Hyperthyroidism

Hyperthyroidism is a syndrome of increased hormone levels in the blood caused by increased activity of the thyroid gland. Their excess speeds up metabolism.

There is also an opposite condition, when the level of these hormones is below normal, so the metabolism is also reduced. Such pathology is classified as hypothyroidism.

[ 1 ], [ 2 ]

Causes hyperthyroidism

Hyperthyroidism is always associated with other pathologies of this endocrine gland. In almost 80% of patients, it occurs as a result of diffuse toxic goiter. This is a uniform enlargement of the thyroid gland, which is also called Basedow's disease or Graves' disease. In this condition, antibodies are produced to the TSH (thyroid-stimulating hormone) receptors of the pituitary gland; this stimulates the gland, it enlarges and produces too many hormonal substances.

Viral inflammations lead to the destruction of the gland follicles and, accordingly, the release of excess hormonal substances into the blood. This type of pathology is relatively mild and temporary.

In nodular goiter, localized compactions (“nodules”) also activate the secretion of thyrohormones.

Hormonal levels also increase with some pituitary tumors, toxic adenoma of the thyroid gland or ovarian goiter.

Taking synthetic hormonal drugs without medical supervision can also provoke the disease. The same condition is possible if the pituitary tissues are not susceptible to this type of hormones.

Hyperthyroidism most often occurs in young women; an important risk factor is always a hereditary predisposition to this pathology.

[ 3 ], [ 4 ], [ 5 ], [ 6 ]

Pathogenesis

What happens in the body with hyperthyroidism?

Since thyroid hormones cause the body to use more oxygen, both heat production and energy metabolism increase.

Androgens are rapidly converted into estrogens. Increased levels of sex hormone-binding globulin are observed. In men, this can lead to gynecomastia.

Tissues become hypersensitive to catecholamines and sympathetic stimulation.

As a result of excess cortisol, symptoms of hypocorticism appear (a phenomenon opposite to adrenal insufficiency).

Sometimes Graves' disease, as the main cause of excessive production of thyrohormones, is familial. In this case, pathological changes are fixed in each subsequent generation. An autoantigen is formed, stimulating the defense system, and autoantibodies appear as a result of the response. As a result of the complex interaction of antigens and antibodies, the level of tyrosine concentration in the blood increases.

[ 7 ], [ 8 ], [ 9 ]

Symptoms hyperthyroidism

Symptoms are directly dependent on the severity, duration, and degree of damage to organs and tissues.

Characteristic changes are in the nervous and mental activity of a person:

• nervousness, excitability
• irritability, sometimes tearfulness
• anxiety, unreasonable fear
• accelerated speech
• thinking disorder
• insomnia.

Hyperthyroidism causes changes in blood pressure, increased heart rate, and heart failure.

Almost half of those affected by hyperthyroidism have a vivid ophthalmological clinic - noticeable protrusion of the eyeballs, swelling of the eyelids. Patients feel "sand in the eyes", later corneal erosion and even blindness may occur as a result of optic nerve dystrophy.

Other symptoms of hyperthyroidism:

• Despite increased appetite, the patient loses weight.
• Thyroid diabetes develops.
• The patient sweats and cannot tolerate heat.
• The skin becomes thinner and always warm and moist.
• Hair also becomes thinner and turns grey prematurely.
• The shins are swollen.
• Shortness of breath appears.
• Digestive problems are a nuisance, and older people often develop anorexia.
• Weakness, trembling, fatigue.
• Severe thirst and polyuria.
• Sexual disorders, menstrual irregularities.

[ 10 ], [ 11 ], [ 12 ], [ 13 ]

Complications and consequences

Metabolic processes affect the whole organism, so their failure also affects the work of all systems and organs. Hence the wide variety of both symptoms and consequences of hyperthyroidism.

Serious complications with late or poor-quality treatment may affect the cardiovascular system. Cardiac arrhythmia occurs, and in very bad cases – myocardial infarction.

The enlarged gland makes it difficult to swallow and breathe normally.

Due to the acceleration of digestion processes, increased intestinal peristalsis is observed, which is accompanied by frequent episodes of diarrhea. Accelerated metabolism provokes the expenditure of reserve deposits of fat reserves. The person noticeably loses weight, he is constantly hot, uncomfortable from excessive sweating.

The impact on reproductive health manifests itself in the disruption of this function, up to female infertility and male impotence. The disorder in the expectant mother can have tragic consequences - from abnormal development of the fetus to mental retardation in the case of the birth of the child.

Hyperactivity of the thyroid gland can be the cause of sleepless nights; Hormonal substances act as a powerful stimulant of the body, significantly reducing the physiological need for regular sleep and proper rest.

Bulging of the eyeballs, which occurs with hyperthyroidism, does not go without consequences: it can be complicated by ophthalmopathy.

[ 14 ], [ 15 ], [ 16 ], [ 17 ]

Complications

The thyroid gland certainly affects all vital organs of the body. Complications of hyperthyroidism are primarily associated with the phenomena of sub- and decompensation. Thus, with the weakening of the heart muscles, which become thinner, as well as the walls of blood vessels, oxygen starvation occurs, metabolic products are not excreted sufficiently. Subsequent acidification of the body is fraught with edema, heart failure, etc.

