hyperthyroidism



Overview of hyperthyroidism

Excess thyroid hormone causes hypermetabolic endocrine disease symptoms vary from person to person, manifested by agitation, irritability, palpitations, increased appetite, weight loss, fear of heat, excessive sweating, etc. Causes are more common, the most common is toxic diffuse goiter treatment includes drug therapy, radioactive iodine therapy, surgical treatment, etc.

Definition

Hyperthyroidism, or hyperthyroidism for short, is an endocrine disease in which the thyroid gland synthesizes and releases excessive amounts of thyroid hormones, causing an increase in the excitability of the body’s sympathetic nervous system and hypermetabolism.

The thyroid gland is the largest secretory gland in the human body and mainly secretes thyroid hormones.

The function of the thyroid gland is regulated by thyroid stimulating hormone (TSH) secreted by the pituitary gland, which stimulates the thyroid gland to synthesize and secrete thyroid hormone by binding to TSH receptors on the surface of thyroid cells.

Thyroid hormone is a necessary hormone to maintain normal metabolism of the body and promote growth and development.

Under-secretion of thyroxine causes hypothyroidism, while over-secretion causes hyperthyroidism.

Classification

There are many different types of hyperthyroidism, and there are two main ways to categorize it.

Classification according to the location and cause of the disease

Primary hyperthyroidism

Primary hyperthyroidism is caused by an abnormality of the thyroid gland itself, which secretes too much thyroid hormone.

It includes toxic diffuse goiter (Graves’ disease), nodular toxic goiter, autonomous hyperfunctional adenoma of the thyroid gland and iodine-derived hyperthyroidism (iodine hyperthyroidism).

Central hyperthyroidism

The lesion is located in the pituitary gland, also known as pituitary hyperthyroidism.

Hyperthyroidism is caused by an abnormality in the pituitary gland, which secretes too much TSH and increases the amount of thyroid hormones.

Classification according to the degree of hyperthyroidism

Clinical hyperthyroidism

Typical clinical manifestations of hyperthyroidism are usually present, and thyroid function tests may have the following characteristics.

Reduced serum TSH levels.

Elevated levels of total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), and free triiodothyronine (FT3).

Subclinical hyperthyroidism

Without hyperthyroidism manifestations, thyroid function tests may have the following characteristics.

Decreased serum TSH levels only.

Normal thyroid hormone levels.

Incidence

The prevalence of clinical hyperthyroidism in China is 0.8%, of which more than 80% is caused by toxic diffuse goiter (Graves’ disease).

The age of onset is 20 to 50 years old.

The incidence of the disease is more common in women than in men.

Causes

Causes

Hyperthyroidism is caused by the thyroid gland synthesizing or secreting too much thyroid hormone due to a variety of reasons, and the common causes are listed below.

Toxic diffuse goiter (Graves’ disease).

Pregnancy.

Choriocarcinoma.

Hyperemesis gravidarum.

Pituitary TSH adenoma.

Autonomous high-functioning adenoma of the thyroid gland.

Chronic high iodine intake or iodine-containing drugs.

Predisposing factors

A common cause is toxic diffuse goiter (Graves’ disease), which is genetically linked, with some patients having genes that predispose them to the disease, and can be triggered by the following factors.

Infection

Infectious diseases caused by bacteria, viruses, etc.

Mental stimulation

Severe mental stimulation, such as frequent anger, temper tantrums, rage, excessive stress, poor sleep.

Drugs

Taking interferon, lithium, etc.

Pathogenesis

Dependent on TSH receptors

Toxic diffuse goiter (Graves’ disease) is mainly caused by autoimmune abnormalities, in which the body produces TSH receptor antibodies that bind to the TSH receptor, leading to thyroid hyperplasia that produces excess thyroid hormones.

Pregnancy, choriocarcinoma, and hyperemesis gravidarum produce excessive amounts of human chorionic gonadotropin (hCG), which acts on the TSH receptor to produce excess thyroid hormone.

Pituitary TSH adenoma, which is the production of too much TSH, resulting in increased thyroid hormone synthesis.

Fetal/neonatal hyperthyroidism, in which maternal antibodies to TSH receptors pass through the placenta into the fetus, producing excess thyroid hormone.

