The term "manifest thyrotoxicosis" refers to a syndrome, the development process of which starts against the background of various kinds of thyroid dysfunction. The mechanism of the development of the disease is based on the increased production of thyroid hormones, which affect the functioning of internal organs. When the first warning signs appear, you should contact an endocrinologist. The specialist will issue a referral for a comprehensive examination and, based on its results, will draw up the most effective treatment regimen.
Pathogenesis
The main thyroid hormone is triiodothyronine (T3). It affects almost all systems of the body. The precursor of triiodothyronine is thyroxine (T4). The formation of these hormones comes from iodine molecules. The latter enters the body with food and undergoes splitting. The end product of the conversion is iodides. They enter the thyroid gland, are oxidized and bind to tyrosine (amino acid). ATfurther, the resulting compound is again oxidized, resulting in the formation of T3 and T4. The latter accumulate in the follicles of the thyroid gland and, if necessary, are released into the bloodstream (thyroid stimulating hormone - TSH is responsible for this).
Under the influence of various adverse factors, this process is disrupted. In this case, it is customary to speak of thyrotoxicosis. It is subclinical and manifest. Thyrotoxicosis in the first case is characterized by a normal level of T3 and T4 and a reduced concentration of TSH. The manifest form of the disease is accompanied by low TSH and an increase in T3 and T4.
Etiology
There are a large number of reasons that lead to the development of the disease. Most often, patients are diagnosed with concomitant pathologies of the thyroid gland, against the background of which the level of hormones changes.
Manifest thyrotoxicosis usually accompanies:
- Diffuse toxic goiter.
- Thyroid tumors of a benign nature.
- Autoimmune diseases.
- Thyrotoxicosis of pregnant women.
- Pathologies of the thyroid gland, the development of which is due to uncontrolled intake of medications.
The most common cause of overt thyrotoxicosis is Basedow's disease (diffuse toxic goiter). At risk are people living in adverse environmental conditions, as well as people whose professional activities involve contact with radioactive iodine.
Clinical manifestations
Symptoms of manifest thyrotoxicosis and their severity directly depend on the action of T3 on the tropic organs. The main clinical manifestations of the disease:
- Excessive sweating. It is hot for a person in any climatic conditions. Patients at the doctor's office note that they stopped dressing warmly in cold weather.
- Psycho-emotional instability. Calmness is often replaced by irritability and even aggression, which can be unsafe for others.
- High heart rate.
- Dramatic weight loss.
- Dry skin.
- Edema.
- Weakness in muscles.
- Increased appetite.
- Stool disorders.
In addition, there are specific symptoms of overt thyrotoxicosis:
- Exophthalmos. This term refers to a condition in which a person's eyeballs protrude strongly.
- Tremor of the fingertips. This condition is revealed when stretching the arms in front of you.
- Increase in the size of the thyroid gland. Determined by the doctor during palpation.
- Eye signs. These include: wide-open surprised eyes, rare blinking, the appearance of a strip of white during the movement of the eye up.
If any of the above symptoms occur, you should consult an endocrinologist.
Diagnosis
After taking anamnesis, listening to complaints and performing a physical examination, the doctormakes a referral for examination. Based on its results, the endocrinologist will be able not only to assess the degree of functioning of the thyroid gland, but also to find out the cause of overt thyrotoxicosis.
Diagnosing a disease involves the following tests:
- Blood test for T3, T4 and TSH.
- Thyroid uptake test for radioactive iodine.
- Radionuclide scan.
- Scintigraphy.
- Thyroid ultrasound.
To identify the cause, a blood test is prescribed for autoantibodies to myeloperoxidase, TSH receptors, and thyroid-stimulating substances.
In the process of differential diagnosis, it is important to distinguish the disease from multinodular toxic goiter and Graves' disease.
Medicated treatment
The treatment regimen for overt thyrotoxicosis directly depends on the cause of the development of the pathology, the severity of its course, the age of the patient and the individual characteristics of his he alth. All drugs can only be prescribed by a doctor, their dosing regimen is also determined by a specialist.
The classic treatment regimen for overt thyrotoxicosis is as follows:
- Taking thyreostatics. These are drugs that suppress the excess production of hormones. As a rule, doctors prescribe the following drugs: Tyrozol, Propicil, Mercazolil. Treatment takes a long time (about 1 year).
- Taking glucocorticosteroids. Means of this group are indicated for severe lesionsfabrics. Against the background of reception, destructive processes stop.
- Use of dietary supplements. They are prescribed if overt thyrotoxicosis is a consequence of an autoimmune pathology. Most often, doctors recommend patients to use the drug "Endonorm".
- Taking drugs containing radioactive iodine. After completion of the course of treatment with these drugs, replacement therapy is indicated. It involves taking synthetic hormones.
During treatment, drugs from the group of b-blockers may be additionally prescribed. They support the work of the heart muscle, suffering against the background of the development of pathology.
Surgical treatment
Surgical intervention is indicated when conservative methods are ineffective. The preparatory stage is to take the above medicines.
During the operation, the surgeon excised part of the gland or the entire organ (the amount of intervention directly depends on the cause and severity of the pathology). Access to the affected part is carried out in an open way or through the use of endoscopic (minimally invasive) equipment.
After undergoing surgery, the patient must take synthetic hormones for the rest of his life.
Consequences
Ignoring pathology can lead to the development of life-threatening cardiovascular complications.
In addition, the consequence of overt thyrotoxicosis may bethyrotoxic crisis. This is a dangerous condition, manifested by tremors, elevated body temperature, excessive arousal, hypertension, anuria, and dysfunction of the heart muscle. The outcome of a thyrotoxic crisis can be both loss of consciousness and death of a person.
Prevention
There are no specific measures, the observance of which will prevent the development of the disease. However, it is possible to reduce the likelihood of overt thyrotoxicosis.
To do this, it is enough to follow the following rules:
- Quit smoking and drinking alcohol.
- Sunbathe less in the summer. In addition, it is undesirable to stay under open sunlight for a long time during their maximum activity.
- Adjust your diet. The menu must include vegetables and fruits. It is undesirable to eat fried, smoked and spicy foods. Food must be boiled, steamed or in the oven. It is important to remember that the diet should be balanced.
These rules apply to both primary and secondary prevention. In other words, lifestyle adjustments significantly reduce not only the risk of developing the disease, but also the occurrence of exacerbations in patients who have already been diagnosed with the disease.
In conclusion
Manifest thyrotoxicosis is a pathological condition that appears against the background of the progression of various thyroid diseases. It is characterized by a high levelhormones T3 and T4 and a reduced concentration of TSH. When the first alarming symptoms occur, you should contact an endocrinologist. The specialist will issue a referral for a comprehensive examination, based on the results of which he will draw up the most effective treatment regimen.
