1. What is hyperthyroidism?
Hyperthyroidism is hyperthyroidism, which means “high” – an increase in thyroid hormones (T3 and T4). The increase in thyroid hormones causes the patient to feel very uncomfortable.
2. Do I have hyperthyroidism?
The clinical manifestations of hyperthyroidism vary, and the more typical manifestations may include one or more of the following.
(1) Hypermetabolic syndrome: fear of heat, excessive sweating, moist skin, excessive eating, weight loss, easy fatigue, etc.
(2) Symptoms of increased excitability of the nervous system: impatience, easily agitated, easy to lose temper, insomnia, dreaminess, easy to wander, hand tremors visible with hands held flat, tongue tremors visible with tongue extension.
(3) Enlarged thyroid gland: manifested as a swelling in front of the neck. When touched (please move gently), the swelling feels soft or somewhat hard in texture, and it moves up and down when swallowing saliva.
(4) Eye protrusion: Mostly bilateral eye protrusion, a few are unilateral. The manifestations are: foreign body sensation, stinging pain, photophobia, tearing, conjunctival congestion, abnormal vision, limited eye movement, and difficulty in closing the eyes. Severe cases may lead to corneal ulceration and perforation, causing total ophthalmia and even blindness.
5) Symptoms of cardiovascular system: Most patients will have panic and rapid heartbeat, and rapid heartbeat in sleep is the characteristic manifestation of hyperthyroidism, some patients have chest tightness, shortness of breath and increased systolic blood pressure. Some patients may be complicated by atrial fibrillation and cardiac hypertrophy, and a few patients may develop heart failure.
(6) Digestive system symptoms: Patients show hyperphagia, easy hunger, increased stool frequency, and some patients may have impaired liver function.
(7) Motor system symptoms: Patients have varying degrees of muscle weakness and muscle atrophy. When generalized muscle atrophy occurs, it is called chronic hyperthyroid myopathy. It may also be accompanied by periodic paralysis and myasthenia gravis.
8) Sexual dysfunction: Men manifest impotence, women manifest irregular menstruation and scanty menstruation, etc. Patients have decreased fertility.
9) Skin changes: A few patients may develop mucinous edema of the limbs, or/and accompanied by other skin changes.
3. What are the types of hyperthyroidism?
Hyperthyroidism can be divided into the following categories according to the etiology.
(1) Thyroid hyperthyroidism The cause is in the thyroid gland itself, due to excessive production of thyroid hormones by the thyroid cells. (1) diffuse toxic goiter (Graves’ disease); (2) autonomic high-functioning thyroid nodules; (3) multinodular goiter with hyperthyroidism; (4) neonatal hyperthyroidism; (5) iodine hyperthyroidism; and (6) follicular thyroid cancer.
2) Pituitary hyperthyroidism caused by pituitary tumors (TSH cell tumors) and non-pituitary tumors.
3) Hyperthyroidism with tumor Some malignant tumors secrete TSH-like substances and cause hyperthyroidism. For example: choriocapillary epithelial carcinoma with hyperthyroidism, staphyloma with hyperthyroidism, lung cancer and gastrointestinal (stomach, colon, pancreas) cancer with hyperthyroidism.
(4) Ovarian goiter with hyperthyroidism.
(5) Symptomatic hyperthyroidism There are two types of hyperthyroidism, one is thyroiditis, including: (1) subacute thyroiditis, (2) painless thyroiditis, (3) postpartum thyroiditis, (4) Hashimoto’s thyroiditis, and (5) radiation thyroiditis. Another category is pharmacogenic hyperthyroidism.
Among the above-mentioned types of thyroid, diffuse toxic goiter (Graves’ disease) and hyperthyroidism are the most common.
4. What are the treatment options for hyperthyroidism? How should I choose?
The common treatments for hyperthyroidism include medication, surgery and iodine-131 therapy.
