward and the eye gap is simultaneously increased ). In addition, the puffiness of the eyelids, the doubling of objects in the field of vision and a rare flashing are noted. It should be noted that due to the characteristic squeezing in this case, against which the dystrophy of the optic nerve also develops, the possibility of absolute loss of sight to patients is not ruled out. Also, among the actual ophthalmologic symptoms can be marked dryness of the eyes and eyes in the eyes, increased lachrymation, the development of corneal erosion, bags under the eyes, the inability to concentrate on a particular subject, etc.
- Cardiovascular system . As we initially noted, for her symptoms of hyperthyroidism and the peculiarities of his current are not easy due to the acceleration of processes in the body and a special need for soil in oxygen. The actual disturbance of the heart rhythm in this situation is extremely weak in responding to the treatment that is being given to it. There is fluttering and flickering of the atria, persistent tachycardia. Against the background of simultaneously increased systolic pressure and reduced diastolic pressure, there is a significant increase in the pressure values (upper and lower) in the rupture. Heart failure develops.
- GIT. Changes in appetite (decrease or, conversely, increase) are noted from the gastrointestinal tract, in elderly people this symptom can reach up to the total refusal to eat. There is also frequent and loose stools, irregularities in bile and digestive processes, abdominal pain of paroxysmal nature.
- Respiratory organs. Against the background of edema and stagnant phenomena, negative changes occur regarding the vital capacity of the lungs, dyspnea develops.
- Locomotor system . Thyrotoxic myopathy develops, in which chronic weakness and muscle fatigue, muscle hypotrophy (the state of muscles caused by insufficiency of intake of nutrients in the body or insufficiency of their assimilation) becomes characteristic signs. There is also a trembling of limbs and the body as a whole, osteoporosis (chronic progressive disease or clinical syndrome (in this case), characterized by a decrease in bone density, with simultaneous disturbance of microarchitecture and enhanced embrittlement, which is relevant due to a number of damaging processes). Against the background of the above symptoms there are difficulties noted during the long walk (especially when climbing the stairs), as well as when wearing weights. The possibility of developing a muscle paralysis is not ruled out, which in this case is reversible.
- Sexual system . In this area, characteristic changes are also noted. So, against the background of violations of the processes of secretion of gonadotropins, infertility may develop. As it was already described earlier, men can develop gynecomastia, the potency decreases. With regard to the impact on the female body of the actual for the disease processes, here in particular there are failures of the menstrual cycle. The manifestation of menstruation is characterized by soreness and irregularity, the discharge is meager in nature, as the accompanying symptoms — marked weakness (which can reach syncope), severe headaches. In extreme manifestations of the menstrual cycle failures, amenorrhea, that is, a complete absence of menstruation, is reached.
- Metabolism . Against the background of the acceleration of metabolic processes, patients face a persistent weight loss, which is achieved even with increased appetite. In addition, heat production increases (which is manifested in the form of increased sweating and temperature). Against the background of accelerated decay of cortisol, a reversible form of adrenal insufficiency develops. There is also an increase in the liver, and if it is a serious form of hyperthyroidism, then jaundice accompanies it. As an additional concomitant of this part of the manifestations of symptoms can be identified and the following: swelling of soft tissues; Thinning of nails, hair and skin; Early and severe gray; Strong thirst, abundant and frequent urination (which is actual due to water metabolism disorders).
External signs of hyperthyroidism are, first of all, an increase in the thyroid gland, which can manifest itself in varying degrees. In some cases, examination and palpation of the neck can determine the cause that provoked hyperthyroidism (nodular or diffuse goiter). For example, if it is a grave disease, then the enlargement of the thyroid gland is characterized by its own symmetry. If probing determines the nodal formation in the area under investigation, then this, in turn, is also an indication of the actual tumor-like process in it.
What is noteworthy, these symptoms of hyperthyroidism often do not appear in the elderly, which determines the hidden (masked) hyperthyroidism. As a typical symptom associated with this disease in the elderly, meanwhile, there may be frequent depressions and weakness, drowsiness and some retardation. It can also be noted that in a pronounced variant, cardiovascular disorders are more frequent in older patients with hyperthyroidism than in young patients.
thyrotoxic (hyperthyroid) crisis
This complication is manifested in the absence of treatment of thyrotoxicosis or in the appointment of treatment that does not actually correspond to the necessary measures. Also, the crisis can be caused by mechanical manipulations performed during examination of the patient or during surgery, which in one way or another affects the thyroid gland. The possibility of developing a crisis against the background of stress is also not excluded.
