Thyrotoxicosis: diagnosis, symptoms, possible causes, treatment and diet

Thyrotoxicosis implies a prolonged increase in the functional activity of the thyroid gland. A synonym for this ailment 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 thyroid activity is possible. For example, during pregnancy.

And the term "toxicosis" means poisoning the body with hormones of the gland, that is, it is a strictly pathological condition that requires the diagnosis and treatment of thyrotoxicosis.

The importance of the thyroid gland

The thyroid gland is a small organ that is 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 this 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 what hormones the thyroid gland produces and what functions they perform in the body.

The main hormones in the gland are triiodothyronine (T3) and thyroxine (T4). The formation of these hormones in the brain stimulates the formation of the pituitary gland. It produces thyroid-stimulating hormone that activates the production of T3 and T4. But the thyroid gland affects the work of the pituitary gland. A high level of T3 and T4 inhibits the synthesis of thyroid-stimulating hormone by the feedback mechanism. It is very important to understand this principle, since it underlies the laboratory diagnosis 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 accelerate energy metabolism.

Causes of the disease

An increase in thyroid activity can occur in such conditions:

• diffuse toxic goiter - is 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 reason for the appearance 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 gland tissue after acute infectious diseases;
• an overdose of thyroid hormones, which are used to treat decreased thyroid function (hypothyroidism).

Increases the likelihood of getting thyrotoxicosis as well as being a female, the presence of autoimmune diseases, the established diagnosis of thyrotoxicosis in immediate relatives.

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 a large amount of thyroid stimulating hormone, which stimulates the production of T3 and T4.

Pathogenesis of the disease

Pathogenesis is a phased development of changes in the body from the onset of the disease until 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 a greater amount of oxygen, which leads to an increase in 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, heart rate and respiration accelerate, sweating increases;
• the conversion of male hormones (androgens) to female (estrogens) increases, which leads to a change in the appearance of a man by a more effeminate type;
• the breakdown of the hormone of the adrenal cortex, cortisol, is accelerated, which leads to a decrease in its concentration in the body.

Clinical manifestations of the disease

Thyrotoxicosis of the thyroid gland: what is it? You need to answer this question in stages, starting with the reasons and ending with the prevention of the disease. It's time to sort out what symptoms and complaints will help 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, his pulse accelerates, and his respiratory rate increases. If these changes are short-term in nature, this does not pose any danger to the body. On the contrary, the activation of the sympathetic part of the nervous system helps a person fight stress and danger. But the presence of such symptoms for a long time eventually leads to depletion of the cardiovascular and respiratory system. The heart muscles get tired pumping blood, pressure and heart rate fall. Breathing is also becoming rarer. Such changes can be fatal for a patient with thyroid toxicosis.

Due to the constantly accelerated metabolism, the patient loses weight, despite increased appetite. In severe illness, the appetite is reduced, diarrhea, nausea and vomiting join.

Patients feel constantly tired and weak. Trembling limbs (tremors) are also characteristic. 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 leads to severe impairment of motor function.

The patient’s psyche also changes. He is constantly aggressive, angry, feels fear and anxiety. Speech of a patient with toxic thyrotoxicosis is accelerated. The course of his thoughts also becomes faster, which can be expressed by increased intellectual abilities.

To understand the principles of treating symptoms of thyrotoxicosis in women, we mention the most common clinical manifestations of this ailment in the female half:

• irregular menstruation, which is accompanied by severe pain in the lower abdomen;
• scarce spotting during menstruation;
• nausea and vomiting;
• feeling of numbness in the limbs;
• bloating (flatulence).

In men, the disease can manifest itself as 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 "from the threshold", only by seeing the patient in the doorway 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, examination of the patient plays an important role in the diagnosis of thyrotoxicosis.

The patient is characterized by wet, pink skin. The skin is thin to the touch, its elasticity is reduced, age-related changes are clearly visible. The condition of the nails is getting worse. The nail plate moves away from the nail bed.

