Guidelines for the treatment of hyperthyroidism (hyperthyroidism)
The thyroid gland and its functions
The thyroid gland is divided into two lobes and is located in the front of the neck under the thyroid cartilage, on either side of the trachea, and is shaped like a butterfly. The adult thyroid gland weighs about 15-25 grams and cannot be clearly seen or easily felt under normal circumstances. There are four parathyroid glands on the back of the two lobes of the thyroid gland and important structures around the thyroid gland such as the recurrent laryngeal nerve and the superior laryngeal nerve.
The thyroid gland has the function of synthesizing, storing and secreting thyroid hormones (T3 and T4). The main functions of thyroid hormones are 1. to increase the breakdown of protein, fat and sugar, to increase the production of heat; to promote human growth and development. Normal people need a certain amount of thyroid hormones to maintain normal physiological functions.
Hyperthyroidism (hyperthyroidism)
Hyperthyroidism is the result of an abnormally high level of thyroid hormones in the patient’s blood. It can be divided into five categories according to the cause, among which toxic diffuse goiter (Graves’ disease) is the most common, with an age of onset of 20-40 years and significantly higher in women than in men.
The common clinical manifestations of hyperthyroidism are.
1. enlargement of the thyroid gland, i.e., thickening of the “neck”.
2. Protrusion of the eyeballs.
3. Hyper-synthesis, manifested as fear of heat and sweating, panic and fatigue, hyper-appetite, thinning, short temper and hand tremors, etc., which may not be typical in elderly people.
Diagnosis of hyperthyroidism: Nuclear medicine can provide accurate and reliable diagnosis of hyperthyroidism. For first-time patients, a comprehensive examination of thyroid function should be performed to make an accurate diagnosis.
The routine tests are
1.Serum thyroid hormone measurement
2.Iodine uptake measurement of the thyroid gland
3. Thyroid nuclear scan
Treatment options for hyperthyroidism include
1.Medical anti-hyperthyroidism drug treatment
2.Surgical treatment
3.Isotope 131 iodine treatment
All three types of treatment are effective, but surgery is rarely used due to the risk of trauma. Internal anti-hyperthyroidism medication is the most widely used, but it can only achieve a 40-60% cure rate, and the recurrence rate of hyperthyroidism is high after stopping medication. The most common side effects are leukopenia, liver toxicity, and the most serious and life-threatening one is granulocyte deficiency. The cure rate of 131 iodine treatment for hyperthyroidism is positively correlated with the dose of 131 iodine treatment. The cure rate of 131 iodine treatment is positively correlated with the dose of 131 iodine treatment. The overall cure rate is over 80%, the failure rate is 2%-4%, and the relapse rate is 1%-4%. The best results are achieved in patients with diffuse goiter with moderate hyperthyroidism.
Isotope 131 radioactive iodine treatment for hyperthyroidism
Why can radioisotope 131 iodine treat hyperthyroidism?
The reason why 131 iodine can treat hyperthyroidism is that most of the 131 iodine enters the body and accumulates in the thyroid gland, releasing beta radiation during the decay of 131 iodine. This ray has a range of only 2 mm in the thyroid gland, and the energy it releases can destroy the hyperfunctional thyroid tissue and shrink the enlarged thyroid gland as if it had undergone an operation. Therefore, 131 iodine treatment for hyperthyroidism has been described as “bloodless surgery”. Through thyroid hormone measurement, thyroid function tests, and the combination of thyroid size and degree of hyperthyroidism, patients are given a certain amount of 131 iodine, which destroys part of the hyperfunctional thyroid tissue while preserving part of the normal thyroid tissue, to treat hyperthyroidism. Generally speaking, more than 80% of patients with hyperthyroidism can have their symptoms and signs rapidly controlled and cured by 131 iodine treatment.
Indications for radioisotope 131 iodine treatment of hyperthyroidism
1. Age 20 years or older, moderate degree of hyperthyroidism.
2. Patients who are allergic to antihyperthyroid drugs and cannot continue to use them, or whose long-term treatment is ineffective, or who relapse after treatment.
3. Combination of heart, liver and kidney diseases that are not suitable for surgery, or relapse after surgery, or those who do not want to operate.
4.Some high-functioning nodules with hyperthyroidism.
Safety of radioisotope 131 iodine treatment for hyperthyroidism
In most cases, the radioactive dose to the thyroid gland only causes destruction and occlusion of the thyroid tissue, and most of the thyroid cells are killed rather than mutated.
On the question of whether 131 iodine treatment of hyperthyroidism induces thyroid nodules, cancer and genetic complications, from decades of follow-up reports and an extensive literature review, no convincing evidence has been found to date that the treatment increases the risk of nail and other carcinomas, leukemia, infertility, preterm birth, miscarriage, birth defects and genetic complications.
