Thyrotoxicosis is a pathological condition caused by an excess of thyroid hormones in the body. Sometimes this condition is called - intoxication with thyroid hormones. In medical practice, the synonym of thyrotoxicosis is hyperthyroidism, which is manifested by an increase in thyroid function glands. However, the increase in thyroid function often occurs in everyday conditions ( pregnancy in women, etc.), whereas the term thyrotoxicosis most fully reveals the meaning of the disease, namely, thyroid hormone poisoning.
Thyrotoxicosis is a pathological condition, the reverse of hypothyroidism. The meaning of the difference lies in the fact that when hypothyroidism the content of thyroid hormones is insignificant and the speed of all processes functioning in the human body is significantly reduced, whereas in thyrotoxicosis, on the contrary, maximum production of hormones with their highest activity is observed
Thyrotoxicosis - Causes
The main cause of thyrotoxicosis is diffuse toxic goiter. It is observed in about 75% of patients. Usually this disease is hereditary in nature and is observed together with other autoimmune diseases ( autoimmune thyroiditis , etc.). Thyrotoxicosis is not an independent disease, but is a whole complex of symptoms observed in diseases such as Basedova's disease, pituitary adenoma, thyrotoxic adenoma, multinodular hyperthyroid goiter, subacute thyroiditis.
Significantly less thyrotoxicosis can be caused by excessive introduction of thyroid hormones (triiodothyronine, thyroxine) into the body, which are used as a substitute therapy after incomplete resection of the thyroid gland, after removal of the entire gland, with hypothyroidism.
Thyrotoxicosis may first occur in infants, in older children, or in adults. Predisposition to the development of the disease usually lasts a lifetime. Previously, thyrotoxicosis must have been associated with diffuse toxic goiter, but a few later were classified and other thyrotoxicosis-associated diseases. In 1961, diffuse toxic goiter was officially recognized as a thyroid disorder, while thyrotoxicosis was also defined as a symptomatic complex due to an excess of thyroid hormones in the blood.
There is a theory that patients with a progressive stage of the disease have abnormal thyroid-stimulating hormones receptors, which perceive their own immune defense as foreign. The second option considers immunity disorders, which consist in not hindering the immune response against their tissues
Forms of thyrotoxicosis
• Easy form of thyrotoxicosis. For this form is characterized by a slight weight loss, tachycardia in mild form (palpitation of the order of 100 beats per minute). Dysfunction is observed exclusively in the thyroid gland, heart contractions remain normal, other organs are unaffected
• The average form of thyrotoxicosis. With this form, the patient significantly loses weight, the heartbeat high enough (about 120 beats per minute). Tachycardia becomes permanent, and it is not affected by sleep or body position changes. For the average form characterized by digestive disorders, which lead to symptoms of adrenal insufficiency and diarrhea, temporary changes in the heartbeat, problems with carbohydrate metabolism, there is a decrease in cholesterol
• Severe form of thyrotoxicosis. This form is observed in cases of previously observed violations of the adequate functioning of the thyroid gland, which were not completely cured, or the treatment itself was not properly prescribed. The severe form of this disease leads to severe dysfunction of organs and systems
Usually the cause of the above-described forms of thyrotoxicosis is diffuse toxic goiter, but sometimes the cause of the disease can be a large number of thyroid hormones that come into the body from the environment and a high content of iodine (the use of iodine-containing drugs)
Thyrotoxicosis - symptoms
People with thyrotoxicosis complain of a feeling of fear and anxiety, increased irritability, sweating, sleep disturbances; trembling of the trunk, tongue and fingers; heart palpitations, sudden weight loss, pain in the heart, nausea, vomiting, diarrhea, exophthalmos, a decrease or the opposite increase (with mild / moderate form) of appetite.
