Gipertireoz (thyrotoxicosis) – the clinical syndrome caused by increase in hormonal activity of a thyroid gland and which is characterized by excess production of tireoidny hormones - T3 (triyodtironina) and T4 (tiroksin). Glut of blood hormones of a thyroid gland causes acceleration in an organism of all exchange processes (the so-called "fire of a metabolism"). This state is opposite to a hypothyroidism at which because of decrease in level of tireoidny hormones processes of metabolism are slowed down. At suspicion on the research of level of hormones of a thyroid gland and TTG, ultrasonography, a stsintigrafiya, if necessary - a biopsy is conducted.
Gipertireoz (thyrotoxicosis) – the clinical syndrome caused by increase in hormonal activity of a thyroid gland and which is characterized by excess production of tireoidny hormones - T3 (triyodtironina) and T4 (tiroksin). Glut of blood hormones of a thyroid gland causes acceleration in an organism of all exchange processes (the so-called "fire of a metabolism"). This state is opposite to a hypothyroidism at which because of decrease in level of tireoidny hormones processes of metabolism are slowed down. Gipertireoz is mainly diagnosed among women of young age.
Reasons of a gipertireoz
Usually develops as result of other pathologies of a thyroid gland caused as violations in gland, and in its regulation: in 70 – 80% of cases development of a gipertireoz is the result of a diffusion toxic craw (Greyvs's disease, the Bazedovy disease) – uniform increase in a thyroid gland. This autoimmune violation at which the antibodies against hypophysis TTG receptors promoting continuous stimulation of a thyroid gland, its increase and resistant excess production of tireoidny hormones are developed.
At virus inflammations of a thyroid gland (a subsharp tireoidit) or an autoimmune tireoidit of Hashimoto destruction of follicular cells of a thyroid gland and receipt develops in blood of excess of tireoidny hormones. In this case has temporary and not character, several weeks or last months. Local consolidations in a thyroid gland at a nodal craw even more increase functional activity of its cages and secretion of tireoidny hormones.
Existence of TTG-sekretiruyushchy tumors of a hypophysis, and also toxic adenoma of a thyroid gland (the tumor producing tireoidny hormones independently, irrespective of control of a hypophysis) or ovary struma (the tumor consisting of cells of a thyroid gland and a sekretiruyushchy tireoidinya hormones) leads to development of a gipertireoz. The condition of a gipertireoz can develop at uncontrolled reception of a large amount of synthetic tireoidny hormones or fabric immunity of a hypophysis to tireoidny hormones. Are predisposed to development of a gipertireoz of the woman, person with the burdened hereditary anamnesis, existence of autoimmune pathology.
Classification of a gipertireoz
Depending on the level of violation distinguish primary (caused by pathology of a thyroid gland), secondary (caused by hypophysis pathology), tertiary (caused by hypothalamus pathology). Allocate several forms of primary gipertireoz:
- subclinical (the T4 level is normal, TTG is lowered, a current asymptomatic);
- manifest or obvious (the T4 level is increased, TTG is considerably lowered, the characteristic symptomatology is observed);
- complicated (vibrating arrhythmia, heart or nadpochechnikovy failure, dystrophy of parenchymatous bodies, psychoses, the expressed deficiency of weight etc.).
Symptoms of a gipertireoz
Manifestations of a gipertireoz at various damages of a thyroid gland are similar though each pathology which is followed by the high level of tireoidny hormones has the features. Symptoms depend on duration and disease severity, on extent of defeat of this or that system, body or fabric.
At a gipertireoza the expressed violations from TsNS develop and mental activity: nervousness and hypererethism, emotional unbalance (irritability and tearfulness), sensation of fear and concerns, increase in intellectual processes and fluent speech, violation of concentration of thoughts, their sequences, sleeplessness, melkorazmashisty tremor.
Cardiovascular frustration at a gipertireoza are characterized by violation of a warm rhythm (the persistent sinusovy tachycardia which is badly giving in to treatment; blinking and trembling of auricles), increase systolic (top) and decrease diastolic (lower) HELL, increase of pulse, increase in linear and volume speed of a blood-groove, development of heart failure.
Ophthalmologic violations (Greyvs's ophthalmopathy) at a gipertireoza it is found more than in 45% of patients. The century is shown by increase in an eye crack, shift (protrusion) of an eyeball () and restriction of its mobility, a rare blinking, doubling of objects, hypostasis forward. There is a dryness, cornea erosion, there are gripes in eyes, dacryagogue, the blindness as a result of a sdavleniye and dystrophic changes of an optic nerve can develop.