On the whole, the hyperthyroid crisis is manifested by the achievement of a peak by signs characteristic of hyperthyroidism. It begins acutely, its course is lightning fast. In patients, there is a pronounced mental excitement, and often it is accompanied by hallucinations and delirium. The trembling of the hands increases, in addition to this, the trembling spreads to the lower extremities and the whole body. Sharply drops blood pressure, there is a muscle weakness with general inhibition of the patient. Vomiting manifests itself in an uncontrollable form, accompanied by fever (signs that indicate the actuality of the infection, in this case are absent), diarrhea, rapid heart rate (reaching 200 beats / min.). When urinating in urine, you can determine the characteristic odor for acetone. The temperature rises (to 41 degrees), pressure.
In some cases, jaundice develops as a result of the acute form of fatty dystrophy, which is relevant for the liver, and adrenal insufficiency may also develop.
It is important to note that the lack of timely assistance can cause the death of the patient due to the transition of the crisis into a coma. Death can occur as a result of an acute form of manifestation of fatty liver disease or due to adrenal insufficiency.
The diagnosis is made primarily on the basis of actual manifestations of the symptomatology, which in particular is to distinguish the features of the appearance of patients and the data obtained with appropriate laboratory tests. Thus, the blood test determines the changes in the content of hormones, ultrasound can detect nodular formations in the thyroid gland, electrocardiography, in view of the complaints about the activity of the cardiovascular system that arise against the background of the disease, makes it possible to introduce a certain specifics regarding the manifested symptomatology in this part.
In addition, computer tomography can be assigned, in which the body images are taken in layer-by-layer mode, which gives a clear idea of where the actual seal is localized. The use of these diagnostic methods allows us to fully clarify the diagnosis, after which — to assign the appropriate course of individual therapy.
In the treatment of hyperthyroidism is focused on the achievement of specific goals. So, first of all, it is necessary to reach a normal level of hormones, which is provided by the appointment of appropriate drug treatment. In addition, the need for surgical treatment is considered, which implies the need to remove adenoma, goiter or tumor formation in the thyroid gland. Additional measures of therapy are symptomatic effects, due to which there is the possibility of improving the performance of systems and organs in the body of a sick person. Let us dwell in more detail on these methods.
The drug treatment of hyperthyroidism, first of all, is the use of antithyroid drugs, mainly they are used in case of a slight increase in the thyroid gland. If the gland reaches a significant size (more than 40 ml), and the general condition is characterized by the manifestation of symptoms indicating the compression of nearby organs, then medication becomes only a preparatory stage for another treatment — for the treatment of the surgical. In the treatment of the disease under consideration, the use of antithyroid drugs, which are a group of thionamides (preparations of Propylthiouracil, Thiamazole, etc.) is quite common nowadays. The basis of the mechanism of drugs corresponding to this group is that they have a purposeful inhibitory effect on the processes directly involved in the formation in the thyroid gland of hormones (in particular, the suppression of thyroid peroxidase).
Under the conditions of highly developed countries, the treatment of thyrotoxicosis is made through the use of carbimazole for this purpose. This drug is a prolonged (otherwise — prolonged) action, in particular, it effectively manifests itself in the case of severe forms of the disease. In addition to the necessary effect on the processes of formation in the thyroid gland of hormones, this drug provides an inhibition of the conversion of T4 (i.e., thyroxine) to T3 (or triiodothyronine). It is noteworthy that when taking 20 mg of this drug, the hypothyroid-induced condition is fully compensated.
Also in the conditions of developed countries as an integral method of treatment is treatment with the use of radioactive iodine. This iodine quickly penetrates the thyroid gland, after which its gradual accumulation takes place within its area. During the decay of radioactive iodine, the cells of the thyroid gland, thyroid cells are destroyed.
As for surgical treatment, the following factors stand out as evidence for it: significant goiter sizes; Recurrence of the disease after treatment at his address using antithyroid drugs; Intolerance of antithyroid drugs used by patients.
If there is a symptom that indicates a possible hyperthyroidism (thyrotoxicosis), you need to contact the endocrinologist.