Initially, the liver function is not impaired, but as the symptoms of thyrotoxicosis increase, a significant increase in the liver is observed. The concentration of bilirubin in the blood rises, jaundice can develop. In severe long-term thyrotoxicosis, impaired function of the sexual glands is observed (in men - gynecomastia and decreased potency, in women - amenorrhea and dysmenorrhea). Perhaps the appearance of symptoms of thyroid diabetes.
Practically 100% of patients have a decrease in mental activity, emotional disorders, asthenia. In severe form of thyrotoxicosis, the basal metabolism reaches 100%. With prolonged current disease, the metabolism and catabolism of proteins is enhanced, which can serve as an impetus to the development of such a disease as osteoporosis . From the side of the cardiovascular system, a whole complex of disorders develops, which was called "thyrotoxic heart". Disturbances from the circulatory system consist in increased heart rate, increased volume of circulating blood and blood flow velocity. Often, the noise and intensification of the heart sounds (more often at the apex of the heart), a gradual increase in the left ventricle, and after him the whole heart.
Isolate a special form of thyrotoxicosis, which against the background of a bradycardia or a normal rhythm is manifested by attacks of the tahisystolic form of atrial fibrillation, with absent symptoms of toxic goiter.
With an increase in the thyroid gland in size, patients have complaints of an increase in the volume of the neck and a violation of swallowing. Diffuse toxic goiter is characterized by manifestations of infiltrative ophthalmopathy - photophobia, lacrimation, a feeling of sand and pressure in the eyes, doubling in gases, decreased vision. Also, special attention is drawn to the exophthalmos, manifested in the protrusion of eyeballs
Thyrotoxicosis - treatment
To determine the correct tactics for treating thyrotoxicosis, its cause is primarily determined. Most often it is a diffuse toxic goiter. For this disease, three main methods of treatment have been developed - treatment with radioactive iodine, conservative and surgical treatment.
Treatment of thyrotoxicosis with radioactive iodine is completely painless and consists of ingestion of a capsule or liquid with radioactive iodine, which gets into the body, accumulates in the cells of the gland and leads to their death and subsequent replacement with a connective tissue. Hypothyroidism is the main complication of treatment with this method. In such cases, life-long substitution therapy with thyroid hormones is indicated.
Conservative treatment of thyrotoxicosis is the administration of thyreostatic drugs (propylthiouracil, thiamazole), whose action is directed at suppressing the activity of the thyroid gland. Conservative treatment requires timely and accurate medication and regular visits to the endocrinologist. In addition, with the help of medicines, they try to compensate for disorders of the autonomic nervous system, the hypothalamus and the central nervous system.
Surgical treatment of thyrotoxicosis is carried out only in the case of ineffectiveness of conservative methods of treatment, with a zoroshnogo location, with a suspicion of a malignant tumor and a significantly increased thyroid gland
Thyrotoxicosis in children
Usually, thyrotoxicosis is found in children who are born from women who have this disease in the past, or who have it in the present. In the development of thyrotoxicosis in newborns, a certain role is played by the acting thyroid stimulant and other thyroid stimulating antibodies, often determined in the blood of the mother and child and passing through the placental barrier.
As a rule, six to twelve weeks after birth, thyrotoxicosis in newborns passes, but in exceptional cases it remains and proceeds for many years, accompanied by a typical clinical picture of diffuse toxic goiter. Children with thyrotoxicosis (usually boys) are usually born prematurely. The most characteristic feature of these children is the protruding convex forehead, many children have an enlarged thyroid gland, their body temperature is slightly elevated. Against the background of increased metabolism, a bad weight gain is characteristic, diarrhea , vomiting, sweating, anxiety, excitability, exophthalmos are observed. The following symptoms can also be observed: enlargement of the spleen and liver, increased heart rate, jaundice, respiratory depression, thrombocytopenia, arrhythmia, enlargement of the heart, overdevelopment of lymphoid tissue and edema. Radiographic examination of the skeleton clearly shows craniostenosis and accelerated development of the osseous system. In the blood there is a very low concentration or total absence of thyroid-stimulating hormone, with an elevated content of thyroid hormones
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