Hyperthyroidism is an abbreviation for hyperthyroidism, which is a clinical syndrome caused by excessive secretion of thyroid hormones due to various etiologies, resulting in increased excitability and hyper-metabolism of the nervous, circulatory and digestive systems. It is a very common endocrine disease. Clinically, patients with hyperthyroidism mainly manifest as panic attacks, fear of heat and sweating, fatigue and weakness, hyperphagia, weight loss, increased frequency of stools or diarrhea, emotional agitation, anxiety, insomnia and nervousness, lack of concentration, slight tremor when extending the tongue or holding the hands forward, scanty menstruation or even amenorrhea in women, and impotence in men.
The cause of hyperthyroidism in Graves’ disease is still unclear, but it may be due to the production of anti-TSH receptor antibodies (TRAb) caused by genetics, infection, immunity and other factors, resulting in excessive synthesis of thyroid hormone, which “overflows” into the blood when it exceeds the storage capacity of the thyroid follicles. When it exceeds the storage capacity of the thyroid follicles, it “overflows” into the blood, and the level of thyroid hormone in the blood rises, leading to hyperthyroidism. Other disorders in which excessive hormone production causes hyperthyroidism include toxic multinodular goiter, autonomously high-functioning adenoma of the thyroid, and pituitary hyperthyroidism. It is important to note that some patients clinically present with symptoms of hyperthyroidism, but the cause is a transient hyperthyroidism due to destruction of the thyroid follicles by inflammation (e.g., subacute thyroiditis, Hashimoto’s thyroiditis, etc.) and the excessive release of stored thyroid hormones in the follicles, called destructive thyrotoxicosis. Therefore, after the onset of hyperthyroidism symptoms we should check for.
① Thyroid function: to clarify if it is hyperthyroidism. elevated T3, T4, FT3, FT4 and significantly decreased TSH clarify hyperthyroidism.
(2) Antibody testing: To determine which type of hyperthyroidism is present, TRAb is an excitatory antibody, which is the causative antibody for Graves’ disease, and elevated antibodies can diagnose Graves’ disease; TPOAb and TGAb are destructive antibodies, which destroy the thyroid follicles and lead to transient hyperthyroidism with excessive release of thyroid hormones. (A high level of these two antibodies represents a Hashimoto factor, and a puncture is required to confirm a diagnosis of Hashimoto’s nail infection.) If both excitatory and destructive antibodies are present, TRAb is predominant and it is still Graves’ hyperthyroidism.
③Thyroid ultrasound: to clarify the presence of enlargement and nodules in the thyroid gland.
④Thyroid 131I uptake rate: 131I uptake rate is increased in Graves’ disease and decreased in Hashimoto’s thyroiditis. In primary hyperthyroidism, when TRAb cannot be measured, an increased 131I uptake rate can clearly indicate Graves’ hyperthyroidism with excessive thyroid hormone synthesis. In addition, in patients with nodular hyperthyroidism, isotope ECT scan can exclude hyperthyroidism caused by high-functioning adenoma.
After a clear diagnosis of Graves’ hyperthyroidism, besides medication, daily lifestyle and diet also play a vital role in the regression of the disease, therefore, we summarize the precautions for patients with Graves’ hyperthyroidism into the following four points.
I. Absolute avoidance of iodine
Iodine is the main raw material for the production of thyroid hormones, and excessive iodine intake can lead to aggravation or prolongation of hyperthyroidism. Absolute avoidance of iodine we should do
① Avoid all seafood and try to eat non-iodized salt. The daily intake of iodine for normal people is 150 micrograms/day, while for hyperthyroidism it should be less than 50 micrograms/day. We classify iodine-containing foods into three classes. The first class contains thousands to tens of thousands of micrograms of iodine per 100 grams, including: kelp (kombu), nori (seaweed), moss strips, jellyfish, etc. The second class contains hundreds to thousands of micrograms of iodine per 100 grams, including: sea crabs, shellfish from the sea, etc. The third category contains more than tens to hundreds of micrograms of iodine per hundred grams, including: sea fish, sea shrimp, etc.; and the iodized salt generally contains about 20-30 micrograms per gram of salt. Therefore, all seafood is highly iodized food relative to hyperthyroidism patients, and iodized salt should be avoided as much as possible.
