Thyrotoxicosis: symptoms and treatment

Thyrotoxicosis( hyperthyroidism) is a pathological condition in which the body produces an excess of thyroid hormones. This is not an isolated disease, but only a syndrome that can develop with a variety of health problems, not necessarily directly related to the thyroid gland. The clinical manifestations of thyrotoxicosis depend on the level of thyroid hormone levels. What causes thyrotoxicosis, what symptoms it manifests, how it is diagnosed and how it is treated, you can learn from this article.

What is thyrotoxicosis?

The thyroid gland is an important organ of internal secretion. Normally, it produces several hormones, the main of which are thyroxine( T4) and triiodothyronine( T3).Thyroxine is about 4/5 of the total number of thyroid hormones produced, and triiodothyronine is 1/5.The biologically active form is triiodothyronine, and thyroxine can be converted to triiodothyronine. Control of the amount of thyroid hormones produced in the body is carried out by the pituitary gland, a small formation of the brain. Yes, it is the brain that is the leader, as in most other situations in the body. The pituitary gland secretes thyroid-stimulating hormone( TTG), which stimulates thyroid cells to produce thyroxine and triiodothyronine. When the amount of thyroxine or triiodothyronine increases beyond normal, the pituitary gland reduces the production of thyroid-stimulating hormone. And vice versa: when the level of thyroxin and triiodothyronine decreases, the amount of thyroid-stimulating hormone increases in order to stimulate the thyroid gland to more active functioning.

The clinical situation, when the body becomes a lot of thyroxine and triiodothyronine and little thyroid-stimulating hormone, and there is the same thyrotoxicosis. And there are several reasons for this state.

Reasons for thyrotoxicosis

The most common causes of thyrotoxicosis are:

• diffuse toxic goiter( Graves' disease).The share of this disease in the structure of thyrotoxicosis accounts for up to 80% of all cases. In this state, specific antibodies are formed in the body that attach to the thyroid gland cells and are perceived by them as a thyroid-stimulating hormone( such is the treacherous deception).As a consequence, thyroid cells intensively produce thyroxine and triiodothyronine, mistakenly believing that their deficiency arose. The thyroid gland diffusely increases in size;
• nodal toxic goiter( Plummer's disease).In this disease, not all of the thyroid gland, but only its individual sites( in the form of nodes), more actively produces thyroid hormones. It is more common in the elderly;
• autoimmune thyroiditis( Hashimoto's thyroiditis) or subacute thyroiditis( viral inflammation of the thyroid gland).Under these conditions, the amount of thyroid hormone produced does not differ from the norm, and the increase in their content in the blood arises as a result of the destruction of thyroid cells and the entry of their contents( ie created hormones) into the blood. These diseases lead to non-severe forms of thyrotoxicosis in comparison with diffuse toxic goiter;
• excess supply of artificial thyroid hormones from the outside. Such a situation arises in the treatment of hypothyroidism by L-thyroxine, when its dose is not controlled by analyzes on the content of hormones. This is the so-called artificial thyrotoxicosis. There are also cases of using thyroxine as a means for losing weight, which is illegal and can also lead to artificial hyperthyroidism;
• excess intake of iodine in the body. This is a fairly rare cause of thyrotoxicosis, but it can not be discounted. The source of iodine can be not only food, but also medicines, for example Amiodarone( antiarrhythmic drug, often used for heart rhythm disturbances);
• adenomas of the thyroid gland;
• pituitary tumors with increased production of thyroid-stimulating hormone;
• is an ovarian tumor that can also produce thyroid hormones( eg, an ovarian's string).

Symptoms of thyrotoxicosis

Patients with thyrotoxicosis are excitable, hot-tempered and emotionally labile.

Thyrotoxicosis more "loves" the female, and even the young. The most common syndrome occurs among the age group of 20-50 years. Symptoms of thyrotoxicosis are numerous and, at first glance, have nothing in common with each other and are not associated with the thyroid gland. And all because thyroid hormones participate in the implementation of many organs and systems, control metabolism, determine the state of immunity, provide reproductive function( especially in women).