What is the diagnosis and treatment of hypothyroidism after radioisotope 131 iodine treatment for hyperthyroidism?
Hypothyroidism can occur regardless of the method of treatment for hyperthyroidism, so hypothyroidism is not unique to radioisotope 131 iodine treatment.
Clinical manifestations of hypothyroidism: fear of cold, low sweating, dry skin, swelling, tight skin, loss of appetite, bloating, constipation, joint inflexibility, muscle aches, drowsiness and mental depression.
Diagnosis of hypothyroidism: The current diagnosis of hypothyroidism is very accurate and reliable, and can be made by measuring thyroid hormones (T3, T4, TSH) in venous blood.
Treatment of hypothyroidism: In the case of hyperthyroidism treated with isotope 131 iodine, the incidence of permanent hypothyroidism increases at a rate of 1-3% per year, which is not related to the dose of the radioactive drug given, but to the patient’s sensitivity to the drug or autoimmune reaction. There is no method to prevent its occurrence, so the key to cure hyperthyroidism is regular checkups for early detection and timely treatment. Replacement therapy is a simple, safe, cost-effective and side-effect-free treatment.
Preventive and dietary principles of hyperthyroidism
Avoid mental triggers, learn to relax and don’t put too much pressure and burden on yourself. A regular life, combined with work and rest, is good for preventing the onset of the disease.
2, for the external use of drugs caused by hyperthyroidism, as long as to avoid inappropriate or abuse of thyroid preparations or iodine-containing drugs can completely prevent the occurrence of medical hyperthyroidism.
3.Eating a moderate diet should be high in calories. High protein. High vitamin. Food should be soft, easy to digest and rich in nutrients. In general, it is advisable to eat light vegetables, fruits with high vitamin content and nutritious lean meat, chicken, eggs and freshwater fish, etc. In addition, it is very important for hyperthyroidism patients to have a moderate diet, avoid overeating and pay attention to dietary hygiene.
4. Reduce the intake of iodine-containing foods, such as kelp, seaweed, nori, etc. Avoid using iodized salt or switch to non-iodized salt.
5. Be cautious of using warm supplements and prescriptions with high iodine content. Forbid the use of kombu, kelp and seaweed with high iodine content.
6.Women who are planning to get pregnant should discuss with their physicians first to decide the timing and whether to adjust the treatment method.
7. Eat less stimulating food, especially coffee and tea, to avoid aggravating symptoms such as palpitations and hand tremors.
The diet and life conditioning of hyperthyroidism patients are crucial. Only by supplying enough calories, proteins, carbohydrates and vitamins every day to supplement their consumption, can the nutritional status of the whole body be improved. Therefore, the diet of hyperthyroidism patients should pay attention to:
1. Increase the supply of calories: Sufficient carbohydrates should be given daily to correct overconsumption. However, we should avoid excessive intake at one time. The correct approach is to increase the number of meals, and in addition to the normal three meals, we can increase two to three meals, generally 5 to 6 meals a day.
2, to ensure protein supply: excessive thyroid secretion can accelerate protein decomposition, so the amount of protein supply should be higher than normal, according to 1.5-2.0 grams per kilogram of body weight per day, because animal protein has a stimulating excitatory effect, should eat less, to soy and other vegetable protein.
3, vitamin supply: hyperthyroidism patients should use more foods rich in vitamin B1, B2 and vitamin C, eat appropriate animal offal, eat more fresh green leafy vegetables, and supplement vitamin preparations if necessary.
4. Mineral supplementation: Hyperthyroidism patients should increase their mineral intake, especially potassium, calcium and phosphorus, etc. If they have diarrhea, they should pay more attention to it.
5.Limit dietary fiber: Hyperthyroidism patients should limit the food with more dietary fiber because thyroid hormones and catecholamines cause excitement in the digestive system and enhance gastrointestinal peristalsis, which is often accompanied by increased bowel movements or diarrhea.
6, avoid iodine food and drugs: iodine is the raw material for the synthesis of thyroid hormone, so you should avoid using foods containing high iodine such as kelp, nori, sea fish, shrimp, hairy vegetables, etc., avoid using certain iodine-containing drugs such as acetaminophen iodofurone, etc., and various iodine-containing contrast agents should also be used with caution.
7, avoid eating spicy stimulating food: such as chili, onion, ginger, garlic, etc.
8, avoid smoking, drinking alcohol, drinking less coffee, strong tea and other stimulating drinks.
9, for patients with proptosis should wear dark glasses when going out to prevent bright light and dust to stimulate the eyes, sleep with a proper pillow, low salt diet or supplemented with diuretics can reduce eye edema.
10. Keep your mood relaxed: avoid excessive fatigue, mood swings, trauma and infection.