If a qualified endocrinologist is asked what thyrotoxicosis is, he will answer that this is a special condition of the body in which the cells of the thyroid gland produce more hormones than are necessary for the normal functioning of all organs and systems. If the level of thyroxine and triiodothyronine in the blood serum turns out to be higher than normal, then various disorders in metabolic processes arise and progress steadily – the basal metabolism sharply accelerates, and the patient becomes noticeable signs of endogenous intoxication. At the same time, practically all internal organs and systems of the human body are steadily suffering – until the synthesis of hormones is corrected, all measures for the drug elimination of thyrotoxicosis symptoms will be ineffective, and the achieved effect will be very short-lived.

WHY DOES THYROTOXICOSIS HAPPEN?

It should be noted that in medicine there is no such separate disease ” thyrotoxicosis ” – the causes of this condition are determined by the processes that force the human thyroid gland to produce more than the amount of thyroid hormones required by age and sex . Thyrotoxicosis is always a separate syndrome that exists in inflammatory, autoimmune, tumor processes that affect such an important part of the endocrine system as the thyroid gland. That is why endocrinologists and specialists in related medical specialties believe that the most common causes of thyrotoxicosis are: 

 

STRESS SITUATIONS 

Especially those that occur once and have significant severity, or, more likely, chronic stress, repeated constantly (often). Despite the fact that a direct causal relationship between stressful situations and the occurrence of symptoms of thyrotoxicosis can not always be traced, it should be remembered that any trauma (mental or physical) is accompanied by sharp changes in the level of thyroid hormones. That is why the constant impact of seemingly unexpressed psycho-traumatic situations is much more dangerous than a one-time severe stress – the body gets used to functioning at a high level of hormones and subsequently begins to “demand” additional stimulation, which causes the thyroid gland to produce more thyroxine and thyronine .

INFECTIONS

Their pathogens can both directly damage the epithelial cells of the thyroid gland, which are responsible for the production of hormones, which will make them synthesize these substances more actively, and general infectious diseases of the body, which are accompanied by sharp changes in metabolic processes.

HEREDITARY Predisposition

Experts have long noticed that among members of some families there is a much larger number of patients with symptoms of thyrotoxicosis of varying severity than in the general population. Research results claim that in the presence of thyrotoxicosis in several close female relatives, the likelihood of this condition in a particular individual increases significantly: for men – 2-3 times compared with the average values, while for women – 5-7 times.  

CHANGES IN THE NORMAL FUNCTIONING OF THE GENITAL GLANDS (GONAD)

By increasing the production of thyroid hormones, the body tries to compensate for the insufficient level of estrogens, progesterone, testosterone and their derivatives. In this case, metabolic defects are much more pronounced than it might seem, because in this case changes occur at all levels of regulation of metabolic processes, and the hypothalamus and the limbic system of the brain are involved in the process.  

DISTURBANCES OF THE NORMAL FUNCTIONING OF THE IMMUNE SYSTEM

Antibodies that form in the body against both foreign cells and their own ( autoantibodies ) stimulate the pituitary gland. In this gland, thyroid-stimulating hormone (TSH) begins to be actively produced, the high concentration of which determines the increased production of thyroxine and triiodothyronine, and the insufficient amount of protein necessary for the binding of these hormones and determines the pronounced effect of thyroid hormones on metabolic processes in the body.

Hormones

Excessive intake of hormonal drugs prescribed for the treatment of hypothyroidism into the body is far from always such phenomena turn out to be reversible and disappear with a decrease in the dose of the hormone coming from the outside.

IODINE

The intake of a large amount of iodine compounds into the body – this trace element is necessary for the synthesis of thyroid hormones and has a stimulating effect on the epithelium that produces thyroxine and thyronine . Iodine (regular) is actively absorbed by the cells of the thyroid gland, and in response they begin to produce more hormone than is needed for the normal functioning of the body. If such intake of iodine (even large amounts) is limited in time, then in the overwhelming majority of cases such thyrotoxicosis is reversible, and the body gradually restores the normal production of hormones. In those cases, when the body receives more iodine than is needed for normal hormone production for a long time (even if this excess is insignificant), the risk of developing thyrotoxicosis increases several times.

MEDICATIONS

Misuse of drugs that contain thyroid hormones – most often overweight patients try to use such drugs. With the help of thyroxine introduced into the body from the outside, they hope to get a quick result and lose extra pounds, but in practice, such self-medication often ends with the patients ending up in endocrinology clinics with symptoms of severe thyrotoxicosis. That is why endocrinologists everywhere refused to prescribe drugs that include thyroxine (as a more active substance in medicines it is used), for the treatment of all cases of obesity that are not associated with insufficient functional activity of the thyroid gland (hypothyroidism). Almost any modern clinic specializing in the treatment of obesity, before prescribing any medications, conducts a thorough examination of the patient, which necessarily includes a study of the level of TSH, T ₄ (thyroxine) and T ₃ (triiodothyronine). Only after the results are obtained, drugs are prescribed if they are really necessary for the regulation of thyroid metabolism and the processes associated with it. 

