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Hyperthyroidism: treatment depends on the severity of the disease

Hyperthyroidism: treatment depends on the severity of the disease

Hyperthyroidism is caused by excessive production of thyroid hormones (T3 and T4) resulting from increased gland function, whereas thyrotoxicosis is a broader term referred to to any condition in which there is excess of these hormones.

Several diseases of the thyroid gland can lead to increased production of thyroid hormones, but it is important to mention that the problem is not always in the thyroid (Table 1). The most common cause of hyperthyroidism is Graves' disease, which occurs when the body produces antibodies that stimulate the functioning of the gland. It may also be due to one or more thyroid nodules that manufacture excess thyroid hormones (toxic uni or multinodular goiter, respectively) or inflammatory thyroid processes, such as Hashimoto's thyroiditis or postpartum thyroiditis. There are a number of other causes, including the rarest, among them, a pituitary tumor capable of producing large amounts of thyroid stimulating hormone (TSH) or a specific type of ovarian tumor called struma ovarii.

Hyperthyroidism may result or excessive intake of iodine or substances with a high concentration of iodine, such as some seaweed tablets, expectorants and the medicine amiodarone (often used to treat cardiac arrhythmia).

An important cause of thyrotoxicosis is hormone ingestion thyroid in the attempt to decrease body weight. In the latter case, the situation can be particularly damaging, since in addition to a large loss of muscle tissue, the ingestion of high doses of thyroid hormones can be potentially fatal.

When hyperthyroidism is mild, called subclinical, the individual usually has no symptoms and, when they do, they are of little intensity. On the other hand, when hyperthyroidism is more intense (frank hyperthyroidism), several signs and symptoms are present. In this case, no doubt, the person needs treatment, even though hyperthyroidism can be severe enough to endanger the individual's life. However, in the case of subclinical hyperthyroidism the need for treatment is debatable. The decision to treat subclinical hyperthyroidism should be made by the endocrinologist taking into account all the risks and benefits involved for each patient.

Since thyrotoxicosis can occur for a variety of reasons (Table 1), the therapeutic strategies will be chosen from depending on the cause of the individual's problem.

In the case of intentional ingestion of thyroid hormones for weight reduction, for example, simple suspension corrects thyrotoxicosis. In the case of Graves' disease, three types of treatment are available: antithyroid drugs, surgery and ingestion of radioactive iodine. For thyroid hormone-producing nodules, in addition to these three therapeutic modalities, it can be destroyed with LASER, radiofrequency and ethanol. People who have Hashimoto's thyroiditis and postpartum thyroiditis are treated with antithyroid drugs, as hyperthyroidism is transitory.

In addition to the cause of hyperthyroidism, several other factors should be evaluated to choose the most appropriate treatment, such as the severity of the disease, the presence of other diseases that may interfere with the treatment, the presence of gestation, the age, etc. Thus, it is evident that the diagnosis and treatment of the disease are complex. In this case, the experience of the endocrinologist will be essential for the choice of the most appropriate therapeutic strategy.

Table 1 - Causes of Thyrotoxicosis

1. Graves' disease (toxic diffuse goiter)


Experts take 6 doubts about self-medication

Experts take 6 doubts about self-medication

Who has never taken an over-the-counter remedy for a headache? Or did you ask the opinion of a family member about which medicine to take on an occasion? Although self-medication serves as a solution to the rapid relief of some symptoms, it is necessary to be very careful, as this practice can have serious consequences for health.

(Health)

HEALTH

HEALTH

The authors followed 9,276 women between the ages of 40 and 50, all enrolled in the Australian Longitudinal Study on Women's Health. After two years, 55% of the participants gained an average of 1.5% of their initial weight. Analyzing the women's work day, the experts concluded that those who worked 35 hours a week were more likely to be sedentary and fatter than those who worked for a shorter period.

(Health)


2. Toxic uninodular goiter
3. Toxic multinodular goiter
4. Thyroiditis: subacute, autoimmune or Hashimoto's, postpartum, post-ingestion of cytokines, etc.
5. Recombinant pituitary adenoma of TSH
6. Trophoblastic tumors producing chorionic gonadotrophin (hydatidiform mole and choriocarcinoma)
7. Induced by iodine
8. Induced by ingestion of the drug amiodarone
9. Radiation
10. Factitious thyrotoxicosis: when there is intentional or non-use of thyroid hormones
11. Ovarian tumor - Struma ovarii
12. Metastases of follicular carcinoma capable of producing thyroid hormones