Diseases

Hyperthyroidism - symptoms, causes and treatment

Hyperthyroidism - symptoms, causes and treatment


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Hyperthyroidism: overactivity of the thyroid gland

One speaks of an overactive thyroid gland (hyperthyroidism) if too many thyroid hormones are produced and released. The causes are often found directly in the thyroid, such as Graves' disease or thyroid autonomy. However, there may also be other underlying diseases and other hormonal disorders. The diverse symptoms reveal the highly active metabolism of the body that arises from hyperfunction. Possible forms of treatment include medication, radio iodine therapy and surgery. In addition, the remediation of possible interference fields plays a further role in treatment in holistic medicine.

Definition

The technical term of hyperthyroidism refers to an increased synthesis and secretion of thyroid hormones (T3 and T4) due to different causes or underlying diseases. As a result, the body's metabolic and circulatory processes are overly stimulated, which manifests itself in a variety of symptoms.

The frequency of the disease in the German population is given as about one to two percent, with significantly more women than men being affected (with a gender ratio of up to one in five).

To be distinguished from an overfunction is the thyrotoxicosis, also called the thyrotoxic crisis. Here, mostly due to pre-existing (undetected) hyperthyroidism, there is an extreme form of the disease, which causes the thyroid hormone level to rise to life-threatening levels.

Thyroid hormones and their function

The thyroid gland (Latin: Glandula thyreoidea) is a butterfly-shaped hormone gland that is located below the larynx in front of and to the side of the trachea and from there releases its hormones directly into the bloodstream. The two best known hormones that are formed by the follicular epithelial cells (thyrocytes) of the thyroid are tetraiodothyronine (thyroxine, T4) and triiodothyronine (T3). According to their name, both hormones have four or three iodine atoms. If an iodine atom is split off from the T4, this creates the T3 hormone, which is more short-lived but more effective.

Most of these hormones are bound in the blood for transport. In a much smaller proportion there are free hormones (fT4 and fT3) that have a direct influence on certain metabolic processes and thus on the whole organism. They regulate the metabolism of protein, fat and carbohydrates and thus have an effect on the energy metabolism, the muscles and the growth of special cells (bones).

The availability of iodine is of great importance for the production of T4 and T3. For adults, the daily need for iodine is given as 150 to 200 micrograms. The recommended amount for children is correspondingly lower, pregnant women and nursing mothers have an increased need. As a rule, iodine can be adequately ingested through food, and supplementary iodine tablets are only medically recommended if there is an increased need for iodine or an iodine deficiency.

The two thyroid hormones are synthesized and stored so that they can be released as needed. The release controls another hormone from the pituitary gland, the so-called thyroid stimulating hormone (TSH).

Another hormone that is produced in the thyroid's C cells is the peptide hormone calcitonin. It takes over tasks in the regulation of calcium and phosphate concentrations in the blood and thus influences the bone metabolism or inhibits bone breakdown processes.

Symptoms

If the levels of T4 and T3 in the blood are too high, this can be manifested by a number of diverse symptoms that indicate the increased metabolism and the hormonal interaction with the autonomic nervous system. Typical signs include:

  • increased pulse and high blood pressure,
  • Irregular heartbeat (feeling of rapid heartbeat or palpitations),
  • inner restlessness and visible nervousness,
  • Sleep disorders,
  • Lack of concentration,
  • Mood swings (including aggressiveness),
  • rapid exhaustion and muscle weakness,
  • Trembling (hand trembling),
  • increased sweating and increased body temperature (sensitivity to heat),
  • Diarrhea or constipation,
  • unintentional weight loss despite hunger and sufficient food intake,
  • Cycle disorders in women,
  • Hair loss,
  • Brittle fingernails,
  • moist, warm, velvety skin.

In older people, it is not uncommon for the symptoms to appear only weakened or even isolated in the presence of elevated hormone levels, which is otherwise rather atypical for the clinical picture.

[GList slug = ”10-signs-for-hypertension”]

An overactive thyroid gland can occur with or without enlargement of the thyroid gland (goiter or goiter), since organ size and function are not directly related.

In the so-called Basedow disease (immune-related hyperthyroidism), on the other hand, pronounced goiter formation (also with knots) is one of the three typical key symptoms. Furthermore, there are increased heart rates (tachycardia) and other cardiac arrhythmias as well as characteristic eye symptoms (including the appearance of the eyeballs (exophthalmos), staring gaze, swelling of the eyelids).

If left untreated, a particularly severe form of hyperthyroidism can develop into a life-threatening condition, the thyreotoxic crisis. However, this is only rarely the case and occurs especially after operations, serious illnesses and excessive iodine intake. This leads to high fever, restlessness, atrial fibrillation and impaired consciousness. This condition always requires emergency medical or intensive care treatment, as in the worst case the affected person can also fall into a coma.