HOW IS THYROTOXICOSIS MANIFESTED?

If we consider such a pathological condition as thyrotoxicosis, its symptoms will depend on many factors, which include the duration of this condition, and its severity, and even the gender of the patient. Women suffer from thyrotoxicosis several times more often than men, and the bulk of new cases of the disease occur during periods of abrupt hormonal changes in the body – puberty, pregnancy and recovery of the body after carrying a child, the time of extinction of reproductive function.

If a person develops thyrotoxicosis, the symptoms of this condition appear as follows:

• a sharp change in body weight that occurs against the background of the usual diet and level of physical activity. That is why endocrinologists say that with rapid weight loss, it is necessary to exclude the presence of not only diabetes mellitus in the patient, but also conditions accompanied by a high concentration of thyroid hormones;
• increased sweating , which cannot be explained by environmental conditions or stress;
• a feeling of heat in all parts of the body – in a person with thyrotoxicosis, the body temperature is really higher than that of his healthy peer, because thyroid hormones, along with interferon, are substances that help the body fight any infectious diseases;
• heart palpitations , and tachycardia cannot be associated with nutrition, physical activity, existing diseases of the cardiovascular and hematopoietic systems;
• the appearance of tremors of the arms, legs, the whole body – the tremor that occurs cannot be explained by atherosclerosis of the vessels of the brain and organic lesions of the nervous system; 
• rapid fatigue – the body simply does not have enough energy to perform its usual functions; 
• nervous excitement and lability (rapid variability) of mood – this is how the direct negative effect of thyroid hormones on the cells of the nervous system ( cortex and subcortical structures of the brain) is manifested ;  
• changes in concentration , absent-mindedness, impaired memory processes that cannot be explained by atherosclerotic lesions of the cerebral vessels;
• instability of the stool – removing more than necessary amount of fluid, the body is trying to “rid” itself of “extra” thyroid hormones (thyroxine and thyronine are highly soluble in water);  
• violation of the menstrual cycle in women – with a significant excess of the level of thyroid hormones in the blood serum from the indicators of the age norm, the development of amenorrhea is possible, which is far from always reversible even with timely treatment of thyrotoxicosis; 
• change (sharp decrease) in sexual desire in men – high concentrations of thyroxine and thyronine suppress the production of testosterone in the body.  

There are also external manifestations of thyrotoxicosis, which are not always noticed by the patient himself or his relatives, who constantly encounter him, but are noticeable to the gaze of an experienced doctor of any specialty, especially an endocrinologist. These symptoms include the identification of goiter and an increase in neck volume (the collars of clothes that he has been wearing for a long time become tight for a person), swelling of a certain part of the neck, impaired swallowing and breathing (if pathological processes accompanied by a noticeable growth of the thyroid gland become the cause of thyrotoxicosis). 

Very often, the first sign that makes a doctor think about the possibility of thyrotoxicosis in a patient is the appearance of exophthalmos – a protrusion of the eye from the orbit of the skull, and its degree depends both on the level of thyroid hormones in the blood serum and on the duration of the disease. In addition, the patients themselves say that they began to blink noticeably less often, which is explained by a decrease in the sensitivity of the cornea to external stimuli and sooner or later leads to the development of keratitis and conjunctivitis. Due to exophthalmos, the location of the axes of the eyeballs changes, so patients complain that it is very difficult for them to examine objects that are close enough to the eye.   

A high level of thyroid hormones negatively affects the state of the organs of the patient’s cardiovascular system – myocardial dystrophy often develops , the main manifestations of which are arrhythmias that are resistant to standard therapy for such conditions, and are uncertain in the nature of pain in the region of the heart. That is why patients with heart disease who are at risk of thyrotoxicosis need timely consultation with an endocrinologist and mandatory laboratory determination of the level of thyroid hormones. 

Depending on how severe the symptoms of thyrotoxicosis are in an individual patient, a mild form of this pathological condition is distinguished, moderate and severe – the criterion for the assignment is not the level of thyroid hormones in the blood serum, but the severity of clinical symptoms.

HOW IS THYROTOXICOSIS DIAGNOSED?

Diagnosis of a condition such as thyrotoxicosis requires careful analysis and comparison of patient complaints, clinical examination data in an endocrinologist’s office, as well as the results of instrumental and laboratory examinations performed in the direction of the doctor.

To establish the very fact of a high level of thyroxine, thyronine and thyroid-stimulating hormone, a blood test is carried out, and to clarify the nature of the lesion and identify the possible cause of the development of thyrotoxicosis, the level of antibodies to thyroid cells, some viruses and bacteria is determined.