Excessive autonomous production of thyroid hormone

Autonomous hyperfunctional thyroid adenoma: associated with a genetic mutation, not regulated by pituitary TSH, the adenoma is able to synthesize and secrete excessive amounts of thyroid hormone on its own.

Iodine hyperthyroidism: associated with long-term high iodine intake or iodine-containing medication, resulting in overproduction of thyroid hormone by the thyroid gland on its own.

Symptoms

The severity of the clinical manifestations of hyperthyroidism is related to the duration of the disease, the degree of hormone elevation, and the age of the patient, and varies between individuals, with each of the major manifestations being referred to as an early manifestation. Symptoms are atypical in the elderly and children.

Major manifestations

Lack of concentration, easily agitated, irritable, may have anxiety and insomnia.

Palpitations (panic), heartbeat often exceeds 100 beats per minute.

Increased appetite and easy hunger.

Increased bowel movements, may have more frequent bowel movements or diarrhea.

Weight loss or even wasting, even if the amount of food remains the same or increases.

Fear of heat and sweating even with minimal activity.

Fatigue and weakness.

Warm, moist skin and flushed face.

Trembling is seen with hands raised flat or tongue outstretched.

Protruding eyeballs, photophobia, tearing, foreign body sensation, distension, etc. Some of them have diplopia and loss of vision.

There are different degrees of thyroid enlargement, and the enlargement may be obvious with a lump in the front of the neck.

Women have scanty menstruation or even amenorrhea.

Men have decreased libido and impotence.

Other manifestations

Eye manifestations

Simple protruding eyes

Mild protruding eyes.

Eyes gleaming.

Contracture of the upper eyelid and widening of the eye fissure.

The upper eyelid cannot descend with the eyeball when both eyes are looking downward.

When looking upward, the skin of the forehead cannot be wrinkled.

Infiltrative Proptosis (Graves’ ophthalmopathy)

Protruding eyeballs.

Foreign body sensation in the eye.

Fear of light.

Tears.

Diplopia.

Decreased visual acuity.

Pain in the eye at rest or after movement.

Incomplete eyelid closure.

Anterior Tibial Mucous Edema

Edema is commonly found in the lower 1/3 of the tibialis anterior (anterior side of the calf) of the lower leg, and occasionally on the dorsum of the foot and knee, upper limbs, and even the head.

The lesions are mostly symmetrical and begin as dark purplish-red patches or nodules.

Then the skin becomes coarse and thick, and finally becomes bark-like, and the lower limbs are thick like elephant skin legs.

Apathetic hyperthyroidism

Mostly seen in elderly patients. The onset is insidious, the symptoms are atypical, and the systemic manifestations and goiter are not obvious.

The main manifestations are obvious emaciation, palpitation, fatigue, dizziness, fainting, neuroticism or indifference, diarrhea, anorexia.

It may be accompanied by atrial fibrillation, muscle tremor and other manifestations. 70% of patients do not have goiter.

Transient hyperthyroidism of pregnancy

It develops at 7 to 11 weeks of gestation and resolves at 14 to 18 weeks and may have the following manifestations.

It is often accompanied by severe vomiting of pregnancy.

Maternal weight does not increase with gestational month.

Heart rate above 100 beats/minute at rest.

No goiter or ocular manifestations.

Complications

Thyroid crisis

It is a syndrome of acute exacerbation of thyrotoxicosis associated with large amounts of thyroxine into the bloodstream and occurs in patients with chronically untreated or inadequately treated hyperthyroidism.

Common triggers

Infection, surgery, trauma, mental stimulation, etc.

Clinical manifestations

High or excessive fever (axillary temperature greater than 39°C).

Profuse sweating.

Tachycardia (>140 beats/min).

Irritability and anxiety.

Nausea, vomiting, diarrhea.

Impaired consciousness, heart failure, shock and coma in severe cases.

Hyperthyroidism heart disease

The incidence of hyperthyroidism heart disease accounts for 10% to 22% of hyperthyroidism and is a serious complication.

It is mainly characterized by serious arrhythmia, such as atrial fibrillation, atrial flutter, heart enlargement, heart failure, angina pectoris and myocardial infarction.

In severe cases, it can lead to death.

Thyrotoxic periodic paralysis

Most commonly seen in young Asian men.

Triggers include exercise, high-sugar diet, full meals, and insulin injections.

The lesions are mainly in the lower limbs, manifested by varying degrees of weakness or complete paralysis of the limbs, often accompanied by hypokalemia.

