Treatment of hyperthyroidism
The most common approach is anti-thyroid medication, which lowers thyroid hormone levels. The hyperthyroid state may eventually go away, but many people will need to continue taking the medication for a long time. Other medications are used for symptomatic conditions, such as rapid pulse and tremors. Another treatment option is radioactive iodine, which can destroy the thyroid gland within 6-18 weeks. Once the thyroid gland is destroyed, or surgically removed, most patients must again take pills of thyroid hormone.
Surgical treatment of thyroid disorders
Removal of the thyroid gland can treat hyperthyroidism, but only if medication has failed or if the thyroid gland is enlarged. Surgical treatment is also indicated for people who have a combination of thyroid nodules. Once the thyroid gland is removed, most patients will need daily thyroid hormone supplementation to avoid developing hypothyroidism.
Knowledge about nail cancer
Nail cancer is rare and least lethal. The main symptom is a swelling or lump in the neck, and less than 10% of thyroid nodules will be cancerous. When nail cancer is diagnosed, the most common treatment is surgery, followed by radioactive iodine or external irradiation therapy.
What is hyperthyroidism?
Hyperthyroidism refers to a state in which an overactive thyroid gland produces large amounts of thyroid hormones into the bloodstream. Toxic goiter is a state of intoxication, caused by an excess of thyroxine produced from any cause. It can be an excess absorption of thyroxine or an excess production by the thyroid gland itself. These terms are often confused by doctors and patients, but in this set we use the term “hyperthyroidism”.
What is thyroid hormone?
Thyroid hormones promote cellular metabolism. They are produced by the thyroid gland. The thyroid gland is located in the lower neck, below the thyroid cartilage. The gland wraps around the trachea and is shaped like a butterfly, connected by two wings (lobes) and a middle part (isthmus). The thyroid gland takes iodine from the blood (mostly from food such as seafood, bread, salt) and uses it to produce thyroxine.
Thyroid hormone regulation-command axis
The thyroid gland itself is regulated by another gland in the brain, the pituitary gland. In turn, the pituitary gland is partially regulated by thyroxine in the blood (feedback regulation of the pituitary gland by thyroxine) and partially regulated by another gland, the hypothalamus, also located in the brain. The hypothalamus secretes a hormone called thyrotropin-releasing hormone (TRH), which signals the pituitary gland to secrete thyrotropin (TSH). Next, TSH stimulates the thyroid gland to secrete thyroxine. If any of these three glands are overactive, too much thyroid hormone may be produced, which in turn leads to hyperthyroidism. The production of thyroid hormone is regulated by the pituitary gland. If there is too little thyroid hormone in circulation to meet functional needs, the pituitary gland releases TSH, which stimulates the thyroid gland to produce more hormone. The opposite is true.
What causes hyperthyroidism?
Common causes include
Graves’ disease
Functional adenomas (“hot nodules”) and toxic multinodular goiter (TMNG)
Excessive absorption of thyroid hormones
Abnormal secretion of TSH
Thyroiditis (inflammatory disease of the thyroid gland)
Excessive iodine uptake
Let’s look at each of these conditions next
Graves’ disease
Graves’ disease, caused by overactive thyroid function, is the most common cause of hyperthyroidism. In this condition, the thyroid gland is often uncontrolled, meaning that it loses its response to the regulation of the pituitary gland through TSH. The condition is hereditary and is more prevalent in women, about five times more often than in men. Diagnosis of Graves’ disease requires nuclear scans and serologic testing. It often has ocular (Graves’ ophthalmopathy) and cutaneous (Graves’ dermopathy) lesions.
Functional adenoma and toxic multinodular goiter
The thyroid gland becomes nodular with age (as do many other parts of the body). In most cases, these nodules do not produce thyroxine and do not require treatment. Occasionally, a nodule may become “autonomic”, meaning that it no longer responds to pituitary regulation via TSH and produces thyroid hormone independently. this is especially true for nodules over 3 cm. When a single nodule produces thyroid hormone independently, it is called a hyperfunctional nodule. If there are multiple such nodules, it is called a toxic multinodular goiter. Functional nodules are easily detected by thyroid scans.