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Hyperthyroidism: when surgery can be an alternative?

Hyperthyroidism: when surgery can be an alternative?

Hyperthyroidism or thyrotoxicosis results from overproduction of thyroid hormones, called T3 and T4.

Several diseases can cause hyperthyroidism, however, Graves' disease is the most common cause of thyroid disease. its appearance. This disease occurs most commonly in people between the ages of 20 and 50, affecting approximately 2% of women and 0.2% of men. It is a type of autoimmune disease, in which the organism produces antibodies capable of stimulating the production of thyroid hormones (T3 and T4). In addition, this disease can lead to the infiltration of substances either behind the eyeball, which pushes it forward, resulting in exophthalmus (jumping eyes), or in the anterior region of the legs (pre-tibial myxedema).

Excessive growth Thyroid hormones can cause several clinical manifestations of variable intensity. The presence of severe hyperthyroidism can lead to serious complications such as congestive heart failure, cardiac arrhythmias, osteoporosis with increased risk of fractures, increased risk of miscarriage, etc. There is also a higher risk of death due to cardiovascular diseases and a fracture of the femur:

SymptomsSigns
Nervousness, anxiety and irritabilityIncreased heart rate
Excessive sweatingIncreased volume Thyroid pain
Excessive heat sensationTremor
PalpitationHot and wet skin
FatigueEyelid shrinkage
Weight reductionSalted eyes (exophthalmia )
Shortness of breathUnbalanced heart rate (arrhythmia)
Muscle weakness
Increased appetite
Changes in eyes
Swelling of legs
Increased frequency of bowel movements
Changes in menstruation
Decreased appetite
Weight gain
Hair loss

In this way, it is imperative that all patients are treated, especially when hyperthyroidism is severe. Unfortunately, none of the currently available treatments is able to specifically act on the cause of the disease, ie block the production of antibodies that stimulate the thyroid. In the case of Graves' disease, three types of treatment can be chosen: antithyroid drugs, surgery and radioactive iodine. The treatment of choice varies between countries. In Brazil, antithyroid medications are still the most used. The literature shows that the probability of remission of the disease (12 months with normal thyroid function after drug withdrawal) is 40-50% after 12 to 18 months of treatment. Radioactive iodine has been increasingly used since it is a definitive and safe treatment, when its contraindications are respected. One of the disadvantages is the high risk of permanent hypothyroidism (lack of thyroid hormones). Contraindications for treatment with radioactive iodine include, among others, pregnant women, women who are breastfeeding, and the presence of a malignant nodule (thyroid cancer).

Surgery is currently restricted to situations in which medications and radioactive iodine are contraindicated. The technique involves total or near total withdrawal of the thyroid. Its advantages are to provide rapid cure and removal of goiter. Its main disadvantages are associated with damage to the parathyroid glands and paralysis of the vocal cords in a small percentage of patients. Such complications are directly related to the surgeon's experience. There are some situations in which surgery may be a therapeutic alternative:

  • Children and pregnant women who have adverse effects or who do not take medicines regularly
  • Individuals with very large goiters (thyroid enlargement) that compress neighboring structures
  • Patients who wish to have definitive treatment but are afraid to use radioactive iodine
  • When a suspected cancer nodule is present

It is important to emphasize that there are also other causes of hyperthyroidism, such as thyroid nodules that manufacture excess T3 and T4, pituitary tumors that produce exaggerated quantities of thyroid stimulating hormone, some types of thyroiditis (inflammation of the thyroid), excessive intake of iodine, among others. Obviously, many factors must be taken into account when choosing the type of treatment, such as the severity of the disease, the presence of other diseases that may interfere with the treatment, gestation, age etc.

Thus, it is evident that the experience of the specialist is of paramount importance in the choice of the therapeutic strategy for which good results are obtained. In the presence of symptoms of hyperthyroidism, patients need to seek medical attention quickly, as the clinical manifestations are very unpleasant and, when the disease is severe, it may involve the risk of death.


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