Osteoporosis

Excessive thyroid hormone will cause decalcification of bones and osteoporosis will occur.

The main manifestation is easy fracture.

Consultation

Department of Medicine

Endocrinology

For symptoms such as unexplained weight loss, hand tremors, irritability, hunger, fear of heat and excessive sweating, and protruding eyes, prompt medical attention is recommended.

Emergency Department

When symptoms such as high fever, vomiting, convulsions, unconsciousness, coma, etc. occur, immediate consultation is recommended.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of documents, common problems

Tips for the doctor

In order to facilitate the doctor’s examination, try not to wear high-collared clothes or necklace jewelry.

If there is any weight change, it is recommended to record the time and result of weight measurement for the doctor’s reference.

In case of vomiting, you can use your cell phone to take photos of the vomit for the doctor’s reference.

Preparation Checklist for Doctor’s Visit

Are there any irritability, panic, hunger, fear of heat and sweating, or protruding eyes?

How long have the above symptoms lasted?

Has there been any change in weight in the last six months?

Does anyone in the blood relatives have thyroid disease?

Are there any allergies to drugs, food or other substances?

Are there any diseases such as hypertension, diabetes, systemic lupus erythematosus, rheumatoid arthritis, etc.?

Are there any cases of exertion, nervousness, frequent anger, or stress?

Laboratory tests: thyroid function, thyroid autoantibodies, blood test, liver function, kidney function.

Imaging tests: thyroid ultrasound, thyroid radionuclide scanning, eye CT, eye magnetic resonance imaging, heart ultrasound, pituitary magnetic resonance imaging

Other tests: electrocardiogram

Thyroid hormone: levothyroxine sodium tablets

Imidazoles: methimazole, carbimazole

Thiouracil: propylthiouracil

Beta-blockers: propranolol, metoprolol

Iodine-containing drugs: amiodarone, compound iodine solution, iodine-containing contrast media

Glucocorticoids: hydrocortisone, prednisone acetate, methylprednisolone, dexamethasone

Diagnosis

Diagnosis is based on

Medical history

A detailed medical history will help the doctor diagnose hyperthyroidism, including past history, medication history, personal history, and family history.

Past history

Thyroid disease, autoimmune disease, pituitary or adrenal disease, diabetes mellitus, cardiovascular disease, tuberculosis, liver disease, and gastrointestinal disease.

Drug history

Thyroid hormone, amiodarone, iodine-containing contrast media and other iodine-containing drugs.

Personal history

Iodine intake, smoking or not, any mental stimulation or trauma before the onset of the disease, sleep condition, menstruation and fertility, pregnancy or not.

Family history

Any history of thyroid disease in first-degree relatives (father, mother, etc.).

Clinical manifestations

Symptoms: hypermetabolic symptoms such as hyperphagia, lethargy, pyrexia, hyperhidrosis, palpitations, agitation, etc.

Signs: physical examination includes signs such as tongue extension, fine tremor visible in the flat hands, active tendon reflexes, etc. Thyroid gland palpation reveals diffuse enlargement of the thyroid gland, soft or tough texture, no pressure pain, tremor is palpable in a few patients, and vascular murmur is present in the neck of some patients.

Laboratory tests

Thyroid function tests

Thyroid function is judged according to the levels of thyrotropin (TSH), serum total thyroxine (TT4), serum total triiodothyronine (TT3), and serum free thyroid hormone to diagnose hyperthyroidism.

Among them, serum total thyroxine (TT4) is stable and reproducible, and is one of the main indicators for diagnosing hyperthyroidism.

The test shows a decrease in thyrotropin and an increase in thyroid hormone levels.

Thyroid autoantibody test

Positive thyroid-stimulating hormone receptor antibody (TRAb) is highly suggestive of toxic diffuse goiter; TRAb can be negative in some patients with Graves’ disease.

This indicator is useful in determining disease activity and evaluating the timing of medication discontinuation, and is also useful in predicting relapse.

Blood tests

It is important to understand the patient’s general condition and provides clues for further investigations.

Some patients may have mildly decreased white blood cell count, hemoglobin, neutrophil and platelet counts.

Biochemical examination

The main purpose is to check the liver and kidney functions, as well as whether there are any abnormalities in blood lipids.

30% of patients have mildly elevated transaminases, suggesting abnormal liver function.