To clarify the size and structural features of the organ, to identify the nature of the pathological process in the thyroid gland, an ultrasound examination of the thyroid gland and the organs of the neck must be performed. If the results of this study are not enough, then a scan of the thyroid gland with radioactive isotopes (iodine or technetium) is performed, as well as a scintigraphic study of this organ of the endocrine system. If necessary, the diagnostic results are supplemented with information obtained after computed and magnetic resonance imaging.

If a patient has exophthalmos, then to clarify its nature, it is necessary to consult a qualified ophthalmologist with a mandatory ultrasound of the orbital area (the state of the fiber located inside the orbit behind the eyeball is studied). If neurological or psychological complaints are detected, it may be necessary to consult a neuropathologist, neurosurgeon or psychiatrist (neuropsychiatrist). If symptoms of reproductive system disorders are detected, an examination by a gynecologist or urologist-andrologist is necessary. 

Only after all these studies and consultations can it be established which disease or condition triggered the development of thyrotoxicosis – the possibility of treating this syndrome directly depends on this.

HOW IS THE TREATMENT PRODUCED?

If a patient is diagnosed with thyrotoxicosis, the treatment of this condition at the current level of development of medicine can be carried out in the following ways:

1. conservative therapy, carried out through the use of drugs and radioactive iodine;
2. surgical intervention, in which the pathological focus existing in the gland, or part of it, is removed;
3. a combination of these techniques.

Conservative treatment of thyrotoxicosis undoubtedly requires more time and a patient’s attentive attitude to his condition. The thyrostatic drugs used in therapy inhibit the functional activity of the epithelial cells of the thyroid gland, which synthesize hormones. Radioactive isotopes have the ability to be captured by thyroid cells, which leads to the death of the functionally active epithelium – as a result of such therapy, the level of hormones in the blood serum gradually decreases, but constant monitoring of such treatment is important . 

Surgical intervention is justified in cases where the doctor sees that the conservative therapy being carried out does not give the expected result or the patient develops severe complications, which makes it impossible to further use the drugs. The operation has to be resorted to in the case when a significant increase in the size of the thyroid gland causes compression of the organs of the neck and the neurovascular bundles passing in the immediate vicinity of this organ. Of course, surgery and removal of the thyroid gland remain the only way out in a situation where the doctor can confidently say that there is a malignant tumor process in this organ or suspects it with a high degree of probability.

In addition, it is necessary to treat the disease or condition that caused the development of thyrotoxicosis – if this condition is not met, conservative treatment methods may not justify the hopes placed on them. The treatment of each case of the disease requires an individual approach to the patient – not only the level of hormones in the blood serum is important, but also the general condition of the patient, and the reason that provoked changes in the thyroid gland.

Particularly noteworthy is the trend towards an increase in cases of uncontrolled use of thyroid hormones – very often drugs containing thyroxine and thyronine are taken by patients who in this way try to deal with excess weight (real or imaginary). As a result of such self-medication, patients end up in the clinic with a characteristic clinical picture of thyrotoxicosis.

THYROTOXICOSIS AND PREGNANCY

In the case when a patient is diagnosed with thyrotoxicosis, pregnancy (its onset and successful completion) becomes problematic, because with an increase in the amount of thyroid hormones, the content of estrogen and progesterone also changes, the production of chorionic gonadotropin changes. If the severity of such disorders is insignificant, then conception is still possible, as is the attachment of a fertilized and actively dividing egg to the uterine lining. The ability to endure pregnancy and give birth to a healthy child remains in doubt, because thyroxine itself can increase the tone of smooth muscles, which is fraught with spontaneous abortion at different stages of pregnancy or premature birth.  

With moderate, and even more severe, thyrotoxicosis, pregnancy almost never occurs without the use of modern reproductive technologies – in such patients, the process of egg maturation is disrupted, and amenorrhea very often develops.

If, under the influence of thyrostatic drugs or radioactive iodine, compensation of thyrotoxicosis was achieved, then the onset of pregnancy is possible, but in this case there is a high probability of the birth of a child with severe malformations, because isotopes and drugs that inhibit the production of hormones have a pronounced teratogenic and embryotoxic effect. That is why pregnancy, which occurred against the background of active treatment of the disease, doctors have to recommend to interrupt.

Successful bearing of the fetus and the birth of a healthy child are possible only if the causes of thyrotoxicosis have been eliminated and a complete remission of the disease has been achieved.

HOW TO FORGET ABOUT THYROID DISEASES?

Lumps on the neck, shortness of breath, sore throat, dry skin, dullness, hair loss, brittle nails, puffiness, puffiness of the face, dull eyes, fatigue, drowsiness, tearfulness, etc. – it’s all a lack of iodine in the body. If the symptoms are “on the face” – perhaps your thyroid gland is no longer able to work normally … You are not alone, according to statistics, up to a third of the entire population of the planet suffers from thyroid problems.