Q: Which group of people are prone to hyperthyroidism?
A: Hyperthyroidism is a common endocrine disease. Women are more prone to hyperthyroidism, and clinically there are significantly more female patients than male. There are many causes of hyperthyroidism, mainly caused by abnormal immune function, in addition to female childbirth (pregnancy, childbirth, abortion); mental factors, high temper, impatience, petty, suspicious, etc. can also cause hyperthyroidism; age factors, adolescents and menopausal people are prone to hyperthyroidism. Work pressure and living environment are the triggers of hyperthyroidism. Being under high tension for a long time and over-intensive labor may be the triggers of hyperthyroidism.
Q: How should hyperthyroidism be treated?
A: There are three types of treatment for hyperthyroidism: medical medication, iodine-131 therapy and surgical treatment. The doctor will determine the treatment plan according to the patient’s specific situation as to what type of treatment the patient should use. For example, patients with mild hyperthyroidism, incipient hyperthyroidism, and insignificant goiter can first choose internal medication. The course of medical treatment is long, taking one and a half to two years. Patients need to adhere to the medication and follow up regularly. In the first six months before taking the medication, they usually go to the hospital every half month or month to check their thyroid function and test their blood picture every week, which is a bit tedious, so not many patients can adhere to the treatment.
If the thyroid gland has more than second degree enlargement, or if the hyperthyroidism is not cured by taking internal medicine for more than two years, you should choose iodine-131 treatment. In North American countries, iodine-131 treatment is the preferred treatment for adult hyperthyroidism, and in China, more and more hyperthyroid patients are starting to choose iodine-131 treatment. For patients with poor medical conditions and in remote areas, it is better to choose iodine-131 treatment. In the absence of a thyroid mass, iodine-131 can achieve the same effect as surgery, and most patients can achieve eradication through one treatment, avoiding the trouble of long-term medication, while the treatment is simple and has no obvious toxic side effects.
Surgery is generally not preferred. Those with uniform enlargement of the thyroid gland without exact masses or lumps that cannot be cured by medication generally choose iodine-131 treatment; if the thyroid gland has masses or nodules and medication is not effective, iodine-131 treatment will not be very effective, and surgery should generally be chosen.
Q: What are the risks of surgical treatment?
A: The risk is that there are complications of surgery. Surgery may injure the recurrent laryngeal nerve, which may lead to vocal cord paralysis and hoarseness, or it may injure the parathyroid gland, which is a gland close to the thyroid gland. If the parathyroid gland is injured and the parathyroid gland is not functional enough, patients may develop hypocalcemia, tingling of the lips, and cramps in the hands and feet.
Q: What kind of patients are absolutely not suitable for iodine 131 treatment?
A: 1. Pregnant women cannot have iodine-131 treatment. If pregnant women have iodine-131 treatment, iodine-131 may affect the growth and development of the fetus after entering the body.
2. Women who are breastfeeding cannot have iodine-131 treatment, as iodine-131 may enter the child’s body through breast milk.
Q: Are there any obvious clinical symptoms of hyperthyroidism recurrence after Iodine-131 treatment, and how often should I review them?
A: When hyperthyroidism relapses after iodine-131 treatment, symptoms of hyperthyroidism will appear again, but they are usually less severe than those before treatment. If a recurrence of hyperthyroidism is confirmed, another iodine-131 treatment should be considered.
The nail function should be rechecked 3 months after Iodine-131 treatment, because the efficacy of Iodine-131 is mainly concentrated in the first 3 months, when the recheck can determine whether the hyperthyroidism is controlled or cured. Regular review can detect hypothyroidism in time and provide thyroxine replacement therapy in time to help restore thyroid function.
Q: Why do some patients with hyperthyroidism relapse after being cured? What are the reasons?
A: The recurrence rate of iodine-131 therapy and surgery for hyperthyroidism is significantly lower than that of internal antithyroid drug therapy. The recurrence of hyperthyroidism is more often due to the disease itself, but there are also factors outside the disease. If the patient has a regular life, a happy mind and a calm heart, the chances of recurrence of hyperthyroidism will be reduced. If the patient is in a state of long-term strain, tension and mood swings, it is not good for controlling hyperthyroidism and the chances of recurrence are high.
Q: What are the causes of hypothyroidism?