About the presence of thyrotoxicosis may indicate the following symptoms:

• increased nervous excitability, short temper, emotional instability, anxiety. Patients with thyrotoxicosis somewhere in a hurry, fidgety, make excess movements( something is teasing in the hands, jerking the foot, and so on).A frequent symptom is the trembling of the hands, and it becomes more noticeable when the arms are extended forward to the horizontal level;
• sleep disturbance. Such patients sleep little and although they feel tired and dissatisfied, they can not fall asleep for a long time, and finally drowning in the arms of Morpheus, often wake up;
• exophthalmos. This is a fairly specific symptom of thyrotoxicosis, consisting in protrusion of the eyeball forward, widening the eye gap. The eye thus seems larger in size than it was before. Exophthalmos in thyrotoxicosis can be accompanied by edema of the eyelids, deterioration of visual acuity, doubling of objects, inability to focus on one image, increased tear, cuts in the eyes, rare flashing. Exophthalmus is usually bilateral, although variants of greater severity of the corresponding symptoms on the one hand are possible. A rare blinking can cause the connection of infectious complications: the development of recurrent conjunctivitis and keratitis;
• increased blood pressure and heart rhythm disturbances. For thyrotoxicosis is characterized by an increase in systolic( "upper") blood pressure and a decrease in diastolic( "lower").Cardiac abnormalities can be different: from a simple increase in heart rate above 90 per minute( sinus tachycardia) to atrial fibrillation, when cardiac contractions become irregular( with large or small gaps), which can cause heart failure;
• change in appetite both upward( more often) and downward;
• disruption of gastrointestinal motility. More often in patients with thyrotoxicosis there is a frequent and liquid stool, accompanied by pain in the abdomen, sometimes vomiting is possible. In connection with the violation of education and outflow of bile may increase the size of the liver with the appearance of jaundice in severe cases;
• increased sweating, a feeling of heat, an increase in body temperature to low-grade figures( 37.5 ° C), and in severe cases and higher. Patients with thyrotoxicosis poorly tolerate hot weather, it provokes an increase in most of the symptoms;
• decrease in body weight with the same level of physical activity and normal diet( or even increased appetite);
• chronic weakness, fatigue, weight loss of muscles. When thyrotoxicosis develops so-called thyroid myopathy, associated with insufficient supply of nutrients to muscle tissue. In severe cases, muscle weakness can reach the degree of paralysis( thyrotoxic muscle paralysis);
• development of osteoporosis, that is, increased brittleness of bones;
• disorders in the genital area. Women are disrupted by the menstrual cycle up to amenorrhea, the onset of pregnancy becomes difficult. Menstruation often becomes painful, poorly tolerated( headaches, nausea and vomiting, dizziness, fainting).In men with thyrotoxicosis, the potency decreases, gynecomastia may develop, that is, an increase in the size of the mammary glands like a female breast( it may be one-sided, although more often symmetrical);
• soft tissue swelling( especially the tibia);
• early graying, thinning and hair loss, thinning and increased brittleness of the nails;
• frequent and profuse urination and, as a consequence, severe thirst;
• increase in the level of glucose in the blood( thyreogenic diabetes);
• an increase in the size of the thyroid gland or a change in its structure with the appearance of nodes( determined by palpation).This symptom is not at all necessary, but often occurs;
• bright glow on the cheeks;
• shortness of breath, violation of swallowing and breathing of the mechanical plan( feeling of a coma in the throat).Disturbance of swallowing is possible with a sufficiently large size of the thyroid gland.

Thyrotoxicosis can be differently tolerated by the body. Depending on the severity of its course and the level of hormones, it is customary to allocate:

• is an easy form( subclinical).With her symptoms are minimal, and the content of thyroxine and triiodothyronine remains normal, but the level of thyroid-stimulating hormone decreases;
• of moderate severity( clinically manifested).In this case, the level of thyroid-stimulating hormone decreases, and the levels of thyroxin and triiodothyronine increase. The higher the concentration of the latter, the more pronounced become the symptoms of thyrotoxicosis;
• heavy. It is most typical for diffuse toxic goiter.

Complications of thyrotoxicosis is a thyrotoxic crisis, or thyrotoxic coma. This life-threatening condition occurs more often with diffuse toxic goiter, which is not treated or is inadequately treated. The provoking factors of this condition are increased demands on the body. For example, trauma, infectious diseases, severe stress, surgical interventions.