(1) Medication for hyperthyroidism Thyroid inhibitors such as tabazol and propylthiouracil are commonly used. These drugs lower thyroid hormone faster, but the disadvantage is that the medication takes a long time, the cure rate is not high, and the recurrence rate is high. Some patients may experience side effects such as hypocellularity and liver function damage. This method is generally considered to be suitable for the following patients: ① mild disease with mild to moderate enlargement of the thyroid gland; ② age below 18 years; ③ hyperthyroidism in pregnancy; ④ old and frail or combined with severe heart, liver and kidney function impairment who cannot tolerate surgery; ⑤ adjuvant treatment before and after iodine-131 therapy; ⑥ preoperative preparation.
2）Surgical treatment The recent results are good, but there are disadvantages such as trauma and scar formation. At present, surgery is most suitable for the following patients: (1) those with particularly obvious goiter, especially with pressure symptoms; (2) those with hyperthyroidism combined with ectopic goiter, such as retrosternal goiter; (3) those with hyperthyroidism and suspected malignant tendency; (4) those who cannot adhere to medication and are not suitable for iodine-131 therapy; (5) those who have failed to take medication and are in a hurry to get pregnant.
(3) Iodine-131 therapy has the advantages of high efficacy, low side effects and low cost, and has become the preferred treatment option for hyperthyroidism in Europe and America.
5.Which patients with hyperthyroidism are suitable for iodine-131 treatment? Which patients are not suitable for this treatment?
According to the guidelines of the Chinese Medical Association Endocrinology Branch and Nuclear Medicine Branch on the diagnosis and treatment of thyroid diseases, the following 9 types of hyperthyroid patients are the best choice for iodine-131 treatment.
1) Age 18 years or older.
2) ineffective anti-thyroid drug therapy, allergy or hypocytosis or impaired liver function, etc.
3) post-operative recurrence of hyperthyroidism.
4) hyperthyroid heart disease or heart disease with other causes.
5) hyperthyroidism with leukocytosis and/or thrombocytopenia or holocytosis.
6) hyperthyroidism in the elderly.
7) hyperthyroidism combined with diabetes mellitus.
8) toxic nodular goiter.
(9) Functional autonomic thyroid nodules combined with hyperthyroidism.
Iodine-131 therapy is contraindicated in the following patients.
(1) Women during pregnancy.
(2) Women who cannot discontinue breastfeeding.
(3) Acute myocardial infarction.
6.Why can Iodine-131 treat hyperthyroidism?
Iodine is a necessary raw material for the synthesis of thyroid hormones by the thyroid gland. The only difference between iodine-131 and iodized salt is that iodine emits rays, therefore, the thyroid gland can absorb iodine-131 to a high degree. Iodine-131 concentrated in the thyroid gland emits charged beta-rays, which have a range of only a few millimeters and therefore do not cause damage to the surrounding thyroid tissue. The beta radiation emitted by iodine-131 kills the increased number of thyroid cells at the cellular level, leaving some of the thyroid cells to maintain normal thyroid function, which some people call “molecular knife therapy”.
7.What are the advantages of iodine-131 treatment for hyperthyroidism?
1) Reliable efficacy 2) Short treatment course
3）Short time required, only 2 days 4）Low cost
5）Less side effects 6）No trauma
8.How effective is iodine-131 in treating hyperthyroidism?
Iodine-131 has been used to treat hyperthyroidism since 1942, and former U.S. President George Bush Sr. was also cured of his hyperthyroidism by this method. Generally speaking, patients’ symptoms gradually decrease about 2 weeks after oral administration of Iodine-131, and the symptoms significantly decrease after 1-3 months, and all symptoms disappear after 3 months-1 year, and only a small number of patients need to repeat the treatment.
We have been engaged in the treatment of hyperthyroidism with iodine-131 since 1995, and have improved the treatment method. Through clinical follow-up, we found that the efficiency is over 98%, and the one-time cure rate is over 75%.
9. Can hyperthyroidism combined with liver function damage be treated with iodine-131?
Hyperthyroidism is often combined with liver function damage, and its incidence can be as high as 1/3. Generally speaking, hyperthyroidism combined with liver function impairment is not a contraindication to iodine-131 treatment, and most patients with combined liver function impairment can recover normal liver function after iodine-131 treatment.