A: There are many causes of hypothyroidism, for example, hypothyroidism may occur after iodine-131 treatment for hyperthyroidism, and Hashimoto’s thyroiditis, where patients have abnormal autoimmune function of the thyroid gland, which is also a cause of hypothyroidism, and thyroid surgery can also cause hypothyroidism.
Q: What are the symptoms of hypothyroidism and what tests are needed?
A: If hypothyroidism occurs after iodine-131 treatment for hyperthyroidism, the symptoms are often more obvious. There will be swollen hands, swollen face, yellow face, excessive weight gain, rough skin, thickened lips, slowed speech, fear of cold, swollen stomach, and a series of other phenomena.
Q: Can a hypothyroid patient get pregnant and have a baby?
A: You cannot get pregnant with hypothyroidism, it will have an effect on the fetus. If a hypothyroid woman wants to have a baby, she must take thyroxine carefully to completely correct the hypothyroidism and consider pregnancy only when her thyroid function is normal and under monitoring.
Q: How should hypothyroidism occur after hyperthyroidism iodine-131 treatment?
A: Patients should detect hypothyroidism as early as possible, and promptly correct hypothyroidism with thyroxine replacement therapy. If hypothyroidism is diagnosed, most hypothyroid patients need long-term thyroxine treatment. As long as the hypothyroidism is completely corrected, the patient’s quality of life is significantly higher than that of those with long-term hyperthyroidism, because thyroxine has no obvious toxic side effects and the patient does not need to run to the hospital frequently.
Q: For patients with hyperthyroidism with proptosis, will the symptoms disappear after treatment?
A: Proptosis is a persistent problem in the treatment of hyperthyroidism, and there is no particularly effective method in the medical field. The principle of treatment is to control hyperthyroidism quickly to help prevent further aggravation of proptosis, because proptosis is a local manifestation of hyperthyroidism in the eyes. Most patients with hyperthyroidism with proptosis have different degrees of relief or even complete return to normal after hyperthyroidism is cured. Most patients with hyperthyroidism with proptosis have varying degrees of relief or even return to normal after cure. If a few patients still have proptosis after cure, they should go to endocrinology and nuclear medicine for further treatment. People with hyperthyroidism should detect and control hyperthyroidism in time to prevent their eyes from becoming protruding.
There is a drug called “Yunque” in nuclear medicine, which is a kind of stable isotope, and this drug is effective in treating proptosis.
Q: How can I detect atypical hyperthyroidism in time?
A: Many patients with atypical hyperthyroidism often go to gastroenterology for indigestion, cardiology for heart problems, or nephrology for swelling, and are found to have hyperthyroidism through nail function tests. Therefore, I suggest that patients with dyspepsia who do not find the cause in gastroenterology, patients with bad heart and patients with swelling who do not find organic changes should go to endocrinology or nuclear medicine to exclude the possibility of hyperthyroidism.
Q: How should hyperthyroid heart disease be treated?
A: Patients with hyperthyroid heart disease need to pay high attention to the fact that if long-term hyperthyroidism is poorly controlled, patients can suffer from heart failure and loss of labor force. The key to the treatment of hyperthyroid heart disease is also to control hyperthyroidism. Once hyperthyroidism is well controlled, the heart condition will be relieved to a great extent, for example, if there was atrial fibrillation before, after controlling hyperthyroidism, atrial fibrillation may disappear; if there was left heart enlargement before, after controlling hyperthyroidism, the heart growth will also be relieved. If the thyroid heart disease is more serious, with serious symptoms such as heart failure, in addition to anti-thyroid medication or iodine-131 treatment, a cardiologist will need to cooperate with the treatment.
Q: Which treatment will be effective in treating hyperthyroidism complications?
A: Patients with hyperthyroidism who have had the disease for a long time, have heavy hyperthyroidism and cannot be effectively controlled for a long time are prone to complications, which will be better treated with Iodine-131. If hyperthyroidism is not well controlled and accompanied by serious complications, such as hyperthyroid heart disease, the prognosis will be very poor if iodine-131 treatment is not given in time or if treatment is abandoned.
Q: Is medication or surgery an option for hyperthyroid heart disease?
A: Generally speaking, patients with hyperthyroid heart disease are less effective with medication alone, and it is even more difficult to have surgery because of poor heart function. In comparison, Iodine-131 treatment is more suitable.