Causes and emergence

According to the German Society for Endocrinology, the two most common causes of hyperthyroidism are primarily thyroid autonomy with uninhibited hormone release, followed by a malfunction of the body's immune system known as Graves 'disease (Graves' disease). Less often, however, other diseases and factors can trigger hyperthyroidism.

Autonomous thyroid

In older people, around the age of fifty, there is predominantly so-called autonomy, in which the normal regulation of hormone production by the pituitary gland is disturbed. The thyroid gland then produces uninhibited hormones, either in the entire tissue or only in one or more delimited areas of the organ. These areas are also called "hot knots". As a rule, these are benign nodules (autonomous adenomas), but they can gradually lead to overfunction. The tissue changes are very rarely malignant thyroid tumors.

Immunogenic hyperthyroidism

Immune-related hyperthyroidism often arises due to Graves 'disease (also called Graves' disease). In this autoimmune disease, certain antibodies lead to a fight against the body's own structures. These so-called autoantibodies do not fight pathogens as usual, but stimulate the cells of the thyroid gland to produce more hormones. This disease is also associated with chronic inflammation of the thyroid gland and enlargement of the gland (goiter).

Typically, there are other changes due to the disease, such as on the eyes. A characteristic picture are protruding eyeballs as well as reddened and swollen eyelids. Painful eye infections can also occur. Changes and swellings on the lower tibia or forefoot (pretibial myxedema) or on the toes and fingers (acropachia) are rare.

But even if these signs are missing, immune-induced hyperthyroidism may still be present. Over a third of all hyperthyroidism (forty percent) is attributed to such a cause. Most women are affected after the age of thirty-five.

Other causes and risk factors

Hyperfunction can be caused by medication or caused by the exogenous supply of certain substances. This can be triggered, for example, in the event of an overdose with thyroid hormones due to an existing underactive or goiter formation (hyperthyeosis factitia) as well as with iodine-containing drugs (amiodarone for cardiac arrhythmias) or other means. Existing hyperthyroidism can be exacerbated by taking certain medications, such as aspirin.

In the initial phase of an inflammatory thyroid disease (thyroiditis, Hashimoto's thyroiditis), there can be temporary hyperthyroidism, which later turns into an underactive thyroid (hypothyroidism). Pregnancy hyperthyroidism due to changes in hormone levels are generally of limited duration.

Rarely, hyperthyroidism is due to a disease (e.g. tumors) of the pituitary and hypothalamus, which are involved in the regulation of thyroid hormone release. Congenital hyperthyroidism is also very rare if the mother has an immunogenic disease (Graves' disease) or certain gene mutations.

Diagnosis

Nowadays, various diagnostic methods help to identify hyperthyroidism and its causes better and faster. Which sequence of examination methods should take place is usually decided individually by the treating internal and endocrinological experts. A precise patient survey, not only on the symptoms, eating and lifestyle habits but also on previous illnesses or thyroid diseases in the family, as well as a general physical examination with palpation of the neck region always precedes the further diagnosis.

In any case, each diagnosis involves taking a blood sample, taking a blood picture and examining the hormone levels specific to the thyroid gland. An overfunction typically shows itself by too low TSH values ​​with simultaneously excessive hormone values ​​for T4 and T3 or for free T4 (fT4) and T3 (fT3). If only the TSH value is reduced, it can be an initial stage, the other values ​​only change after the manifestation has taken place. In order to find the cause, the blood is also checked for possible thyroid antibodies.

In addition to the blood values, a diagnosis is primarily based on an ultrasound examination. With the help of ultrasound (color Doppler sonography), thyroid complaints can be better recognized and a diagnosis can usually be made quickly and reliably. In the case of hyperfunction, the images show, for example, excessive blood flow to the organ. It is also possible, under certain circumstances, to perform a fine needle puncture during the examination in order to further examine removed thyroid tissue.

If the diagnosis is not yet clear or specific information is still missing, for example about discovered nodes in the thyroid gland, scintigraphy is also used. This imaging method allows statements to be made about the functionality, but represents a certain strain on the body through the use of radioactive radiation.

Depending on the cause and the effects, further examinations and tests may be advisable.

Treatment

Conventionally, there are three treatment options for hyperthyroidism: therapy with medication (thyrostatics), radioiodine therapy or ultimately an operation. Specialized medical specialists from the field of internal medicine or endocrinology must examine all those affected most carefully in order to determine the correct form of therapy. Age, general health and the severity of overfunction also play a role.

Medical therapy

To treat the symptoms of hyperfunction, so-called thyrostatics are used in many cases, which inhibit hormone formation or its release into the blood via different mechanisms of action. However, every drug carries the risk of certain side effects and the cause of the disease cannot be remedied with these drugs.