Imaging

Ultrasonography

Ultrasonography of the thyroid gland provides information about thyroid nodules and the distribution of blood flow within the thyroid gland.

Extraocular muscle ultrasound can assess extraocular muscle involvement.

In hyperthyroidism, blood flow in the thyroid is abundant and increased in velocity.

CT or magnetic resonance imaging

CT and MRI of the eye can rule out other causes of proptosis.

Radionuclide scan of the thyroid gland

It is mainly used in the differential diagnosis of hyperthyroidism to help clarify the cause.

Concentration of large amounts of nuclide in some tissues of the thyroid gland and no nuclide uptake in other thyroid tissues and the contralateral thyroid gland suggests that it may be an autonomous high-functioning adenoma of the thyroid gland.

Very low or even no iodine uptake by the thyroid gland suggests inflammatory hyperthyroidism.

Other tests

Electrocardiogram

The ECG shows sinus tachycardia.

The electrocardiogram may show sinus tachycardia or atrial fibrillation.

Eye examination

It includes three examination indexes: proptosis, diplopia and optic nerve damage. The severity of hyperthyroid eye disease is assessed in the following table. Intermittent diplopia occurs with exertion or walking, nonsustained diplopia occurs with blinking, and sustained diplopia occurs with reading.

Occurs intermittently

Optic nerve evoked potentials or other test abnormalities, visual acuity >9/10

Moderate 21～23 Non-persistent occurrence of visual acuity 8/10～5/10

Moderate

21～23

Non-persistent occurrence

Visual acuity 8/10～5/10

Severe >23 persistent occurrence visual acuity <5/10

Severe

＞23

Persistent

Visual acuity <5/10

Diagnostic Criteria

Diagnostic criteria for hyperthyroidism

Hyperthyroidism can be diagnosed when 3 of the following are present, but hypermetabolic symptoms are not obvious in apathetic hyperthyroidism; a few patients do not have goiter.

Hypermetabolic symptoms and signs.

Enlarged thyroid gland.

Decreased serum TSH levels and increased thyroid hormone levels.

Diagnostic criteria for toxic diffuse goiter

The first two of these are essential for diagnosis and the last three are diagnostic aids.

The diagnosis of hyperthyroidism is established.

Diffuse enlargement of the thyroid gland (confirmed by palpation and ultrasound).

Protruding eyeballs and other infiltrative ocular signs.

Anterior tibial mucous edema.

Positive TSH receptor antibodies (TRAb), thyroid peroxidase antibodies (TPOAb).

Differential Diagnosis.

The most common cause of hyperthyroidism is toxic diffuse goiter (Graves’ disease), which needs to be differentiated from the following conditions.

Inflammatory thyrotoxicosis

Similarities: both have hypermetabolic symptoms such as hyperphagia, lethargy, pyrexia, excessive sweating, palpitations, and agitation.

Differences: Inflammatory thyrotoxicosis is caused by the destruction of thyroid follicles by inflammation and the excessive amount of thyroid hormones stored in the follicles entering the circulation. It can be differentiated by thyroid function tests, ultrasonography, CT or magnetic resonance imaging.

Pseudo hyperthyroidism

Similarities: Both have hypermetabolic symptoms, such as polyphagia, emaciation, fear of heat, excessive sweating, palpitations, agitation, etc.

Differences: Pseudohyperthyroidism is caused by excessive intake of exogenous thyroid hormone, such as taking too much thyroid hormone. It can usually be differentiated by taking a history, checking thyroid function, and ultrasonography.

Simple goiter

Similarity: Both have an enlarged thyroid gland.

Difference: Simple goiter has no hypermetabolic symptoms and can be differentiated by thyroid function tests.

Thyroid cancer

Similarities: Both can have a swelling in the neck.

Differences: Thyroid cancer is visible as a lesion on ultrasonography, and cancer cells are visible on histopathologic examination.

Treatment

Aims of treatment

Reduce the level of thyroid hormone in the blood and improve the symptoms.

Treatment Methods

Drug therapy

Effects: Application of antithyroid drugs can reduce the synthesis of thyroid hormones and relieve the symptoms of hyperthyroidism.

Drugs: The commonly used antithyroid drugs are imidazole and thiouracil, and β-blocker (propranolol) can be used to control the clinical symptoms of hyperthyroidism at the early stage of the treatment, and then discontinued within 2 to 6 weeks.