The patient's pupils are dilated. And due to an increase in the size of the palpebral fissure, the eyeball literally bulges 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 with thyrotoxicosis. It represents an increase in the size of the thyroid gland, which is visible as a protrusion on the neck. Three stages of goiter are distinguished:

• Stage 1 - an enlargement of the gland is visible only with instrumental diagnostics;
• Stage 2 - goiter can be diagnosed with palpation of the gland;
• Stage 3 - an increase is visible with the naked eye.

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 severity;
• heavy.

A mild degree is characterized by moderate weight loss, heart rate up to 100 in 1 min, other endocrine glands without pathology, the general condition of the patient is satisfactory.

With the moderate severity of the disease, weight loss is more pronounced, the heartbeat is 100-120 for 1 min with periodic rhythm disturbances, diarrhea and vomiting are added, carbohydrate metabolism is disturbed, adrenal gland malfunction occurs, and 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 untreated, 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, which is manifested by a steady 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 clarified. Most attention is paid to hereditary predisposition.

Complaints and clinical manifestations of the disease are similar to those for other forms of thyrotoxicosis. Visually, in most cases, a diffuse enlargement of the thyroid gland is determined. For thyrotoxicosis with toxic goiter, the presence of seals in the form of nodules is not characteristic, as with a nodular form. In elderly people 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 in women;
• more often mental disorders develop;
• palpitations rarely occur;
• It is difficult to treat with medicines, more often it is necessary to apply surgical treatment.

Laboratory diagnostics

First of all, when making a diagnosis, clinical manifestations, examination and history data are taken into account. Only after a thorough conversation and objective examination do they start additional methods for the diagnosis of 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 determination of the levels 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 or thyroid gland - the level of hormones varies in different ways.

With primary thyroid damage, the levels of triiodothyronine and thyroxine increase, and the amount of thyroid stimulating hormone becomes lower. If the changes relate to the pituitary gland, then the amount of TK and T4, and thyroid stimulating hormone increases. Separately, a latent form of thyrotoxicosis is isolated. It manifests itself as normal levels of T3 and T4 with an increased concentration of thyrotropin.

As a rule, the level of total T3 is increased in all patients, therefore, it is usually sufficient to determine the levels of T4 and thyrotropin. Who is prescribed an analysis for triiodothyronine?

• In the presence of symptoms of increased thyroid function at a normal T4 level.
• With an accidentally detected increase in thyroxine levels 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 thyroid hormone levels is also possible without thyrotoxicosis. This condition occurs with a decrease in the sensitivity of body tissues to T3 and T4.

In addition to determining the level of hormones in the blood, such laboratory tests are carried out:

• general blood analysis;
• general urine analysis;
• biochemical blood test: cholesterol, protein, glucose, liver tests;
• the content of B and T lymphocytes in the blood.

Instrumental diagnostics

The most informative instrumental method for diagnosing changes in the thyroid gland is ultrasound. Ultrasound results directly depend on what thyrotoxicosis takes place. With a diffuse form, an increase in the size of the gland and a decrease in echogenicity are observed.

For the nodular form, the presence of foci of increased echogenicity is characteristic. These are the very nodes. The diagnostician should write the sizes of the nodes, especially their blood supply. If the nodes are pierced with blood 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 with normalization of thyroid function.

Modified ultrasound method - ultrasound dopplerography. With its help, the features 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, 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. For this, a small piece of tissue of the node is examined using a microscope. This eliminates the cancer process. Such a study is not routine. It is recommended in the presence of large nodes with active blood supply.

What diseases do you need to differentiate thyrotoxicosis with?

First, when making a diagnosis, it is necessary to establish the exact cause of the increase in thyroid hormone levels. In addition to changing 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, the differential diagnosis of thyrotoxicosis is carried out with the following diseases:

• pituitary resistance to T3 and T4;
• pituitary adenoma;
• thyroid cancer metastases that synthesize hormones;
• artifact thyrotoxicosis - with an overdose of thyroid hormone preparations;
• iatrogenic thyrotoxicosis - due to medical errors;
• congenital pathology of the synthesis of T3 and T4.

