Thyrotoxicosis implies a prolonged increase in the functional activity of the thyroid gland. A synonym for this disease is "hyperthyroidism". In most literary sources, there is an opinion that these concepts are absolutely identical. But it is not so. Hyperthyroidism is not necessarily a pathology of the body; a physiological increase in the activity of the thyroid gland is possible. For example, during pregnancy.
And the term "toxicosis" means poisoning the body with gland hormones, that is, this is a strictly pathological condition that requires diagnosis and treatment of thyrotoxicosis.
Importance of the thyroid gland
The thyroid gland is a small organ located on the front of the neck. Its weight is only 15-20 grams. Anatomically, it is located in front of the thyroid cartilage of the larynx, which is why it got its name. It consists of two lobes, which are connected by an isthmus.
For a better understanding of the symptoms and diagnosis of thyrotoxicosis, it is necessary to understand which hormonesthe thyroid gland produces, and what functions they perform in the body.
The main hormones of the gland: triiodothyronine (T3) and thyroxine (T4). Stimulates the synthesis of these hormones formation in the brain called "pituitary". It produces thyroid-stimulating hormone, which activates the production of T3 and T4. But the thyroid gland also affects the work of the pituitary gland. A high level of T3 and T4 inhibits the synthesis of thyroid-stimulating hormone by a feedback mechanism. It is very important to understand this principle, as it underlies the laboratory diagnosis of forms of thyrotoxicosis.
The main role of thyroxine and triiodothyronine is the acceleration of metabolic processes in the body. Hormones increase the breakdown of proteins and fats, increase heat production and speed up energy metabolism.
Causes of disease
An increase in thyroid activity can occur in the following conditions:
- diffuse toxic goiter - manifested by an increase in the size of the gland and increased synthesis of hormones by it;
- nodular goiter - dense nodules appear on the surface of the gland, the cause of which is not completely clear;
- autoimmune thyrotoxicosis - occurs when the body produces antibodies against thyroid cells, which leads to inflammation of the organ and an increase in its function;
- subacute thyroiditis - inflammation of the tissues of the gland after acute infectious diseases;
- an overdose of thyroid hormones, which are used to treat an underactive thyroid gland (hypothyroidism).
Increasesthe probability of getting sick with thyrotoxicosis is also belonging to the female sex, the presence of autoimmune diseases, the diagnosis of thyrotoxicosis in the next of kin.
In addition to the actual changes in the thyroid gland, an increase in its functional activity is possible with the growth of a tumor formation in the pituitary gland - thyrotropinoma. This tumor produces large amounts of thyroid-stimulating hormone, which stimulates the production of T3 and T4.
Pathogenesis of disease
Pathogenesis is a gradual development of changes in the body from the onset of the disease to complete recovery. Knowledge of the pathogenesis is necessary for a full understanding of the clinic, diagnosis and treatment of thyrotoxicosis.
What happens in the human body with an increase in thyroid function?
- tissues absorb more oxygen, resulting in increased heat production and energy absorption;
- tissues become more sensitive to the action of the sympathetic nervous system, due to the activation of which blood pressure rises, the heartbeat and breathing speed up, sweating increases;
- the conversion of male hormones (androgens) to female hormones (estrogens) increases, resulting in a change in the appearance of a man in a more effeminate type;
- accelerates the breakdown of the hormone of the adrenal cortex - cortisol, which leads to a decrease in its concentration in the body.
Clinical manifestations of the disease
Thyrotoxicosis of the thyroid gland: what is it? Answer tothis question is necessary in stages, starting with the causes and ending with the prevention of the disease. It's time to sort out what symptoms and complaints will help to suspect the presence of this ailment.
The activity of all vital systems of the body increases: cardiovascular and respiratory. The patient's blood pressure rises, the pulse accelerates, and the respiratory rate increases. If these changes are of a short-term nature, this does not pose any danger to the body. On the contrary, the activation of the sympathetic division of the nervous system helps a person to deal with stress and danger. But the presence of such symptoms for a long time eventually leads to exhaustion of the cardiovascular and respiratory systems. The muscles of the heart get tired of pumping blood, pressure and heart rate fall. Breathing also becomes more rare. Such changes can be fatal for a patient with thyrotoxicosis of the thyroid gland.
Due to the constantly accelerated metabolism, the patient loses weight, despite increased appetite. In severe cases of the disease, the appetite is reduced, diarrhea, nausea and vomiting join.
Sick people feel constant fatigue and weakness. It is also characterized by trembling of the limbs (tremor). With a long course of thyrotoxicosis, osteoporosis develops - softening of bone tissue. Calcium is washed out of the bones, but a large amount of potassium accumulates. This results in severe impairment of motor function.
