I. What is hyperthyroidism?
Hyperthyroidism is a disease caused by increased secretion of thyroid hormones in the body due to various causes, resulting in increased excitability and hypermetabolism of multiple systems, such as nerves, circulation and digestion.
Hyperthyroidism is a common endocrine disorder with a prevalence of 0.5%-1%.
Etiology of hyperthyroidism
The etiology of hyperthyroidism is complex and generally results from a variety of factors, including genetic background (or susceptibility genes), viral infection, autoimmunity, and increased iodine intake.
Clinical manifestations of hyperthyroidism
Clinical manifestations of hyperthyroidism may include: fear of heat, excessive sweating, easy hunger, excessive eating, weight loss, palpitations, hand trembling, increased frequency of stools, hair loss, menstrual disorders or even menopause in women, excitement, sexual anxiety, irritability and insomnia, fatigue and even periodic weakness of limbs. It is mostly accompanied by thickening of the neck or protruding eyes, and mucinous edema in front of the tibia.
Severe hyperthyroidism may manifest as high fever, nausea, vomiting, diarrhea or depression, poor eating, significant wasting and weakness.
The danger of hyperthyroidism: long-term uncontrolled hyperthyroidism may lead to heart enlargement, arrhythmia and heart failure, and liver function damage; in serious cases, hyperthyroid crisis may occur.
What kind of tests should be done for suspected hyperthyroidism?
1. Thyroid function: To clarify the presence of hyperthyroidism;
2. Thyroid-related antibodies: to clarify whether there are autoimmune factors in hyperthyroidism and to guide the use and discontinuation of medication;
3. Thyroid iodine uptake rate: It can be distinguished from thyroiditis and can guide the diagnosis and treatment;
4. Blood routine: to understand whether there is a decrease in white blood cells in the blood, which can guide the treatment;
5. Liver function: to understand whether there is any abnormality in liver function, which is of guiding significance for treatment;
6.Electrocardiogram: to understand whether there are arrhythmias;
7. Cardiac ultrasound: to understand whether the heart has enlarged and cardiac function;
8. Thyroid ultrasound: to understand whether the thyroid gland is enlarged, whether there are nodules or masses, and blood flow, which is meaningful for the treatment;
9. Thyroid imaging: It can help to identify the nature of thyroid nodules or masses, and help to calculate the amount of 131 iodine for those who intend to undergo 131 iodine therapy.
V. Treatment of hyperthyroidism
At present, there are three treatment methods for hyperthyroidism.
1.Medical treatment
There are two main drugs in common use: methimazole (Tabazol/Sage) or propylthioxypyrimethamine.
Advantages.
(1) The efficacy of the drug is certain, and the effect can be seen in about 2 weeks after taking it, and the symptoms can be significantly relieved in about 1-2 months;
(2) relatively small side effects, high safety, no permanent hypothyroidism.
Disadvantages.
(1) The course of treatment is long, ideally about 1.5-2 years, some patients longer;
(2) Relapse rate is high after stopping the drug, about 20-40%;
(3) It is required to follow the doctor’s prescriptions, weekly blood tests in the early stage of treatment, and rechecking nail function and liver function every 1-2 months, and rechecking 2-3 months in the stable stage of treatment and maintenance period to adjust the dosage;
(4) Common side effects include: rash, skin pruritus, with an incidence of about 10%; rare side effects include: granulocyte deficiency, with an incidence of about 0.3%; toxic liver disease, with an incidence of 0.1%-0.2%; rare side effects include: vasculitis, etc. Adverse reactions should be reported to the doctor immediately.
2.131 iodine treatment
Principle.
The radioactivity of 131 iodine is used to destroy the thyroid cells and reduce the secretion of thyroid hormones.
Advantages.
Simple and safe, one-time dose, efficiency up to about 90%, low recurrence rate.
Disadvantages.
(1) Early stage may lead to transient aggravation of hyperthyroidism and even induce thyroid crisis; there is a risk of aggravation of proptosis. Therefore, for severe hyperthyroidism and severe proptosis, 131I therapy is recommended after control and stabilization.
(2) Permanent hypothyroidism.
The incidence is high, reportedly increasing by 5% per year, reaching 30% in 5 years and up to 40%-70% in 10 years. Once it occurs, it needs to take thyroxine replacement therapy for life and cannot be stopped.
3.Surgical treatment
Principle.
Surgery is used to remove most of the thyroid tissue so that thyroid hormone secretion is reduced.
Advantages.
High efficiency, low recurrence rate, mainly for people with thyroid lumps or nodules, with malignant or malignant tendency.
Disadvantages.
(1) Invasive, with some surgical risk;
(2) High cost and surgical scars;
(3) There is also a chance of recurrence and permanent hypothyroidism.
The above three treatment methods have their own advantages and disadvantages and can be freely chosen. However, please consult a specialist for liver function impairment, leukopenia, recurrent hyperthyroidism, pregnancy, etc.
VI. Hyperthyroidism and pregnancy
(1) If the patient’s hyperthyroidism is not controlled, it is recommended not to get pregnant. Because uncontrolled hyperthyroidism increases the incidence of miscarriage, preterm delivery, pre-eclampsia, placental abruption, etc., and increases the risk of preterm birth, intrauterine growth retardation, and small full-term babies, and can cause fetal or neonatal hyperthyroidism.
(2) If the patient is receiving oral medication, blood FT3 and FT4 reach normal range, stop oral medication or apply the minimum dose of medication, pregnancy is possible.
(3) Internal oral medication is the first choice for controlling hyperthyroidism during pregnancy, and thyroid surgery can also be performed in the fourth to sixth month of pregnancy.
(4) Those who are treated with 131 iodine for hyperthyroidism should pay attention to contraception for at least 6 months.
(5) It is recommended to check thyroid function before pregnancy.
VII. Hyperthyroidism and proptosis
(1) Some patients with hyperthyroidism may have proptosis, which may include swollen eyelids, photophobia, tearing, dryness, foreign body sensation, diplopia, or even loss of vision, etc. In severe cases, the eyes may protrude significantly and cannot close completely, resulting in corneal ulcers.
(2) Some patients with proptosis may have normal nail function, or hyperthyroidism may occur after several years of proptosis.
(3) Treatment of proptosis can be hormone shock therapy, orbital radiotherapy or hormone combined with orbital radiotherapy, or surgery if conservative treatment is ineffective.
8. Precautions
The following points should be noted after the occurrence of hyperthyroidism.
Iodine prohibition: Hyperthyroidism is not iodine deficiency, but iodine intake should be limited. Avoid eating kelp, seaweed, seafood and other foods and iodine-containing drugs as much as possible.
Quit smoking: smoking can aggravate the disease.
Pay attention to rest and avoid overexertion, and you can supplement calories and nutrition appropriately.