Infections, stress, and overloads of the body can complicate the situation with a thyrotoxic crisis, when all the symptoms of hyperthyroidism sharply worsen. With an extremely unfavorable prognosis, coma and death are possible. Thyrotoxic crisis is specific only to women.

The exacerbation is accompanied by severe tachycardia and fever, in some cases the patient is delirious, in others, during an apathetic crisis, there is absolute indifference to the outside world. The progression of such symptoms leads to a comatose state and even death.

Depending on the intensity of such manifestations, doctors distinguish between three and five degrees of hyperthyroidism.

[ 18 ], [ 19 ], [ 20 ], [ 21 ]

Diagnostics hyperthyroidism

Hyperthyroidism is diagnosed based on the typical clinical picture and complaints of the patient. The following is also performed:

• blood test for TSH, thyroxine and triiodothyronine
• ultrasound examination
• electrocardiogram
• radioisotope scintigraphy, and if necessary, biopsy.

[ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]

Tests

Blood analysis is the main and determining test in making an accurate diagnosis. It is prescribed by an endocrinologist after examining the patient and listening to his complaints. The analysis consists of determining the amount of thyroid hormones T4 and T3, which indicates their excess. They also determine the amount of thyroid stimulating hormone (TSH), which gives an idea of the involvement of the pituitary gland.

During the course of treatment, blood tests for these indicators should be repeated several times a year.

[ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ]

TSH in hyperthyroidism

If the TSH content is zero, then free hormones T3, T4 may be in the upper limits of the norm. Endocrinologists rely on the indicators of these substances when prescribing medications to a patient.

The thyroglobulin level indicates the nature and development characteristics of the disease. The corresponding antibodies cleanse the gland, ridding it of destroyed cells and other elements.

Antibodies to TSH, when there are signs of thyrotoxicosis, release substances whose task is to block excessive activity of the endocrine gland.

Instrumental diagnostics

Any thyroid disease requires ultrasound examination, including hyperthyroidism. The equipment helps the doctor "see" the size and structure of the organ, and use a sensor to assess its blood supply. Positive ultrasound results are a signal for scintografy.

Scintographic examination is mandatory when nodular hyperthyroidism is suspected. It helps the specialist to determine the mode in which individual parts of the gland, in particular the nodes, function. These two methods help differentiate hyperthyroidism and other pathologies accompanied by thyrotoxicosis, for example, multinodular goiter, thyroiditis, etc.

A puncture biopsy of an organ is performed when there are specific indications for such manipulation.

If it is necessary to assess the condition of the pituitary gland (in case of hyperthyroidism as a consequence of pituitary adenoma), computed tomography or MRI of the brain is indicated, and sometimes both.

In connection with the disruption of the heart and blood vessels, it is recommended to conduct an ECG, which best reveals such defects.

Prevention

The main measures to prevent hyperthyroidism are to ensure that the body receives enough iodine and that if problems with the thyroid gland arise, they are eliminated without delay.

• Nutrition should be balanced and high-quality, without excesses in the form of spicy, fried, floury, fatty, smoked and salty dishes. Vegetables, fruits, other products rich in fiber, vitamins and microelements, a fermented milk diet - this is what is the key to healthy and rational nutrition.
• You can't eat "when you have to", it is useful to always maintain regularity in food intake. Dietary recommendations are extremely important, so those who have recovered from hyperthyroidism must strictly follow them.
• Bad habits should be fought decisively, getting rid of them once and for all. Physical activity, moderate sports loads will not only diversify leisure, but will become a source of vigor, excellent mood, which play far from the last role in overcoming any illness.
• After successful treatment, regular hormonal examination is necessary. Sometimes supportive conservative therapy is indicated, which, on the advice of a doctor, can last a year or more.
• You shouldn't overuse sunbathing.
• Ideally, a hyperthyroid patient should be constantly monitored by an endocrinologist.

[ 36 ], [ 37 ], [ 38 ], [ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ]

Forecast

Depending on the complexity, causes and other circumstances, hyperthyroidism is treated with medication or surgery. Timely and professional treatment gives good results. Both methods effectively eliminate the signs of the disease. It is worth considering that the use of drugs to suppress excessive activity of the gland is not recommended during breastfeeding and pregnancy. Pregnancy is also undesirable for a year after treatment. Self-medication is unacceptable!

The prognosis for adults is almost always favorable – not only for life, but also for work capacity. With the exception of thyrotoxic crisis – this extremely dangerous condition threatens the patient’s life and requires immediate qualified intervention. With a complicated diagnosis, the prognosis depends on their causes, severity and other circumstances. Fatal outcome most often occurs due to cardiac and respiratory problems.

Hyperthyroidism and the army

Hyperthyroidism is of particular concern to doctors who examine conscripts at military registration and enlistment offices. After all, even in Napoleon's time it was known that men with a pronounced goiter were bad warriors. They say that the famous commander personally examined the necks of his recruits.

Healthy and resilient young men are also needed in the modern army. Unfortunately, only some of them pass the medical examination without any problems. The environment, poor quality food, unhealthy habits and lifestyle in general do not contribute to the blooming appearance and health of many teenagers and young men.

If hyperthyroidism or similar diseases are suspected, the conscript is carefully examined and given a deferment for treatment. In complicated or advanced cases, exemption from military service is possible.

With a responsible attitude to one’s health, every person can overcome hyperthyroidism and continue to live a full life.

[ 44 ], [ 45 ]