10. Is iodine-131 treatment for hyperthyroidism safe?
Some people may be concerned about the radiation, but this is not necessary. The dose of iodine-131 used in the treatment of hyperthyroidism is very small, only a few millicuries (molecular measurement), and 80% to 90% of the iodine-131 taken is absorbed by the thyroid gland, so there is no significant damage to non-treated organs and tissues. The worldwide observation of treatment cases proves that iodine-131 treatment for hyperthyroidism is very safe and does not lead to an increase in the incidence of tumors and does not affect future fertility. Regarding some possible side effects during the treatment, our staff will inform you in detail and deal with them in advance.
11.Do I need to be hospitalized for iodine-131 treatment of hyperthyroidism? What preparations do I need to make before treatment?
Generally speaking, no hospitalization is required and treatment can be performed on an outpatient basis.
However, in order to ensure the effectiveness of treatment, patients should make some necessary preparations, as follows.
12.What do I need to pay attention to after receiving Iodine-131 treatment?
1) In order not to affect the absorption of iodine-131, it is necessary to continue to keep fasting for 2 hours after taking iodine-131.
2) Do not take or apply drugs or foods that contain high levels of iodine, such as iodine-containing preparations, kelp, seaweed, sea fish and shrimp, etc., within 1 month after taking iodine-131.
3) Pay attention to rest and avoid emotional excitement and cold. Because a large amount of thyroid hormone is released into the blood during the destruction of thyroid cells by iodine-131, the symptoms of hyperthyroidism may be aggravated in the short term. Therefore, one month after iodine-131 treatment, patients need to pay attention to rest and avoid strenuous exercise, emotional excitement, colds, etc. to prevent the occurrence of thyroid crisis.
(4) Individual patients may experience significant aggravation of hyperthyroidism symptoms, please visit our department in time.
5）Avoid close contact with infants and children for 1 week after treatment, do not breastfeed for 2 months, and contraception is required for 6 months for men and 1 year for women.
(6) A common complication of iodine-131 treatment is that a small number of patients may develop hypothyroidism. For timely detection and effective treatment, please visit our outpatient clinic regularly after treatment.
13.What are the manifestations of hypothyroidism?
(1) Fear of cold and less sweating, swelling, dry skin, weakness and drowsiness.
2）Little speech, indifferent expression, slow reaction, memory loss.
(3) Bradycardia, low blood pressure.
(4) Loss of appetite.
14.Will hypothyroidism happen to me? What should I do if hypothyroidism occurs?
Hypothyroidism may occur not only with iodine-131 treatment, but also with other treatments such as medication and surgery. Some patients with hyperthyroidism may develop hypothyroidism after a period of time even without treatment, such as patients with high levels of destructive antibodies TgAb and TPOAb. Fortunately, hypothyroidism can be easily corrected. Therefore, the guidelines for the treatment of hyperthyroidism in Europe and the United States classify the development of hypothyroidism after hyperthyroidism treatment as a successful treatment. After the development of hypothyroidism, the application of thyroid hormones such as levothyroxine nasal tablets or thyroid tablets can rapidly correct the hypothyroid state without side effects from the rational application of thyroid hormones. Some of the hypothyroidism can disappear automatically (transient), while some of them need to take medication for life (permanent).
15.What should hyperthyroidism patients pay attention to in terms of diet?
In hyperthyroidism, due to the excessive secretion of thyroid hormones, the metabolism of three major nutrients, namely sugar, fat and protein, is accelerated, and patients need to increase nutrition to compensate for the consumption in their bodies. During hyperthyroidism, patients need to reduce the intake of iodine-containing food, pay attention to some protein and high vitamin (such as vegetables), and eat pumpkin and banana in moderation.
Special note: During the recovery period after iodine-131 treatment, patients should control their diet in moderation during the rest period in order to avoid gaining weight.
16.When can I have children after Iodine-131 treatment?
Infertility caused by hyperthyroidism can be cured and fertility can be restored. We recommend that conception can take place six months after iodine-131 treatment for men and one year after treatment for women.