Advantages: Safe treatment, controlled drug dosage, reversible effects, and does not permanently lead to hypothyroidism.

Disadvantages: Longer treatment period (1 to 2 years), slow effect (4 to 8 weeks), high relapse rate (50% to 60%, 75% relapse within 3 months after stopping the drug), and adverse effects.

Indications

Mild to moderate condition.

Mild to moderate enlargement of the thyroid gland.

Pregnant women, advanced age, or those who are unfit for surgery due to other serious illnesses.

Pre-surgical preparation.

Those who have recurrence after surgery and are not suitable for 131I treatment.

Patients with moderately to severely active thyroid-related eye disease.

Dosage and Course of Treatment

During the treatment period, the medication should be taken according to the doctor’s instructions, according to the dosage and course of treatment, and should not be reduced or stopped at will.

Treatment Period

Symptoms can be controlled in 4 to 8 weeks.

Thyroid function check is required every 4 weeks during the treatment period.

Maintenance period

When the serum thyroid hormone reaches normal, it is necessary to reduce the dosage, usually for 12 to 18 months.

Thyroid function should be checked every 2 months during the maintenance period.

Therapeutic effect

Antithyroid medication for hyperthyroidism remission: discontinuation of medication for 1 year, serum TSH and thyroid hormones are normalized.

The best indicator of discontinuation of antithyroid drugs: normal thyroid function and negative TRAb.

Factors for recurrence of hyperthyroidism: smoking, significant thyroid enlargement, persistent high titer of TRAb, and abundant thyroid blood flow.

Adverse drug reactions

Can cause granulocyte deficiency, rash, toxic liver disease, vasculitis.

It is necessary to make sure that there is no liver function abnormality before treatment, and to monitor blood routine and liver function regularly after treatment.

Radioiodine therapy

Treatment purpose: Destroying thyroid tissue and reducing thyroid hormone production.

Treatment mechanism: Using the beta rays released after 131I is ingested by the thyroid gland to destroy thyroid tissue cells.

Treatment method: 131I can be used alone for hyperthyroidism patients with moderate goiter.

Advantages: cheaper, high cure rate, can reach more than 85%, low recurrence rate.

Disadvantages: May cause hypothyroidism and requires lifelong medication.

Indications

Enlarged thyroid gland II degree.

Allergy to antithyroid drugs.

Relapse after antithyroid drug treatment or surgery.

Hyperthyroidism combined with heart disease.

Hyperthyroidism with leukopenia, thrombocytopenia or pancytopenia.

Hyperthyroidism combined with liver, kidney and other organs function damage.

Refusal of surgical treatment or contraindication to surgery.

Contraindications

Pregnancy and lactation are prohibited for radioactive iodine treatment.

Relative contraindications in patients with infiltrative synostosis hyperthyroidism.

Treatment effect

The cure rate of hyperthyroidism treated with 131I reaches more than 85%.

Symptoms are reduced and the thyroid gland shrinks in 2 to 4 weeks after treatment; thyroid function returns to normal in 6 to 12 weeks.

Those who are not cured can have a second treatment after 6 months.

Those who still have poor results need to be treated with antithyroid medication or opt for surgery.

Side effects

Hypothyroidism

Hypothyroidism is an unavoidable result of 131I treatment, with an incidence of about 5% per year, reaching 40% to 70% over 10 years.

After 131I treatment, thyroid function should be monitored regularly, once every six months to one year, and hypothyroidism should be detected as early as possible, and thyroxine replacement therapy should be taken in time, which requires lifelong medication.

Radioactive thyroiditis

It often occurs 7 to 10 days after radioactive iodine treatment.

In severe cases, aspirin or glucocorticoids may be given.

Induced thyroid crisis

Occurs mainly in patients with severe hyperthyroidism with uncontrolled symptoms.

Aggravation of active thyroid-related ophthalmopathy

Exacerbation of proptosis and significant worsening of ocular discomfort.

Surgery

Advantages: The cure rate of surgery is 90%～95%, the mortality rate of surgery is less than 1%, and the recurrence rate is low.

Disadvantages: There are certain complications (e.g., bleeding, infection, and in a few cases, damage to the recurrent laryngeal nerve), and in a few cases, hypothyroidism may occur.

Indications

Secondary hyperthyroidism or high-functioning adenoma.

