What Are the Most Common Overactive Thyroid Symptoms?

Hyperthyroidism, referred to as "hyperthyroidism," is a condition in which the thyroid gland releases excessive thyroid hormones, causing the body's metabolic metabolism and sympathetic nerve excitement to cause palpitations, sweating, eating, increased stool frequency, and weight loss. Most patients also have symptoms such as exophthalmos, eyelid edema, and vision loss.

Basic Information

nickname

Hyperthyroidism

English name

hyperthyroidism

Visiting department

Endocrinology

Common causes

May be related to factors such as lack of sleep and stress

Common symptoms

Increased stool frequency, weight loss, fear of sweating, easy to lose temper, etc.

Causes of hyperthyroidism

Causes of hyperthyroidism include diffuse toxic goiter (also known as Graves' disease), inflammatory hyperthyroidism (subacute thyroiditis, painless thyroiditis, postpartum thyroiditis, and Hashimoto's hyperthyroidism), drug-induced hyperthyroidism (caused by levothyroxine sodium and iodine) Hyperthyroidism), hCG-related hyperthyroidism (temporary hyperthyroidism during vomiting in pregnancy), and hyperthyroidism in pituitary TSH tumors.

More than 80% of clinical hyperthyroidism is caused by Graves 'disease. Graves' disease is a thyroid autoimmune disease. The patient's lymphocytes produce thyroid-stimulating immunoglobulin-TSI. TSI we measured clinically is a thyrotropin receptor antibody: TRAb. .

The cause of Graves' disease is currently unknown, and may be related to factors such as fever, lack of sleep, and high mental stress, but the clinical cause of most patients cannot be found. Graves disease is often combined with other autoimmune diseases, such as vitiligo, hair loss, and type 1 diabetes.

Clinical manifestations of hyperthyroidism

Thyroid hormone promotes metabolism and promotes the body's redox reaction. Hypermetabolism requires the body to increase food intake; gastrointestinal activity increases, and the number of stools increases; although eating more, but the oxidation reaction increases, the body's energy consumption increases, and the patient shows weight loss; thermogenesis Increased performance fear of sweating, low fever in individual patients; increased thyroid hormones stimulate sympathetic nerve excitement, clinical manifestations of palpitations, tachycardia, insomnia, emotional excitement, and even anxiety.

Patients with hyperthyroidism who have not been properly treated for a long time can cause hyperthyroid heart disease.

Examination of hyperthyroidism

Physical examination revealed that the patient's goiter (mild to severe swelling) was often insignificant in elderly patients, and the thyroid gland was soft or moderate. Severe patients could hear full-term vascular murmurs with a stethoscope, severe hyperthyroidism, or even with hands There is tremor on touch. The heart rate of patients with hyperthyroidism mostly increases, and the heart rate often exceeds 90 beats per minute at rest, and elderly patients can show rapid atrial fibrillation. Patients with hyperthyroidism have hot flashes of the skin and fine hand tremors. Many patients also show eyelid edema, eyelid fissure widening, less blinking in the eyes, and conjunctival congestion and edema. Severe patients can show exophthalmos, restricted eye movements, and even incomplete eyelid closure.

Some of the more severe patients with hyperthyroidism show anterior myxillary edema of the tibia (tibia). The anterior tibial skin is thickened, thickened, and rough, with an orange peel and thickened hairs, similar to elephant skin legs. Treatment is quite difficult.

Diagnosis of hyperthyroidism

The diagnosis of hyperthyroidism is not difficult, as long as the hyperthyroidism is considered, a thyroid function test can be performed.

T ₃ , T ₄ , FT ₃ , and FT ₄ secreted by the thyroid gland are significantly increased. Due to the feedback of the thyroid and pituitary axis, TSH is often reduced. If a patient's T ₃ , T ₄ , FT ₃ , and FT ₄ increase, accompanied by a decrease in TSH, that is hyperthyroidism.

Because hyperthyroidism is mostly Graves' disease, it is a thyroid autoimmune disease, so it is often accompanied by an increase in thyroid autoantibodies, thyroid globulin antibodies and thyroid peroxidase antibodies. Graves disease patients have a kind of thyroid stimulus due to the production of filter cells. Functional immunoglobulin-TSI, so clinically tested for thyroid stimulating hormone (TSH) receptor antibody-TRAb positive.

Some patients with hyperthyroidism can only show an increase in T ₃ and FT ₃ , T ₄ and FT _{4 are} normal, but TSH decreases, we call it "T ₃ hyperthyroidism." "T ₃ hyperthyroidism" is more common in elderly patients with hyperthyroidism or patients with toxic autonomic nodules.