The development of thyrotoxic crisis is associated with the intake of a large amount of thyroxine and triiodothyronine in the blood, while reducing adrenal hormones. The crisis is characterized by the maximum severity of most of the symptoms of thyrotoxicosis. It develops quickly, sometimes even lightning fast. Body temperature rises to 40-41 ° C, the heart rate reaches 200, the blood pressure rises sharply, and then falls( because of adrenal insufficiency), breathing is disrupted( becomes frequent and superficial), indomitable vomiting and diarrhea, profuse sweating develops. The excretion of urine decreases, and then ceases altogether( anuria develops).All this is accompanied by a sharp psychomotor arousal with delirium and hallucinations, which is then replaced by a pronounced apathy with muscle weakness, a loss of consciousness is developed up to the coma. Such a state requires urgent resuscitation measures to save the life of the patient.

Diagnostics of

The main method that confirms the presence of thyrotoxicosis is the laboratory diagnosis, in particular the determination of the level of hormones of the thyroid gland and TSH in the blood. Decrease in TSH and increase of thyroxine and triiodothyronine indicates the presence of thyrotoxicosis. Other diagnostic methods( search for antibodies, ultrasound, scintigraphy, computed tomography, puncture thyroid biopsy) are used to establish the immediate cause of thyrotoxicosis.

Treatment of

Approaches to the treatment of thyrotoxicosis exist different, and the methods can be both conservative and operative. The choice of method of treatment is purely individual, determined by the attending physician, taking into account the cause of thyrotoxicosis, concomitant diseases, the severity of thyrotoxicosis, the age of the patient, and so on.

Let's consider the basic ways of treatment in more detail:

• medication( conservative) treatment. It consists in taking medications that suppress the production of thyroid hormones. The main such drugs are Merkazolil and Tyrosol. Drugs usually need to be taken for a long time( at least 1-1,5 years) under the control of indicators of a general blood test and a biochemical blood test( ALAT, ACAT).During treatment, it is necessary to periodically monitor the levels of thyroid hormones and TSH in the blood in order to adjust the dose( the tests must be taken at least once every 3 months).The dose of drugs is selected individually, and after normalizing the level of hormones in the blood, maintenance therapy is prescribed. Sometimes drug therapy is prescribed as a preparatory stage before surgical treatment;
• surgical treatment. Its essence consists in removing part or almost the entire thyroid gland( subtotal resection).They resort to the surgical method, when the drug treatment turned out to be ineffective, when the size of the thyroid gland is so great that it prevents normal breathing and swallowing, when the gland compresses the neurovascular bundles on the neck. Removal of the thyroid gland entails the development of hypothyroidism, that is, a lack of thyroid hormones, which is compensated by the constant intake of artificial hormones from the outside;
• treatment with radioactive iodine preparations. The essence of such treatment consists in taking once-only preparations containing radioactive iodine, which is absorbed by the cells of the thyroid gland alone. Cells of the thyroid gland under the influence of radiation die within a few weeks. Since the cells are destroyed, such treatment is irreversible, that is, it is comparable in essence to the operative removal of the thyroid gland. Accordingly, the development of hypothyroidism after such treatment with the need for hormone replacement therapy with the thyroid gland is possible. Sometimes a single dose of radioactive iodine is not enough, and thyrotoxicosis persists. In such cases, their reuse is possible.

Often in the treatment of thyrotoxicosis, β-blockers( Atenolol, Bisoprolol, Metoprolol and others) are used as adjuvant in connection with their effect on the cardiovascular system and blocking action on the thyroid hormones themselves. Drugs contribute to reducing the frequency of heartbeats and lowering blood pressure.

In the treatment of thyrotoxicosis, an important role is given to nutrition recommendations. Food should be maximally vitaminized, rich in minerals, high in protein, fat and carbohydrate content. Exciting products( coffee, strong tea, spices, chocolate and so on) should be excluded.

Thus, thyrotoxicosis is a fairly frequent endocrinological problem. It can be caused by a number of reasons, not always associated with thyroid pathology. Symptoms of thyrotoxicosis are numerous and diverse, should be evaluated in a complex, since each of them, taken separately, does not indicate thyrotoxicosis. Diagnosis of this condition is based on determining the level of hormones of the thyroid gland and thyroid-stimulating hormone of the pituitary gland in the blood. The main methods of treatment of thyrotoxicosis are the use of drugs, radioactive iodine preparations and surgical removal of the thyroid gland almost entirely or partially. From thyrotoxicosis can completely get rid of, you just have to be patient and not lose heart.

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