Separately conduct differential. diagnosis of thyrotoxicosis with diseases that are not accompanied by an increased level of T3 and T4:

• neurosis and psychosis;
• myocarditis - inflammation of the heart muscle;
• cardiosclerosis - proliferation of connective tissue in the wall of the heart;
• tachycardia (heart palpitations) and arrhythmias (rhythm disturbances) of other origin;
• taking drugs (cocaine, amphetamine);
• decreased adrenal function;
• adrenal gland tumor with increased synthesis of adrenaline (pheochromocytoma).

In the diagnosis of thyrotoxicosis in women, attention should be paid to its differences from menopausal neurosis.

Separately, it is worth bringing the main differences between thyrotoxicosis and myocarditis.

Drug treatment

After a full diagnosis of thyrotoxicosis and determining the form of the disease, they begin treatment. First of all, they turn to the help of drug therapy.

The drugs "Merkazolil" and "Propylthiouracil" block the production and release of thyroid hormones. The dosage of "Merkazolil" at the beginning of treatment is 30-40 mg per day.

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Treatment with "Mercazolilum" or "Propylthiouracil" rarely leads to side effects, but they can occur. The patient may experience:

• vasculitis - inflammation of the vascular wall;
• jaundice;
• thrombocytopenia - lower platelet counts;
• agranulocytosis - a decrease in the level of neutrophils;
• allergic reactions: itching, urticaria;
• arthralgia - pain in the joints.

The drug of choice for the treatment of thyrotoxicosis syndromes in women during pregnancy is Propylthiouracil in a dose of 100-300 mg per day. In this case, "L-thyroxine" is not prescribed.

Treatment of symptoms of thyrotoxicosis in women, which are manifested by menstrual dysfunction and increased levels of estrogen in the blood, require replacement therapy with combined oral contraceptives. This method can be prescribed in combination with basic drugs if hormonal changes are too pronounced. If the level of sex hormones is slightly increased, it will go down on its own when the thyroid function normalizes.

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 with the ineffectiveness of the drug method. There are other indications for surgery:

• large sizes of the thyroid gland, because of which it compresses neighboring organs;
• goiter located behind the sternum;
• drug intolerance;
• relapse of thyrotoxicosis after drug therapy.

The main surgical intervention for this disease is thyroidectomy. It means the complete removal of the thyroid gland. After such an operation, replacement therapy with "L-thyroxine" is mandatory.

The relapse rate after surgery is 5-10%. The most common postoperative complications: hypoparathyroidism (parathyroid insufficiency) and laryngeal paresis due to damage to the recurrent nerve.

Another way to treat thyrotoxicosis is with radioactive iodine therapy. There are a number of indications for this treatment method:

• postoperative relapse;
• severe concomitant disease, in which surgery or drug treatment is not recommended;
• people of advanced age;
• patient refusal from surgery.

Radioactive iodine therapy has several advantages over other treatment methods:

• high efficiency - quickly leads to clinical remission;
• low cost - cheaper than surgery and medical treatment;
• 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 an excess of thyroid hormone is produced. This affects energy metabolism, accelerating it. As a result of this, a person loses weight, his heartbeat and breathing become more frequent, sweating increases.

In the analyzes, an increase in the concentration of thyroid hormones - T3 and T4 is recorded. Ultrasound examination of iron is increased, it is possible to have nodes of different sizes.

Treatment consists of taking drugs that inhibit the action of the thyroid gland. The main ones are Merkazolil and Propylthiouracil. They reduce the concentration of T3 and T4 in the blood. Surgical treatment is also applicable - thyroidectomy, and radioactive iodine therapy.

Reviews of thyrotoxicosis on the Internet vary. The course of the disease and 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.