An enlarged thyroid swelling is called a goitre. It can be caused by too much or too little thyroid hormones. The most common cause is a hyperthyroid disease as a result of excessive thyroid hormones produced in the body from stress. The condition typically occur in a woman. The last case of hyperthyroid condition seen by me occur in a Filipino maid . Her blood test confirmed her condition and she was treated by me with medicine for 2 years . After 2 months her blood tests were normal but her clinical symptoms were still present. The medicine was reduced to a minimum and she finally returned home after the 2 years of treatment. She could continue working but decided to return home to rest.
Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.
Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.
1.Graves' disease - diffuse goitre(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.
2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.
3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.
4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.
Symptoms:
1.anxiety, shaking, feeling nervous or irritated
2.fast heartbeat or palpitations
3.feeling hot
4.Excess sweating
5.increased appetite
6.loss of weight
7.fatigue, exhaustion
8.increased frequency of bowel movements
9.changes in menstrual periods
10.eye irritation
11.bulging of the eyes
12.double vision
13.blurred vision
Signs:
1. Enlarged thyroid gland -diffuse or nodular
2.Bruit or blood flow sounds may be heard over the thyroid
3.Skin warm and sweaty
4. fine brittle nails
5.fine hair
6.Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure
7.Fine tremors of hands
8.Eye : bulging, periorbital edema, lid lag
Confirming tests are:
1. blood test is done for presence of high thyroxine(T3 and T4) and low TSH (thyroid stimulating hormone) levels.
2. Blood for thyroid antibodies(thyroiditis)
3. Ultrasound of the thyroid gland
Medical treatments is by:
1.Anti-thyroid drugs
reduce the production of excess thyroid hormones
The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition. Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs. Side effects include lowering of white cell count and commitant infection of the throat.
Relapse after 1-2 years treatment are quite common.
2.Radioactive iodine therapy
is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.
The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.
3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.
A subtotal thyoidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyoid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.
4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones
b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.
c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthroid disease.
Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can develop hypothyroidism later on in life when the thyroid hormones production is reduced.
Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.
Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthroid disease.
Avoid stress and anxiety.
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