② Reduce the opportunity to eat out. The salt used in restaurants is usually iodized salt, and with the same frying pan, we cannot guarantee that the last customer ordered is not seafood, and it is inevitable that a large amount of iodine is mixed into the food during the cooking process.
③ Avoid using medicines and cosmetics that contain iodine. Drugs include: amiodarone, an anti-arrhythmic drug; contrast agent for CT enhancement; iodine for disinfection; iodine-containing vitamin tablets (including Sun Cun, Jin Shier Kang, etc.); cosmetics and other cosmetics include: face wash, shampoo, mask, foot bath powder, etc. containing seaweed ingredients.
④ Avoid traveling to coastal cities. The speciality of coastal cities is seafood, and it is impossible to avoid the intake of large amounts of iodine during the course of tourism and dining, and it can even be said that there is a lot of iodine in the sea breeze. In short, we should try to avoid excessive intake of iodine in our life (in terms of food, use and play), and “absolutely avoid iodine”.
When hyperthyroidism occurs after pregnancy, as long as the TRAb is positive, iodine should be absolutely avoided; Graves’ disease hyperthyroidism is a result of desperate iodine intake and desperate production of thyroid hormones, resulting in an excess of hormones, so iodine (raw materials) should not be added. The fetal thyroid gland has not yet developed and what it really needs is the mother’s FT4 (finished product). As long as the mother’s nail function is normal and Ft4 is sufficient, the fetus will not be iodine deficient. Even if the thyroid hormone level of the hyperthyroid mother decreases later due to the effect of hyperthyroidism medication, the supplement should be eugenol, etc. (L-T4), which is the finished product, not the raw iodine.
In terms of diet hyperthyroidism patients should also pay attention to.
① Stimulating foods (e.g. spicy foods, coffee, strong tea, etc.): Hyperthyroid patients can have symptoms of sympathetic excitement such as panic, fear of heat, mental excitement, insomnia, etc. Stimulating foods can lead to aggravation of the above symptoms and should be avoided until thyroid function is fully controlled. In addition, certain cold medicines, such as Tylenol. It is because these drugs contain pseudoephedrine, which can lead to an increased heart rate, and can be taken after thyroid function is controlled.
Calcium: High metabolism is one of the characteristics of hyperthyroidism, therefore, middle-aged and elderly patients with osteoporosis should pay attention to calcium and vitamin D supplementation.
③Vitamins: Hyperthyroidism patients are extremely prone to vitamin deficiency. In addition, hyperthyroidism itself and the application of anti-thyroid drugs in hyperthyroidism treatment cause a decrease in white blood cells, which also requires increased vitamin supplementation.
Avoid infection
The low total white blood cell count and granulocyte count in hyperthyroid patients can easily lead to infections. If infection occurs, it may cause the relapse or aggravation of controlled hyperthyroidism, or even the emergence of hyperthyroid crisis. Studies have shown that infections can increase TRAb and prolong the course of hyperthyroidism. Therefore, it is important to learn to prevent all kinds of infections, and once the signs of infections are detected, they should be treated early, and it is not recommended to rely on one’s own resistance to resist.
Three, pay attention to rest
Patients with hyperthyroidism should not stay up late and engage in strenuous activities such as long-distance running, swimming and mountain climbing. In addition, some patients with hyperthyroidism may have protruding eyes, which paralyze the extra-ocular muscles and cause visual fatigue and eye swelling. After reading books and newspapers for a long time, especially after watching TV, the eyes often feel swollen and painful. Therefore, patients with this disease should pay attention to reducing eye irritation and visual fatigue.
Four, follow the doctor’s instructions for medication
At present, antithyroid drugs are still the basic treatment for Graves’ hyperthyroidism. They do not destroy the follicular structure of the thyroid gland, are safe and effective, have reversible effects, and do not cause permanent hypothyroidism. However, drug treatment is a long-term process, with an average treatment time of two years. In particular, regular follow-up visits are needed to adjust the drug dose within six months after the onset of the disease, and some patients may experience liver function damage and a decrease in white blood cells, so regular blood and liver function checks are needed at the early stage of hyperthyroidism to understand whether there are any drug side effects. This requires the full cooperation of patients, regular treatment, and taking medication as prescribed by the doctor in order to achieve the expected therapeutic effect.