Hyperthyroidism

Hyperthyroidism is a syndrome of increasing the level of hormones in the blood, caused by increased activity of the thyroid gland. Excess of them speeds up the metabolism.

There is also the opposite state, when the level of these hormones is below the norm, so the metabolism, respectively, is also reduced. This pathology is classified as hypothyroidism.

[1], [2]

Causes of the hyperthyroidism

Hyperthyroidism is always associated with other pathologies of this endocrine gland. Almost 80% of cases it occurs due to diffuse toxic goiter. This is a uniform increase in thyroid gland, which is also called Basedova, 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 increases and produces too many hormonal substances.

Viral inflammation leads to the destruction of the gland follicles and, accordingly, to the ingestion of excess hormonal substances into the blood. This type of pathology is relatively light, has a temporary nature.

With nodular goiter, local seals ("nodules") also activate the secretion of thyroid hormones.

The hormonal level also rises for some tumors of the pituitary gland, with toxic adenoma of the thyroid gland or ovarian stem.

Admission of synthetic hormonal drugs without medical supervision can also provoke the disease. The same condition is possible if the pituitary tissues are unresponsive to this type of hormone.

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's going on in the body with hyperthyroidism?

Since thyroid hormones cause increased use of oxygen by the body, heat formation and energy exchange also increase.

Androgens are intensely converted into estrogens. There is an increased level of globulin, which binds the sex hormones. In men this is fraught with gynecomastia.

The tissues become hypersensitive to catecholamines, sympathetic stimulation.

Due to an overabundance of cortisol, symptoms of hypocorticism (a phenomenon opposite to adrenal insufficiency) appear.

Sometimes Graves' disease, as the main cause of excess thyroid hormone production, has a family character. In this case, pathological changes are fixed in each subsequent generation. An autoantigen that stimulates the defense system is formed, as a result of the response, autoantibodies appear. The result of the complex interaction of antigens and antibodies is an increase in the level of tyrosine concentration in the blood.

[7], [8], [9]

Symptoms of the hyperthyroidism

Symptomatology consists in direct dependence on the severity, duration, degree of damage to organs and tissues.

Characteristic are changes in the nervous and mental activity of man:

• nervousness, excitability
• irritability, sometimes tearfulness
• anxiety
• accelerated speech
• Thinking disorder
• insomnia.

Hyperthyroidism causes a change in blood pressure, accelerated heart rate, heart failure.

Almost half of the patients with hyperthyroidism have a bright ophthalmological clinic - a noticeable protrusion of the eyeballs, edema of the eyelids. Patients at the same time feel "sand in the eyes," later, there may be erosion of the cornea and even blindness as a consequence of optic nerve dystrophy.

Other symptoms of hyperthyroidism:

• Despite increased appetite, the patient loses weight.
• Diabetes of thyreogenic etiology is developing.
• The patient sweats, can not tolerate heat.
• The skin is thinned, always warm and moist.
• Hair is also thinner, prematurely graying.
• Swollen legs.
• Appears shortness of breath.
• Difficulties in digestion are being documented, anorexia often develops in the elderly.
• Weakness, trembling, fatigue.
• Strong thirst and polyuria.
• Sexual disorders, menstruation disorders.

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

Complications and consequences

Exchange processes concern the whole organism, therefore their failure also affects the operation of all systems and organs. Hence the great variety of both the symptoms and the consequences of hyperthyroidism.

Serious complications with delayed or substandard treatment can affect the cardiovascular system. There is a cardiac arrhythmia, and in very bad cases - a myocardial infarction.

Increased iron complicates normal swallowing and breathing.

In connection with the acceleration of the digestive process, there is an increased intestinal peristalsis, which is accompanied by frequent episodes of diarrhea. Accelerated metabolism provokes the use of reserve deposits of fat stores. The person noticeably grows thin, he is constantly hot, uncomfortable from excessive sweating.

Influence on reproductive health is manifested in the violation of this function up to female infertility and male impotence. An upset in a future mother can have tragic consequences - from abnormal fetal development to mental retardation in the case of the birth of a child.

Hyperactivity of the thyroid gland may 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 adequate rest.

Do not pass without consequences and bulging eyeballs that occur in hyperthyroidism: it can be complicated by ophthalmopathy.

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

Complications

The thyroid gland, of course, affects all the vital organs of the body. Complications of hyperthyroidism are associated primarily with the phenomena of sub- and decompensation. Thus, with the weakening of the heart muscles, which become thinner, and also the walls of blood vessels, oxygen starvation occurs, the products of metabolism are not sufficiently removed. The subsequent acidification of the body is fraught with edema, heart failure and so on.

Infections, stresses, body overloads can complicate the situation with thyrotoxic crisis, when all the symptoms of hyperthyroidism are sharply exacerbated. With an extremely unfavorable prognosis, a coma and a lethal outcome are possible. Thyrotoxic crisis is inherent only in women.