Standard preparations are mainly thionamides (for example carbimazole and thiamazole). These directly inhibit the formation of thyroid hormones. Other agents that work by reducing iodine intake are used less frequently and only under certain conditions. They also usually require medical monitoring.

After a certain period of treatment, there is a chance, especially with the most common causes (Graves' disease and thyroid autonomy), that a lowered hormone level remains even without medication. If the disease recurs, one of the other forms of therapy is usually sought.

Since the effects of the hormonal changes only begin to take effect, beta-blockers are often used to treat many symptoms. Heartbeat, feelings of fear and tremors can be treated well with it, for example. For very mild forms of hormone overproduction, these drugs can even offer an alternative and make further measures unnecessary.

Radio iodine therapy

The treatment with radioactive iodine can only be carried out by specialized institutions and represents a considerable radiation exposure, which requires a daily quarantine of those affected. This form of therapy is generally prohibited for pregnant and lactating women and for young children and adolescents up to around fifteen years of age.

Indications for radio iodine therapy can be given for Graves' disease and for thyroid autonomy. A good prerequisite is if there is no significant enlargement of the thyroid. However, it must be checked individually whether the alternative to surgery is preferable to this type of treatment.

The radioactive iodine administered orally (capsule) or intravenously accumulates in the tissue of the thyroid gland and there leads to cell destruction by the local radiation. A common risk is a subsequent hypofunction, but it is less dangerous and easier to treat. So far, no harmful effects of radiation on other parts of the body are known.

Surgery

If the disease is particularly severe or there is a thyreotoxic crisis, the recommended treatment is often to remove the thyroid gland. Even with a large goiter, surgery is the first therapy recommendation.

The entire organ can be removed or only a partial resection can be performed. In the event of partial removal, functional tissue and the parathyroid glands should be preserved. However, the remaining function is not always sufficient to prevent a subfunction. Applied procedures are performed through a small skin incision on the front of the neck or minimally invasively.

Particular risks in these operations are possible injury to the parathyroid glands and later voice and speech disorders due to damage to the neighboring larynx.

Treatment methods of holistic medicine

In naturopathy and holistic medicine, the various factors that influence the thyroid are of great importance. Possible disorders of the vegetative nervous system and other regulating hormone glands, which can cause a functional disorder of the thyroid gland, receive appropriate attention in the diagnosis. Attention is also paid to the possible individual disposition to thyroid disease.

Against this background, holistic medicine believes that, among other things, an overload of the organism due to stress, a lack of recovery phases, little exercise and fresh air, mental conflicts and a diet that is stressful to the metabolism are responsible for contributing to thyroid dysfunction. In addition, scars or latent foci of pus (especially on the teeth and tonsils) are suspected of creating interference fields that irritate the thyroid gland directly or influence the hormonal control circuit via the pituitary and hypothalamus.

Conventional medicine can be used to find and eliminate possible interference fields using various diagnostic methods. For example, procedures such as neural therapy or bioenergetic methods are available. Cold clay wrap is recommended as a local physical application, and targeted breathing and voice exercises can have a balancing effect on the thyroid.

Sufficient exercise in the fresh air as well as a low-protein and high-fiber diet relieve the metabolism and stimulate the body's healing powers. But there are also numerous other supportive options, such as homeopathy, milieu therapy, phytotherapy, psychotherapeutic procedures, relaxation methods, Bach flower therapy or a treatment with minerals according to Dr. Schuessler (Schuessler salts).

The hyperthyroidism basically remains a serious disease that always requires specialist treatment. Depending on the case of illness and in consultation with a doctor, further measures can have a supporting effect. (jvs, cs)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Pschyrembel: Clinical dictionary. 267th, revised edition, De Gruyter, 2017
  • Herold, Gerd and co-workers: internal medicine. Self-published by Gerd Herold, 2019
  • German Society for Endocrinology (DGE) e. V .: Patients-disorders-hyperthyroidism (accessed: August 12, 2019), endokrinologie.net
  • German thyroid center: worth knowing (available: August 12, 2019), deutsches-schilddruesenzentrum.de
  • Professional association of German internists (ed.): Internists in the network - hyperthyroidism (accessed 12.08.2019), internisten-im-netz.de
  • German Society for Pediatrics and Adolescent Medicine (ed.): S1 guideline: Hyperthyroidism. As of January 2011, AWMF Register No. 027/041, awmf.org
  • De Leo, Simone, Lee, Sun Y. and Braverman, Lewis E .: Hyperthyroidism, in: The Lancet, Issue 388/10047 (2016), pp. 906-918., The Lancet

ICD codes for this disease: E05ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


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