What is hyperthyroidism?
Hyperthyroidism is a condition in which an excess of thyroid hormone in the blood there is present. Contrary to popular belief, hyperthyroidism is not itself a disease.
Too large an amount of thyroid hormone can be the result of taking thyroid hormone tablets (thyreotoxicosis factitia), but is in most cases the result of an over-active thyroid gland. To hyperactivity of the thyroid gland may lie at the basis a number of diseases. The most common cause is the process by which the patient forms antibodies against its own thyroid called Graves' disease. The antibodies which then makes the body, engage on particular receptors of the thyroid gland, which in turn leads to an excessive activity of this gland. When this happens, the thyroid will be without the brains encourage the thyroid to do so (which is normally the case), will create a lot of hormone.
Of Graves' disease occurs when there is swelling of the thyroid gland (goiter) occurs along with bulging eyes (Exophthalmos) and a rapid heartbeat (tachycardia). This is called the Merseburger Trias, at the residence of Von Basedow. The syndromes which give hyperthyroidism have similar symptoms, making them largely form an overlapping spectrum.
Background information
The thyroid gland (glandula thyreoidica) is a small Butterfly-shaped organ that normally located to the front of the neck (just below the Adam's Apple). A normally functioning thyroid iodine absorbed from food to put in two hormones. These hormones, T4 and T3, have an activating role in metabolism. There are various conditions that underlie a too large or too little thyroid hormone synthesis.
Causes of hyperthyroidism
The following diseases or processes may have hyperthyroidism result:
- Thyreotoxicosis factitia
- An intake of thyroid hormone tablets by the patient (typically used to loose weight) often leads to a too large amount of thyroid hormone in the blood.
- Graves' disease
- In this case, there is an ongoing autoimmune process in which the body produces antibodies against the TSH receptor of the thyroid. The consequence is a massive stimulation of the production of thyroid hormone.
- Benign tumor in the thyroid gland (adenoma Toxic)
- A solitary tumor in the thyroid gland can result in an impaired production of thyroid hormone.
- Multiple benign tumors of the thyroid gland (Toxic multi-nodular goiter, also called Plummer's disease)
- Thyroiditis (De Quervain's disease and Hashimoto's disease)
- Because of a (virus) infection or a car-immuunproces creates an inflammation of the thyroid tissue. The already produced and stored thyroid hormones are released, resulting in hyperthyroidism. After a short hyperthyreotische phase ignition will cause a lesser functioning of the thyroid gland and thus to a deficiency of thyroid hormone (hypothyroidism)
- Adenoma in the pituitary gland
- Sometimes there will be a benign tumor in the pituitary gland, an adenoma. If this cells that TSH thyroid (schildklierstimulerendhormoon) create, will work very fast without a physiological purpose.
Hyperthyroidism symptoms
The thyroid hormones, thyroxine and tri-jew thyronine regulate the intensity of the metabolism. When an excess of thyroid hormone metabolism will be stimulated, which is reflected in the following complaints:
- Heat intolerance (very quickly have hot)
- Weight loss (despite normal food intake)
- Excessive perspiration
- Hunted feeling
- Tachycardia (rapid heartbeat sometimes more than 100 beats per minute)
- Tremor (trembling usually the fingers, hands)
- Diarrhea
- Disordered menstrual cycle
- Cardiac arrhythmias - very rarely
- Fatigue
- Muscle weakness
- Nausea and vomiting - rarely
- Eye problems (strabismus, changes in visual acuity, Exophthalmos)
In the case of the previously described Graves' disease, there are still a number of characteristic symptoms. These include the goiter (goiter), which is sometimes seen, an enlargement of the thyroid gland. The gaping eyes (exopthalmus) which the patient often give a hunted look are no expression of agitation, but by an increasing volume of tissue behind the eyes. This will release the eyeball what forward. In extreme cases, the eyes even no longer be closed. Also there might be a typical swelling of subcutaneous connective tissue (myxoedeem), this mainly on the shins.
Diagnostics
When there is an excess of thyroid hormone and the accompanying complaints must first of all, the cause can be found. Often there will be a blood test be done to look at the amount of TSH (thyroid-stimulating hormone) and T4 (thyroid hormone). When the thyroid gland itself, works too hard at Graves ' disease or a toxic adenoma, there will be a very high level in the blood to be found, but very few T4 TSH. This is because the pituitary gland no longer does TSH if there is enough (or too much) thyroid hormone is. Also an opportunity to look at whether special antibodies are present in the blood that are directed against the thyroid gland.
In addition to blood tests in research into the cause of hyperthyroidism also used nuclear medical examinations. In such an examination, that thyroid scintigraphy is called, is radioactive iodine-123 administered to the patient that is included in the thyroid gland. Via a nuclear scan can now be calculated how much iodine is listed there. As a result of this research can be given a iodine-131 therapy thyroid less hard to make it work.
Hyperthyroidism treatment
The treatment of complaints arising from an excess of thyroid hormone is entirely dependent on the cause of this. In the case of Graves ' disease is it possible the functioning of the thyroid gland to block that doesn't respond (with carbimazole). It should then be included otherwise often thyroid hormone deficiency arises. After a time (e.g. 1 year), the treatment can be discontinued to see if there is again a normal thyroid operation occurs. In many of the cases the thyroid remains active and will be a part of this be removed (surgically) or be "killed" through therapy with radioactive iodine.
If there is a toxic adenoma (a small part of the cells to actively working), there can be chosen for radiotherapy. Radioactive iodine is then in high dose administered and mainly the "sick" cells will be included. Hereby the radiation of the radioactive iodine destroys these cells without further damage to the surrounding tissue to cause. This is a safe and good method to this cause of hyperthyroidism to deal with, and in many cases no other therapy more needed.
Also homeopathic remedies are applied in hyperthyroidism, the functioning is, however, no scientific evidence.