Types and forms of hyperthyroidism

Types and forms of hyperthyroidism can be very diverse. If we talk about primary hyperthyroidism, then basically it appears due to diffuse toxic goiter or the so-called Graves disease.

Grave's disease is called an autoimmune disease that has an incomprehensible etiology. Many of the patients who have just been diagnosed with this condition report that the disease has a family history. This, most likely, suggests that Graves' disease may be caused by a hereditary factor.

Because of this disease the thyroid gland increases and becomes hyperactive - it produces an increased amount of thyroid hormones. This is due to the fact that the immune system produces abnormal antibodies, thus stimulating the thyroid gland.

Congenital hyperthyroidism

Such a disease appears because the thyroid-stimulating immunoglobulins undergo transplacental transference. A high concentration of these substances in the blood of the expectant mother in the process of raising a child is likely to lead to the appearance of a newborn hyperthyroidism.

Congenital hyperthyroidism is mainly transient and disappears after 3 months, sometimes prolonging to several years. Both boys and girls can be ill with it.

Many babies are born prematurely, and many of them have an enlarged thyroid gland. Such children are very restless, differ in hyperactivity and mild excitability. Their eyes are open very wide and look bulging. There can be sharp acceleration of breathing and increased ripple, high temperature. In the blood serum there is an increased T4. Symptoms such as the bulging of the large fontanel, the rapidly skeletal skeleton, the synostosis of the seams on the skull may also arise. In the presence of craniosynostosis, there may be a delay in mental development. In such children, even though they actively suck the breast, the body weight is added very slowly.

[1], [2], [3], [4], [5], [6],

Primary hyperthyroidism

There are 3 more causes of primary hyperthyroidism, although they are not so common. It:

1. multinodular toxic goiter;
2. adenoma;
3. subacute thyroiditis.

But they all do not exceed 20% of all cases of hyperthyroidism.

In general, the hypothyroid phase comes in to replace the hyperthyroid phase. The course of treatment in such cases can last a very long time - for many months.

Secondary hyperthyroidism

Secondary hyperthyroidism is the hyperfunction of the thyroid gland, as well as the increase in its production of T3 and T4 hormones. This is due to the pituitary gland, which has a stimulating effect on it.

Sometimes the disease can arise because of a pituitary tumor that produces an overabundance of thyroid-stimulating hormone, but this is a rarity. This hormone itself stimulates the thyroid gland to produce a large number of hormones. Another rare cause of hyperthyroidism may be the pituitary gland's resistance to the thyroid hormones produced. Because of this, he will produce an excess of thyroid-stimulating hormone, despite the presence of thyroid hormones.

In a woman, the disease can appear due to a bubble drift, because then the thyroid gland in abundance receives a chorionic gonadotropin. If you remove the cause - a bubble drift - hyperthyroidism disappears.

Diagnosis is based on the results of laboratory tests:

• The indicator of the concentration of thyroid hormones in the blood is calculated - it will be increased if the patient is suffering from hyperthyroidism;
• The indicator of the concentration of thyroid-stimulating hormone of the pituitary gland is calculated, which also increases in the presence of secondary hyperthyroidism.

Drug-induced hyperthyroidism

The drug type is manifested due to excess in the body of triiodothyronine and thyroxine, introduced into it together with medications. Also, the reason may be hormone replacement therapy, which is used to cure hypothyroidism, suppressive therapy for getting rid of thyroid cancer and benign nodes in it, overdose of thyroid hormones with drugs, which are taken to control the body weight. 

Medicamentous hyperthyroidism can have such types, distinguished by severity:

• The mild form, including the symptoms - there is no atrial fibrillation, the heart beat rate is 80-120 / min., A slight decrease in working capacity, there is no sharp weight loss, slight tremor of the hands;
• The average form at which it is isolated is a pulse increase, a weight loss of 10 kg, a heart rate of 100-120 / min., There is no atrial fibrillation, a reduced capacity for work;
• The severe form at which observed - atrial fibrillation, heart rate of 120 + / min, a sharp decrease in weight, thyrotoxic psychosis, disability, parenchymal organs undergo dystrophic changes.

There is also a slightly different classification of degrees of problematicness of the disease:

• Light subclinical hyperthyroidism, which is diagnosed mainly by the results of hormonal analysis, when the clinical picture is erased;
• Average manifest hyperthyroidism, in which the clinical picture of the disease is seen well;
• Severe complicated hyperthyroidism, which is observed - heart failure, psychosis, the presence of atrial fibrillation, thyrogenic adrenal insufficiency, severe weight loss, parenchymal organs degenerate.

[7], [8], [9], [10], [11], [12]

Autoimmune hyperthyroidism

Often in hyperthyroidism thyroid is an autoimmune nature, and the diseases of such a plan mainly appear due to a viral infection. There is an infection of the cell wall, after which the immune system begins to reject it - as a result, instead of protecting the body, immunity on the contrary destroys it.

Viral diseases in humans happen very often, and for the development of an autoimmune process, it takes a long time, so it is often difficult to establish why an autoimmune hyperthyroidism has occurred due to which infection. It is also impossible to understand why autoantibodies, which are produced by immune cells, affect one or another organ. It is possible that the matter here is in some genetic defects, which are the cause of the development of certain diseases.

Antibodies stimulate the work of thyroid cells, as do thyroid-stimulating hormones. Because of their influence, the thyroid tissue proliferation takes place, resulting in the production of an excess of hormones T4 and T3.

It should be noted that this disease affects women more often - 5 times more often than men.

[13], [14], [15], [16], [17], [18], [19], [20]

Toxic hyperthyroidism

It develops because of the excess secretion of hormones diffuse tissue shchitovidki, because of what happens the poisoning of the body with these hormones.