The aggravation is accompanied by severe tachycardia and fever, in some cases the patient raves, in others, with apathetic crisis, absolute indifference to the external world is observed. The progression of such symptoms leads to a coma and even death.

Depending on the intensity of such manifestations, physicians distinguish three to five degrees of hyperthyroidism.

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

Diagnostics of the hyperthyroidism

Hyperthyroidism is diagnosed by a typical clinic and complaints of the patient. And also conduct:

• the analysis of a blood on TTG, a thyroxine and trijodtironin
• ultrasonography
• electrocardiogram
• radioisotope scintigraphy, if necessary - biopsy.

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

Analyzes

The analysis of blood is the main and determining in the formulation of an accurate diagnosis. He is appointed by an endocrinologist, examined the patient and listened to his complaints. The analysis consists in determining the amount of thyroid hormones T4 and T3, which indicates their excess. Also set the amount of thyroid-stimulating hormone (TSH), which gives an idea of the involvement of the pituitary gland.

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

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

TTG in hyperthyroidism

If the TSH content is zero, then the free hormones T3, T4 can be in the upper limits of the norm. From the indicators of these substances, endocrinologists are just coming out when the patient is prescribed medicinal preparations.

The index of thyroglobulin indicates the nature and peculiarities of the development of the disease. The corresponding antibodies are cleansed in the gland, removing it from the destroyed cells and other elements.

Antibodies to TTG at signs of thyrotoxicosis secrete substances whose task is to block the excessive activity of the endocrine gland.

Instrumental diagnostics

Any thyroid disorder needs ultrasound, including hyperthyroidism. The equipment helps the doctor "see" the size, structure of the organ, with the help of the sensor to evaluate its blood supply. Positive results of ultrasound are a signal for the appointment of scintigraphy.

Scintograficheskoe research must be carried out with suspicion of nodular hyperthyroidism. It helps the specialist to establish in which regime certain parts of the gland function, in particular the nodes. These two methods help differentiate hyperthyroidism and other pathologies accompanied by thyrotoxicosis, for example, multinodular goiter, thyroiditis and so on.

A puncture biopsy of the organ is performed with specific indications for such manipulation.

If you want to assess the condition of the pituitary gland (with hyperthyroidism as a consequence of pituitary adenoma), a computerized tomography or MRI of the brain is shown, and sometimes both.

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

Prevention

The main measures for the prevention of hyperthyroidism are to ensure that the body receives enough iodine, and if there are problems with the thyroid gland they were eliminated without delay.

• Food should be balanced and quality, without excesses in the form of sharp, fried, flour, fatty, smoked and salty foods. Vegetables, fruits, other foods rich in fiber, vitamins and microelements, a sour-milk diet - that is the key to healthy and rational nutrition.
• You can not eat "when you have to," it is useful to constantly observe the regularity in eating. Dietary recommendations are extremely important, so we have to follow them unswervingly in hyperthyroidism.
• Bad habits should be given a decisive battle, once and for all, getting rid of them. Physical activity, moderate sports loads not only diversify leisure time, but will become a source of cheerfulness, excellent mood, playing far from the last role in overcoming any sickness.
• After successful treatment, regular hormonal examination is necessary. Sometimes supportive conservative therapy is indicated, which, according to the doctor's advice, can last a year or more.
• Do not abuse sunbathing.
• Ideally, a hyperthyroid patient should be constantly observed by an endocrinologist.

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

Forecast

Depending on the complexity, causes and other circumstances, hyperthyroidism is treated with a medicamental or surgical method. Timely and professional treatment gives good results. Both methods effectively eliminate the signs of the disease. It should be taken into account that the use of drugs to suppress excessive activity of the gland is not recommended for breastfeeding of children and during pregnancy. For a year after the treatment, pregnancy is also undesirable. Self-medication is inadmissible!

The prognosis for adults is almost always favorable - not only for life, but for working 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. Lethal outcome is most often due to cardiac and respiratory problems.

Hyperthyroidism and the army

Hyperthyroidism causes increased attention among doctors who examine conscripts in military registration and enlistment offices. After all, even in Napoleonic times, they knew that men with severe goiter were bad fighters. They say that the famous commander personally inspected the necks of his recruits.

Healthy and hardy young men are needed in the modern army. Unfortunately, only some of them pass medical examination without any problems. Ecology, poor-quality food, unhealthy habits and, in general, the way of life do not contribute to the blossoming sight and health of many adolescents and young men.

If there is a suspicion of hyperthyroidism or similar diseases, the draftee is carefully examined and provided with a respite for treatment. In complicated or neglected cases, exemption from conscription is possible.

With a responsible attitude towards one's health, each person can overcome hyperthyroidism, continue full-fledged life.

[44], [45]