Primary hyperthyroidism of more than moderate severity.

Types of hyperthyroidism such as large glands with compression symptoms, or retrosternal goiter.

Those who have relapsed after antithyroid drugs or 131I treatment or those who have difficulty adhering to long-term medication.

Patients with hyperthyroidism in mid-pregnancy who have the above indications should be considered for surgical treatment and can be treated without termination of pregnancy.

Contraindications

Adolescent patients.

Patients with mild symptoms.

Elderly patients or those with severe organic diseases who cannot tolerate surgery.

Surgical procedure

Subtotal thyroidectomy is usually performed, with 2 to 3 grams of thyroid tissue preserved on each side.

Postoperative care

Pay close attention to the changes of respiration, body temperature, pulse and blood pressure on the day after surgery to prevent hyperthyroidism crisis.

Adopt semi-recumbent position to facilitate respiration and drainage of blood accumulated in the incision.

Help the patient to discharge sputum in time to keep the airway open.

Postoperative complications

Postoperative dyspnea and asphyxia: it is the most critical postoperative complication, mostly occurring within 48 hours after surgery. If it is not found in time and handled appropriately, asphyxia may occur and endanger life.

Laryngeal recurrent nerve injury: it is a direct injury of surgery, such as the nerve being cut, ligated, squeezed and pulled. A few are caused by postoperative hematoma compression or scar tissue pulling.

Superior laryngeal nerve injury: it is caused by cutting off the superior thyroid artery and vein without close to the thyroid gland, or cluster ligation of the superior thyroid artery and vein.

Hypoparathyroidism: It is caused by the parathyroid glands being mistakenly cut, contused or impaired blood supply during surgery, and its incidence is directly related to the scope of thyroid surgery and the experience of previous surgeons.

Thyroid crisis: one of the life-threatening complications after hyperthyroid surgery.

Traditional Chinese Medicine (TCM)

Chinese medicine believes that hyperthyroidism belongs to the category of “galls”, which are caused by stagnation of qi, blood stasis and phlegm condensation in the neck.

Chinese medicine treatment of hyperthyroidism needs to recognize the evidence and take appropriate treatment and medication according to different disease mechanisms.

Avoid superstitious local remedies, partial remedies and secret remedies, and always go to regular medical institutions.

Other treatments

Treatment of Graves’ ophthalmopathy (GO)

Mild GO

can usually be relieved within a certain period of time, and treatment should focus on controlling hyperthyroidism and general therapy.

General treatment measures include smoking cessation (including avoidance of second-hand smoke), a low-salt diet, eye protection such as tinted glasses, artificial tears, use of antibiotic eye ointment or eye masks during sleep, and high-resting position.

Moderate and severe GO

GO active stage: treatment is preferred to antithyroid drugs and surgery is used after hyperthyroidism is controlled. Other special treatments include glucocorticoid therapy, retrobulbar radiation therapy, orbital decompression surgery.

GO stable stage: corrective ophthalmic surgery can be done.

Treatment of hyperthyroidism during pregnancy

Timing of pregnancy

If the patient’s hyperthyroidism is not controlled, pregnancy is generally not recommended.

If the patient is being treated with antithyroid medication and the thyroid hormones have reached the normal range, pregnancy can be carried out according to the doctor’s instructions.

Treatment during pregnancy

Antithyroid medication: Because of the teratogenic effects of the medication, it should be avoided in early pregnancy (the first 12 weeks), and if necessary, propylthiouracil can be used as a priority. Methimazole can be chosen in the middle and late stages of pregnancy.

Surgery: Surgical treatment of hyperthyroidism should be avoided in principle during pregnancy. If surgery is really necessary, the best time is the middle of pregnancy (14 to 27 weeks).

Lactation treatment

Postpartum recurrence of toxic diffuse goiter (Graves’ disease) in pregnant women can be treated with methimazole, but it should be taken in the appropriate dose under the guidance of a doctor so as not to affect the health of the child.

The drug should be taken after breastfeeding.

Prognosis

Cure

Hyperthyroidism has a long course. After active treatment, most of them have a good prognosis, and some of them can be relieved by medication without affecting life expectancy.

If recurrent hyperthyroidism occurs and medication is ineffective, radioactive iodine or surgical treatment is needed. After surgery, there will be varying degrees of hypothyroidism, and long-term thyroid hormone replacement therapy will be needed to maintain normal metabolism.