This disease can develop due to infection, poisoning with toxins, genetic factors, mental trauma.

Toxic hyperthyroidism develops in this way - immune surveillance is disrupted, which causes autoantibodies to form in the thyroid cells. They promote stimulation of the thyroid gland, which increases its functioning and increases the gland, as its tissue grows because of it. It is also important that tissues change their sensitivity to thyroid hormones, which destroys their metabolic process.

To cure the disease, thyreostatic medications are used that suppress the production rate of hormones, as well as their overabundance from the body - this helps to calm the thyroid and reduce its size. Also these drugs take away the excess of vitamins C and B, contribute to the improvement of metabolism, soothe and support the functional activity of the adrenal glands.

Subclinical hyperthyroidism

Subclinical hyperthyroidism is a condition where the concentration of TSH in the blood serum has a lower level, while the thyroid hormone indices remain within the prescribed norm. In these cases, there are also no obvious clinical signs that the patient is suffering from hyperthyroidism.

Basically, this disease occurs as a result of long-term presence of multinodular goiter or in patients with a history of thyrotoxicosis, which were also treated with thyreostatics. Such patients should be checked from time to time for the level of thyroid hormones, as well as TSH, even if there are no signs of hyperthyroidism.

The risk of possible progression of subclinical hyperthyroidism to the manifest form in clinical and biochemical cases was also studied. The studies were conducted with a small amount of selected cases, and the observation period amounted to a time interval of 1-10 years. Observations showed that in the 1-4 year period, progress was about 1-5% per year, and it was also found that the probability of a clinical manifestation would be higher in those patients who had a blood serum TSH level of less than 0.1 mIU / L .

Artificial hyperthyroidism

With it, the thyroid hormone levels exceed their normal level, which is due to the intake of a large amount of hormonal drugs for the thyroid gland.

The thyroid produces hormones T4 and T3, and in the case of the appearance of hyperthyroidism, it begins to produce an overabundance of these substances on its own. If the same pattern is observed due to taking hormonal drugs, the disease is called artificial hyperthyroidism.

The disease can also occur if the patient intentionally takes an excessive amount of thyroid hormones. Sometimes artificial hyperthyroidism may appear due to abnormality of the thyroid gland tissues.

To get rid of the disease, you need to stop taking the hormone drug, and if the medical indicators demonstrate that there is no such need, you should reduce the dosage. Further, you will need to be examined 1-2 times a month to make sure that the symptoms of the disease go to waste or disappear altogether.

Patients who suffer from Munchausen's syndrome should undergo psychiatric supervision and treatment in this area.

[21], [22], [23]

Hyperthyroidism after childbirth

Often this type of hyperthyroidism occurs 2-4 months after childbirth, when a relapse of thyrotoxicosis starts, for the treatment of which thyreostatics are needed. In general, this interval is sufficient for safe breastfeeding, but even during lactation, small doses of PTU (daily allowance - about 100 mg) will not cause the child harm.

But sometimes the disease is so pronounced that it is necessary to stop lactation with dopaminomimetics and take thyreostatics in large doses - as it is done during periods outside of feeding and pregnancy.

Postpartum thyroiditis, as well as autoimmune disease of Graves can result in hyperthyroidism after childbirth. Given that thyroiditis after childbirth is considered a more common cause of short-term hyperthyroidism, it is impossible to miss the onset of Graves' disease.

Among the main differences in these diseases is that with hyperthyroidism because of postpartum thyroiditis, the thyroid gland is slightly enlarged, Graves' ophthalmopathy is not at all. With Graves' disease, the opposite is true, and, in addition, the concentration of thyroid hormones in the blood serum increases.

Borderline hyperthyroidism

Due to the thyroid-stimulating hormone acting on the thyroid, a balanced circulation of hormones T4 and T3, as well as iodothyronines, is provided. The indicator of this hormone is controlled with the help of the hypothalamic hormone TRH, and also has an inverse relationship to the production of hormones of type T3.

For example, in the primary production of thyroid hormones decreases, but the TSH indices are generally quite high. But with 2 or 3 forms of the disease, when a decrease in the production of thyroid hormones occurs due to problems with the functioning of the hypothalamus and the pituitary, the TSH indices are rather low.

Indications of primary testing for differential detection of thyroid pathology and monitoring the relevance of hormone replacement therapy should have the following expected figures:

• Euthyroid status: 0.4 to 4 μIU / mL;
• Hyperthyroid status: less than 0.01 μIU / ml.

If the TSH indices are in the range 0.01-0.4 μIU / ml, it is necessary to again measure them in the future, because this may be a symptom of borderline hyperthyroidism or some serious disease that is not related to the thyroid gland. Another reason for such indicators may be too aggressive treatment with medication.

[24], [25], [26], [27], [28], [29], [30], [31]

Transient hyperthyroidism

This physiological variation mainly occurs before the 16th week of pregnancy and is explained quite easily - this is necessary to cover the need for hormones in the volumes in which they are needed for both mother and baby.

Among the signs of the disease is a slight increase in temperature, change in mood, difficulty in staying in a hot climate. Some pregnant women may lose weight at the beginning of gestation, which will not be associated with toxicosis.

These symptoms are of course quite difficult to identify at the initial stage of pregnancy, as they are not too different from the usual behavior of the organism in this position. But in such cases, all pregnant women are assigned a number of laboratory examinations to find out the indicator of the level of hormones. This is done, because similar signs can mean the presence of a serious pathology, such as, for example, diffuse thyrotoxic goiter.

If laboratory tests have shown the presence of transient hyperthyroidism, it should not be treated, although there is a need for constant monitoring of the body so as not to miss the point of possible appearance of signs of more serious diseases of the thyroid. They are dangerous because they can be a threat to the baby.