The patient's psyche is also changing. He is constantly aggressive, angry, feels fear and anxiety. The speech of a patient with toxic thyrotoxicosis is accelerated. Fasterbecomes the course of his thoughts, which can be expressed by increased intellectual abilities.
To understand the principles of treating the symptoms of thyrotoxicosis in women, we will mention the most common clinical manifestations of this disease in the female half:
- irregular menstruation accompanied by severe pain in the lower abdomen;
- meager spotting during menstruation;
- nausea and vomiting;
- feeling of numbness in limbs;
- bloating (flatulence).
In men, the disease can be manifested by an increase in the mammary glands (gynecomastia) and a decrease in potency.
Appearance of a patient with thyrotoxicosis
Sometimes a doctor can make a diagnosis "on the threshold" only by seeing the patient at the door of his office. But sometimes the problems are not so visible, and a more thorough examination of the patient is necessary. But, in any case, the examination of the patient plays an important role in the diagnosis of thyrotoxicosis.
The patient is characterized by moist, pink skin. To the touch, the skin is thin, its elasticity is reduced, age-related changes are clearly visible. The condition of the nails worsens. The nail plate is moving away from the nail bed.
The patient's pupils are dilated. And by increasing the size of the palpebral fissure, the eyeball literally protrudes outward. This symptom is called exophthalmos. The pigmentation of the eyelids is enhanced, they have a brown tint.
One of the most characteristic visual symptoms is goiter in thyrotoxicosis. It is an enlargement of the thyroid gland, whichvisible as a protrusion on the neck. There are three stages of goiter:
- 1 stage - enlargement of the gland is visible only with instrumental diagnostics;
- 2 stage - goiter can be diagnosed by palpation of the gland;
- 3 stage - magnification is visible to the naked eye.
Degrees of severity
In addition to indicating the form of the disease (diffuse toxic goiter, nodular goiter, etc.), it is also necessary to establish the severity of thyrotoxicosis of the thyroid gland. There are three degrees:
- light;
- moderate;
- heavy.
Mild degree is characterized by moderate weight loss, heart rate up to 100 per 1 min, other endocrine glands without pathology, the patient's general condition is satisfactory.
With moderate severity of the disease, weight loss is more pronounced, the heart rate is 100-120 per 1 min with periodic rhythm disturbances, diarrhea and vomiting join, carbohydrate metabolism is disturbed, adrenal dysfunction occurs, the concentration of cholesterol in the blood decreases.
In severe thyrotoxicosis, the patient's condition is extremely serious, there is a violation of the work of all organs and systems of the body.
If the disease is not treated, complications can occur. The most serious condition is thyrotoxic crisis. It is manifested by a sharp increase in the concentration of thyroid hormones in the blood, which leads to disruption of the vital systems of the body.
Diffuse toxic goiter
This is an autoimmune disease that manifests itself persistentlyan increase in the secretion of T3 and T4 by the thyroid gland, as well as a diffuse increase in its size. According to statistics, diffuse thyrotoxicosis occurs 5-10 times more often in women than in men. The exact cause of the disease has not yet been elucidated. The greatest attention is paid to hereditary predisposition.
Complaints and clinical manifestations of the disease are similar to those in other forms of thyrotoxicosis. Visually, in most cases, a diffuse enlargement of the thyroid gland is determined. Thyrotoxicosis with toxic goiter is not characterized by the presence of seals in the form of nodules, as in the nodular form. In the elderly and in men, there may be no visible enlargement of the gland. But this is not a reason to exclude the diagnosis of diffuse toxic goiter.
In men, the course of the disease has some features:
- progresses faster than women;
- more likely to develop mental disorders;
- rarely increased heart rate;
- hard to treat with medication, more often have to use surgery.
Laboratory diagnostics
First of all, when making a diagnosis, clinical manifestations, examination data and anamnesis are taken into account. Only after a thorough conversation and an objective examination, they proceed to additional methods for diagnosing thyrotoxicosis.
All methods for determining changes in thyroid function can be divided into two groups: laboratory and instrumental.
The laboratory diagnosis of thyrotoxicosis is based on the definitionlevels of total and free triiodothyronine, total and free thyroxine and thyroid-stimulating hormones in the blood. Depending on where the pathological process develops - in the pituitary gland or the thyroid gland - the level of hormones changes in different ways.
In primary thyroid disease, the levels of triiodothyronine and thyroxine increase, and the amount of thyroid-stimulating hormone becomes lower. If the changes concern the pituitary gland, then the amount of T3 and T4, and thyroid-stimulating hormone, also increase. The latent form of thyrotoxicosis is isolated separately. It is manifested by normal levels of T3 and T4 with an increased concentration of thyrotropin.
As a rule, the level of total T3 is elevated in all patients, so it is usually sufficient to determine the levels of T4 and thyrotropin. Who is prescribed an analysis for triiodothyronine?
