The term "manifest thyrotoxicosis" refers to a syndrome, the start of the development process of which occurs against the background of various kinds of disorders of the thyroid gland. The mechanism of the development of the disease is based on the increased production of thyroid hormones that affect the work of internal organs. If the first alarming signs occur, you need to contact an endocrinologist. The specialist will draw up 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 body systems. The precursor of triiodothyronine is thyroxine (T4). The formation of these hormones occurs from iodine molecules. The latter enters the body with food and undergoes splitting. The final conversion product is iodides. They enter the thyroid gland, oxidize, and bind to tyrosine (an amino acid). Subsequently, 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 talk about thyrotoxicosis. It is subclinical and manifest. Thyrotoxicosis in the first case is characterized by a normal level of T3 and T4 and a low 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 an ailment. Most often, associated pathologies of the thyroid gland are detected in patients, against the background of which the level of hormones changes.
Manifestation of thyrotoxicosis, as a rule, accompanies:
- Diffuse toxic goiter.
- Tumors of the thyroid gland are benign.
- Autoimmune diseases.
- Thyrotoxicosis of pregnant women.
- Pathologies of the thyroid gland, the development of which is due to the uncontrolled intake of medications.
The most common cause of manifest thyrotoxicosis is Bazedova 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 tropic organs. The main clinical manifestations of the disease:
- Excessive sweating. It’s hot in any climate. Patients at the doctor's note that they stopped dressing warmly in cold weather.
- Psycho-emotional instability. Calmness is often replaced by irritability and even aggression, which may be unsafe for others.
- Heart palpitations.
- A sharp decrease in body weight.
- Dry skin.
- Swelling.
- Muscle weakness.
- Increased appetite.
- Upset stool.
In addition, there are specific symptoms of manifest thyrotoxicosis:
- Exophthalmos. This term refers to a condition in which a person's eyeballs bulge strongly.
- Tremor of the fingertips. This condition is detected by stretching the arms in front of you.
- An increase in the size of the thyroid gland. It is determined by the doctor during palpation.
- Eye signs. These include: wide-open, surprised eyes, rare blinks, the appearance of a strip of white during eye movement up.
If any of the above symptoms occur, you should contact your endocrinologist.
Diagnostics
After collecting an anamnesis, listening to complaints and conducting a physical examination, the doctor draws up a referral for examination. Based on its results, the endocrinologist can not only assess the degree of thyroid functioning, but also find out the cause of the manifestation of thyrotoxicosis.
Diagnosis of the disease involves the following studies:
- Blood test for T3, T4 and TSH.
- Thyroid uptake test.
- Radionuclide scan.
- Scintigraphy.
- Ultrasound of the thyroid gland.
To identify the cause, a blood test is prescribed for autoantibodies to myeloperoxidase, TSH receptors, as well as thyroid-stimulating substances.
In the process of differential diagnosis, it is important to distinguish the disease from multinodular toxic goiter and Graves disease.
Drug treatment
The treatment regimen for manifest thyrotoxicosis directly depends on the cause of the development of the pathology, the severity of its course, the patient's age and individual characteristics of his health. All drugs can only be prescribed by a doctor, the dosage regimen is also determined by a specialist.
The classic treatment regimen for manifest thyrotoxicosis is as follows:
- Reception of thyreostatics. These are drugs that suppress the excessive production of hormones. As a rule, doctors prescribe the following drugs: "Tyrosol", "Propicil", "Merkazolil." Treatment takes a long time (about 1 year).
- Taking glucocorticosteroids. Means of this group are indicated for severe tissue damage. Against the background of reception, destructive processes stop.
- The use of dietary supplements. They are prescribed if manifest thyrotoxicosis is a consequence of an autoimmune pathology. Most often, doctors recommend patients to use the tool "Endonorm."
- Taking drugs containing radioactive iodine. After completing the course of treatment with these agents, replacement therapy is indicated. It involves taking synthetic hormones.
During treatment, drugs from the group of b-blockers can be additionally prescribed. They support the work of the heart muscle, suffering against the development of pathology.
Surgical treatment
With the ineffectiveness of conservative methods, surgical intervention is indicated. The preparatory stage is to take the above medicines.
During the operation, the surgeon excises 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 surgery, the patient should take synthetic hormones for the rest of his life.
Effects
Ignoring the pathology can lead to the development of life-threatening complications from the cardiovascular system.
In addition, a thyrotoxic crisis may result from manifest thyrotoxicosis . This is a dangerous condition, manifested by tremors, fever, excessive excitement, hypertension, anuria and impaired functioning of the heart muscle. The outcome of a thyrotoxic crisis can be both loss of consciousness and the 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 manifest thyrotoxicosis.
To do this, it is enough to follow the following rules:
- Stop smoking and drinking alcohol.
- In summer, less sunbathing. In addition, it is undesirable for a long time to be in open sunlight during their maximum activity.
- Adjust your diet. The menu must necessarily contain vegetables and fruits. It is undesirable to eat fried, smoked and spicy dishes. Food should be cooked, 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 adjustment significantly reduces not only the risk of developing the disease, but also the occurrence of exacerbations in patients in whom the disease has already been diagnosed.
Finally
Manifested thyrotoxicosis is a pathological condition that appears against the background of the progression of various thyroid diseases. It is characterized by an increased level of the hormones T3 and T4 and a low concentration of TSH. If you experience the first alarming symptoms, you must consult an endocrinologist. The specialist will draw up a referral for a comprehensive examination, based on the results of which will make the most effective treatment regimen.