Differential diagnosis of hyperthyroidism

There are also some inflammatory hyperthyroidism (or destructive hyperthyroidism) in the clinic. The permeability of the thyroid follicular cell membrane changes due to the thyroid inflammatory response. A large amount of thyroid hormones in the filter cells are released into the blood, causing significant thyroid hormones in the blood. Elevated and decreased TSH, clinical manifestations and biochemical examinations closely resemble hyperthyroidism. Inflammatory hyperthyroidism includes subacute thyroiditis, hyperthyroidism, painless thyroiditis, postpartum thyroiditis, and iodine-induced hyperthyroidism type 2. Differentiating Graves' disease from inflammatory hyperthyroidism is important because the former requires active treatment and the latter does not. The biggest difference between the two is the thyroid ¹³¹ I rate test, the former is elevated or normal, the latter is inhibited; in addition, the former is positive for TRAb, the latter is negative; the former is associated with thyroid related Ophthalmopathy, which is not associated with thyroid-related ophthalmopathy.

Complications of hyperthyroidism

1. Hyperthyroidism with pregnancy

Hyperthyroidism mostly occurs in women of childbearing age. Therefore, some patients with hyperthyroidism and pregnancy are often encountered clinically. Because antithyroid drugs have teratogenic effects on the fetus, it is necessary to discuss with the doctor based on the condition to decide whether the fetus should be retained or left. Patients with hyperthyroidism during pregnancy are contraindicated in radioiodine therapy. Most patients with hyperthyroidism who need to continue their pregnancy are treated with drugs. The minimum effective dose is used as much as possible. Do not use thyroid hormone at the same time during treatment. FT ₄ ), free T ₃ (FT ₃ ) and TSH instead of total T4 and total T3. Free T4 needs to be maintained at the upper limit of normal value during treatment.

2. Thyroid-related eye disease

Most of hyperthyroidism is Gravs' disease, which is an organ autoimmune disease. Organ autoimmune diseases often combine with other organ autoimmune diseases. Patients with hyperthyroidism often have exophthalmos. Exophthalmos are the orbits (including extraocular muscles and posterior eyeball fat). Organ autoimmune diseases. Except in patients with Graves disease, exophthalmos can be clinically expressed, and other thyroid autoimmune diseases, such as chronic lymphocytic thyroiditis, can also exophthalmos, so we call it "thyroid-related eye disease." There is no direct relationship between thyroid-related eye disease and Graves disease. They are not "father-son" relationships, but "brother" relationships. Satisfactory control of hyperthyroidism is helpful for eye diseases, but not necessarily better.

Hyperthyroidism Treatment

There are three ways to treat hyperthyroidism, antithyroid drugs, radioactive iodine, and surgery.

There are two types of antithyroid drugs-imidazoles and thiouracils. Representative drugs are methimazole (also known as "tabazole") and propylthiouracil (also known as "propylpyrimidine").

Drug treatment is suitable for pregnant women with hyperthyroidism, children, and patients with mild thyroid enlargement. The treatment usually takes 1 to 2 years, and the dose of the drug needs to be increased or decreased according to the thyroid function. There are some side effects of drug treatment, including granulocytopenia, drug allergy, impaired liver function, joint pain and vasculitis. The side effects of the drug should be closely monitored during the initial period of drug treatment, especially the lack of granulocytes. Patients should be warned of fever and / or fever Sore throat, granulocytes need to be checked immediately to determine if agranulocytosis occurs, and if it does occur. Stop treatment immediately. Another disadvantage of drug therapy is the high recurrence rate after discontinuation.

Radioiodine treatment and surgical treatment are both destructive treatments, and hyperthyroidism is not easy to recur. Radioiodine is suitable for patients with moderate thyroid enlargement or recurrence of hyperthyroidism. The doctor calculates the radiation dose required for each patient based on the patient's thyroid iodine uptake rate. Radioiodine is an absolute contraindication for pregnant and nursing women. Due to the delayed effect of radioactive iodine, the incidence of hypothyroidism is 3% to 5% per year with time. Radioiodine treatment is not suitable for patients with hyperthyroidism with thyroid eye disease, because the eye disease may worsen after treatment.

Surgical treatment is suitable for those with significant goiter, or highly suspected of malignant thyroid tumors, or who have oppressed trachea causing dyspnea. Before surgery, drugs need to be used to control the thyroid function within the normal range, and a compound iodine solution should be taken orally for preoperative preparation.