- If you have symptoms of overactive thyroid with normal T4 levels.
- When an increase in the level of thyroxine is accidentally detected in the absence of symptoms. In such patients, thyroid function may be normal, and T4 may increase with a change in the amount of proteins that bind this hormone.
- An increase in the level of thyroid hormones is possible without thyrotoxicosis. This condition occurs when the sensitivity of body tissues to T3 and T4 decreases.
In addition to determining the level of hormones in the blood, the following laboratory tests are carried out:
- complete blood count;
- general urinalysis;
- biochemical blood test: cholesterol, protein, glucose, liver tests;
- content of B- and T-lymphocytes inblood.
Instrumental diagnostics
The most informative instrumental method for diagnosing changes in the thyroid gland is ultrasound. The results of ultrasound directly depend on what kind of thyrotoxicosis occurs. In the diffuse form, there is an increase in the size of the gland and a decrease in echogenicity.
The nodular form is characterized by the presence of foci of increased echogenicity. These are the nodes. The diagnostician must write the size of the nodes, the features of their blood supply. If the nodes are permeated with vessels and are actively supplied with blood, this should alert the doctor about the malignancy of the node. In most cases, the nodes are benign and go away on their own when the thyroid function returns to normal.
Modified ultrasound method - Doppler ultrasound. With its help, the characteristics of the blood supply to the thyroid gland are determined.
Another diagnostic method is scintigraphy. For its implementation, the patient takes a special drug, in this case it is radioactive iodine, which accumulates in the tissues of the gland. With a typical clinical picture and changes in the level of hormones in the blood, scintigraphy is not performed. It is done only in controversial cases in order to differentiate the diffuse form from postpartum or subacute thyroiditis, autoimmune thyroiditis.
The most informative method for diagnosing nodular goiter is a node biopsy with histological examination. To do this, a small piece of node tissue is examined using a microscope. This allows you to exclude the cancer process. Such research is not done routinely. It is recommended in the presence of large nodes with an active blood supply.
What diseases should thyrotoxicosis be differentiated from
Firstly, when making a diagnosis, it is necessary to establish the exact cause of the increase in thyroid hormone levels. In addition to changes in the structure of the gland itself, an increase in T3 and T4 is possible due to tissue resistance to hormones, as well as due to increased synthesis of hormones outside the gland.
Therefore, differential diagnosis of thyrotoxicosis is carried out with the following diseases:
- Pituitary resistance to T3 and T4;
- pituitary adenoma;
- Metastases of thyroid cancer synthesizing hormones;
- artificial thyrotoxicosis - with an overdose of thyroid hormone preparations;
- iatrogenic thyrotoxicosis - due to medical errors;
- congenital pathology of T3 and T4 synthesis.
Separately conduct dif. diagnosis of thyrotoxicosis with diseases that are not accompanied by elevated levels of T3 and T4:
- neuroses and psychoses;
- myocarditis - inflammation of the heart muscle;
- cardiosclerosis - proliferation of connective tissue in the wall of the heart;
- tachycardia (rapid heartbeat) and arrhythmias (rhythm disturbances) of other origin;
- drug use (cocaine, amphetamine);
- decreased adrenal function;
- a tumor of the adrenal gland with increased synthesis of adrenaline (pheochromocytoma).
When diagnosing thyrotoxicosis in women, attention should be paid to its differences fromclimacteric neurosis.
| Signs | Thyrotoxicosis | Climacteric neurosis |
| Headache | Not typical | Periodically worries the patient |
| Sweating | Constantly throughout the body | Not constant, comes on in bursts with a sensation of heat |
| Mental disorders | Nervousness, constant fear and anxiety | Irritability |
| Slimming | Progresses in patients | Not typical, usually weight gain |
| Pain in the heart area | Do not disturb the patient | Occur periodically, have a stabbing character |
| Changes in heart rate | Constant acceleration of heartbeat | Tachycardia intermittent during hot flashes and sweating |
| The size of the thyroid gland | Increased | Within normal range |
| Exophthalmos | Character | Not typical |
| Cholesterol levels | Decreased | Increased |
| Skin condition | Thin hot pink | Normal thickness, turns pink during hot flushes |
| Blood pressure | Increased | Also upgraded |
Separately, it is worth mentioning the main differences between thyrotoxicosis and myocarditis.
| Signs | Thyrotoxicosis | Myocarditis |
| Frequency changesheart rate | Persistent tachycardia | Tachycardia during exercise |
| Pain in the heart area | Not developing | May take place, have a aching, pressing character |
| Body weight | Progressively declining | May drop slightly |
| Shortness of breath | Only for severe illness | Characteristic already in the early stages, during physical activity |
| Mental disorders | Characteristic | Not typical |
| The size of the thyroid gland | Increased | Within normal range |
| Exophthalmos | Character | Not typical |
| Heart measurements | May be increased in severe disease and development of thyrotoxic heart | Increased already in the early stages of the disease |
| Heart sounds | Sounding | Weakened |
| Changes in ECG | Decrease in the height of the P and T waves in severe course, increase in mild, possible atrial fibrillation | The height of all teeth is reduced, the ST segment is under the isoline |
Medicated treatment
After a full diagnosis of thyrotoxicosis and determining the form of the disease, treatment begins. First of all, they turn to the help of drug therapy.