Hyperthyroidism is more serious and not timely treatment, or inadequate treatment of patients may occur thyroid crisis, the death rate is more than 20%, the cause of death is mostly due to hyperthermia and hypothyroidism, cardiac failure, pulmonary edema, severe water, electrolyte metabolic disorders.

66% of patients with symptoms of proptosis can be reduced after treatment and usually recover in 6 months to 3 years, 20% have no change and 14% will worsen.

Harmfulness

Hyperthyroidism can affect multiple systems throughout the body, such as the mental system, cardiovascular system, digestive system, musculoskeletal and skin.

Hyperthyroidism can affect bone decalcification and osteoporosis occurs.

Proptosis will occur, affecting the patient’s appearance, and even some patients will have diplopia and blindness.

Presence of anterior tibial mucous edema will cause thickening of the skin of the lower legs, with orange peel and bark-like changes.

It can lead to thyrotoxic heart disease, which can cause heart failure, and may induce pre-existing ischemic heart disease (angina pectoris, myocardial infarction) and heart failure.

The emergence of thyroid crisis untreated may be life-threatening.

Hyperthyroidism in pregnant women can lead to miscarriage, preterm labor, pregnancy-related hypertension, low-birth-weight babies, intrauterine growth restriction of the fetus, stillbirth, thyroid crisis, and heart failure.

Daily

Daily Management

Dietary management

A high-calorie, high-protein, high-vitamin, low-iodine, low-fiber diet should be adopted, and attention should be paid to hydration.

Staple food should be rice and noodles and in sufficient quantity to satisfy the body’s ability to accelerate metabolism.

High-quality proteins such as milk, eggs, lean meat (beef, etc.) and soybean products can be added to correct the negative nitrogen balance in the body and alleviate body wasting and muscle atrophy.

Consume more fresh vegetables and fruits, especially foods rich in B vitamins and vitamin C, such as unrefined coarse grains, animal liver, nuts, strawberries and oranges.

Try to consume non-iodized salt to ensure the synthesis of thyroid hormones.

Reduce the intake of foods with high fiber content such as celery and sweet potatoes to reduce the frequency of bowel movements.

Prohibit the intake of stimulating foods and beverages, such as strong tea and coffee, to avoid mental excitement.

Eat more food rich in calcium, phosphorus and other minerals such as yogurt, cheese and nuts as appropriate, and sunbathe more to prevent osteoporosis; for those with low blood potassium, eat more apples and bananas.

Drink more water, drink 2000~3000 ml of water per day to replenish the water lost from sweating, diarrhea, accelerated respiration, etc. However, those with concurrent heart disease should avoid drinking a lot of water to prevent aggravating edema and causing heart failure.

Exercise management

Mild activities such as walking, tai chi and yoga can be chosen to avoid strenuous exercise.

Those with heart failure or severe infection should rest in bed and should not exercise.

Others

Avoid iodine-containing drugs and iodine-containing contrast media, as well as traditional Chinese medicines such as oyster, kombucha and danshen.

Avoid smoking, including second-hand smoke, which is associated with the development of eye disease and can worsen the condition.

Enhance self-protection, the collar of the upper garment should be loose to avoid compressing the thyroid gland, and squeezing the thyroid gland with hands is strictly prohibited.

Appropriately increase rest time, maintain sufficient sleep, avoid staying up late to prevent aggravation of the condition.

Elevate the head when sleeping or resting to reduce postbulbar edema and eye distension.

Wear dark glasses when going out to reduce glare, dust and foreign objects on the eyes.

Learn ways to control emotions and reduce stress, and handle life’s emergencies correctly.

Avoid infection, severe mental stimulation, trauma and other factors that trigger thyroid crisis.

Check your own pulse every morning before waking up and measure your weight regularly.

Disease monitoring

Measure your pulse every morning before getting up.

Regular weight measurement.

Follow-up

Long-term follow-up after treatment is necessary to observe the effect of treatment and to detect complications in time.

Regularly check thyroid function and liver function according to the doctor’s instructions.

Pay attention to your own physical condition. If you develop high fever, nausea, vomiting, unexplained diarrhea, or worsening of protruding eyes, etc., you should be alert to the possibility of thyroid crisis and should consult a doctor in time.

Prevention

Reasonable diet