The drugs "Mercazolil" and "Propylthiouracil" block the production and releasethyroid hormones. The dosage of "Mercazolil" at the beginning of treatment is 30-40 mg per day.
Beta-blockers are also prescribed to normalize heart rate and heart rate. This group includes "Atenolol", "Metoprolol" and others. "Atenolol" is prescribed at a dose of 100 mg per day.
These drugs are prescribed in a complex way. With a decrease in clinical manifestations (after 2-3 weeks), beta-blockers are canceled. The dosage of "Mercazolil" is reduced to 5-10 mg. This dose is prescribed for adults for 1.5 years and children for 2 years.
When the level of T3 and T4 returns to normal, thyroid hormones are prescribed - "L-thyroxine". This is a necessary measure for the prevention of hypothyroidism (decrease in the functional activity of the gland). The dosage of "L-thyroxine" is 50-75 mcg per day. It has also been taken for a year and a half.
Treatment with "Mercazolil" or "Propylthiouracil" rarely leads to the development of side effects, but they can occur. The patient may experience:
- vasculitis - inflammation of the vascular wall;
- jaundice;
- thrombocytopenia - decrease in platelets;
- agranulocytosis - decreased neutrophil levels;
- allergic reactions: itching, hives;
- arthralgia - joint pain.
The drug of choice for the treatment of thyrotoxicosis syndromes in women during pregnancy is Propylthiouracil at a dose of 100-300 mg per day. At the same time, "L-thyroxine" is not prescribed.
Treatment of symptomsthyrotoxicosis in women, which are manifested by menstrual dysfunction and an increase in the level of estrogen in the blood, require replacement therapy with combined oral contraceptives. This method can be prescribed in combination with the main drugs, if hormonal changes are too pronounced. If the level of sex hormones is slightly elevated, it will drop on its own with the normalization of thyroid function.
For the treatment of autoimmune thyrotoxicosis, corticosteroids are used ("Prednisolone", "Dexamethasone"). These drugs suppress the activity of the immune system, thereby reducing the production of antibodies against thyroid cells.
Other treatments
Surgical treatment of thyrotoxicosis in women and men is used when the medical method is ineffective. There are other indications for surgery:
- large size of the thyroid gland, because of which it squeezes neighboring organs;
- goiter located behind the sternum;
- drug intolerance;
- recurrence of thyrotoxicosis after drug therapy.
The main surgical intervention for this disease is thyroidectomy. It means complete removal of the thyroid gland. After such an operation, replacement therapy with "L-thyroxine" is required.
Recurrence rate after surgery is 5-10%. The most common postoperative complications are: hypoparathyroidism (parathyroid insufficiency)and paresis of the larynx due to damage to the recurrent nerve.
Another way to treat thyrotoxicosis is radioactive iodine therapy. There are a number of indications for this method of treatment:
- postoperative recurrence;
- Severe comorbidity for which surgery or medication is not recommended;
- older people;
- Patient refusal from surgery.
Radioiodine therapy has a number of advantages over other treatments:
- high efficiency - quickly leads to clinical remission;
- low cost - cheaper than both surgery and medication;
- safety - minimal exposure and the inability to develop severe complications, as after surgery.
Conclusions
Thyrotoxicosis of the thyroid gland: what is it? We briefly summarize the article. This is a disease in which thyroid hormone is produced in excessive amounts. This affects energy metabolism, accelerating it. As a result, a person loses weight, his heartbeat and breathing quicken, sweating increases.
In the analyzes, an increase in the concentration of thyroid hormones - T3 and T4 is recorded. On ultrasound, the gland is enlarged, there may be nodes of different sizes.
Treatment consists of taking drugs that depress the thyroid gland. The main ones are Mercazolil and Propylthiouracil. They reduce the concentration of T3 and T4 in the blood. Surgical treatment is also applicable - thyroidectomy, and therapyradioactive iodine.
Reviews about thyrotoxicosis on the Internet vary. The course of the disease and the prognosis depend on the form of the disease, the timeliness of the start of treatment and the regularity of taking the drugs. The main responsibility in the treatment of thyrotoxicosis lies not with the doctor, but with the patient. He must strictly adhere to the doctor's recommendations for a speedy recovery.