Gipertireoz is characterized by change of metabolism and acceleration of the main exchange: weight reduction at the increased appetite, development of tireogenny diabetes, increase in heat production (perspiration, temperature increase, intolerance is warm), insufficiency of adrenal glands as a result of bystry disintegration of cortisol under the influence of hormones of a thyroid gland. At a gipertireoza there are changes of skin - it becomes thin, warm and damp, a hair - they become thinner and early turn gray, nails, hypostases of soft tissues of shin develop.
As a result of hypostases and developments of stagnation in lungs short wind and decrease in vital capacity of lungs develops. Gastric frustration are observed: the increased appetite, violation of digestion and a bile production, an unstable chair (frequent ponosa), attacks of belly-aches, increase in a liver (in hard cases – jaundice). At elderly patients the loss of appetite up to anorexia can be observed.
At a gipertireoza signs of a tireotoksichesky myopathy are observed: a hypotrophy of muscles, muscular fatigue, constant weakness and a shiver in a body, extremities, development of osteoporosis, violations of physical activity. Patients experience difficulties at long walking, rise on a ladder, transfer of weights. Sometimes reversible "tireotoksichesky muscular paralysis" develops.
Violation of water exchange is shown by strong thirst, a frequent and plentiful urination (polyuria). Disorder of functions of the sexual sphere at a gipertireoza develops as a result of violation of secretion of men's and female gonadotrophins and can cause infertility. At women violations of a menstrual cycle (an irregularity and morbidity, poor allocations), the general weakness, a headache and faints are noted; men have a ginekomastiya and decrease in a potentiality.
Complications of a gipertireoz
At an adverse current of a gipertireoz tireotoksichesky crisis can develop. Infectious diseases, a stress, big physical activity can provoke it. Crisis is shown by a sharp aggravation of all symptoms of a gipertireoz: fever, sharp tachycardia, symptoms of heart failure, nonsense, progressing of crisis to coma and a lethal outcome. The "apathetic" option of crisis – apathy, absolute indifference, a kakheksiya is possible. Tireotoksichesky crisis occurs only at women.
Diagnostics of a gipertireoz
Gipertireoz is diagnosed on characteristic clinical manifestations (appearance of the patient and complaints), and also results of researches. At a gipertireoza informatively determination of content in blood of TTG hormones (contents is reduced), T 3 and T 4 (contents is increased).
At ultrasonography of a thyroid gland determine its sizes and existence in it of nodal educations, by means of a computer tomography the place of formation of knots is specified. Carrying out the ECG fixes existence of deviations in work of cardiovascular system. The radio isotope stsintigrafiya of a thyroid gland is carried out for assessment of functional activity of gland, definition of nodal educations. If necessary carry out a biopsy of knot of a thyroid gland.
Treatment of a gipertireoz
The modern endocrinology has several methods of treatment of a gipertireoz which can be applied separately or in a combination with each other. To such to methods belong:
- Conservative (medicamentous) therapy.
- Surgical removal of a part or all thyroid gland.
- Radio iodic therapy.
It is unambiguously impossible to define the best method which would be suitable absolutely for all patients with gipertireozy. The choice of a method of the treatment optimum suitable for the specific patient gipertireozy, is carried out by the endocrinologist taking into account many factors: age of the patient, the disease which caused and its weight, an allergy to drugs, existence of associated diseases, individual characteristics of an organism.
Conservative treatment of a gipertireoz
Drug treatment of a gipertireoz is directed to suppression of sekretorny activity of a thyroid gland and decrease in development of excess production of tireoidny hormones. Tireostatichesky (antitireoidny) medicines are applied: or propiltiouratsit which complicate accumulation of the iodine necessary for secretion of hormones in a thyroid gland.
The important role in therapy and recovery of patients with gipertireozy is played by non-drug methods: dietotherapy, balneotherapy. With gipertireozy sanatorium treatment with emphasis on cardiovascular diseases is recommended to patients (1 time in half a year).
In food the sufficient content of proteins, fats and carbohydrates, vitamins and mineral salts has to be included, the products exciting TsNS are subject to restriction (coffee, strong tea, chocolate, spices).
Surgical treatment of a gipertireoz
Before making crucial decision on surgery, all alternative methods of treatment, and also a look and volume of possible surgical intervention are discussed with the patient. Operation is shown for some patients with gipertireozy and consists parts of a thyroid gland at a distance. Indications to operation is the single knot or growth of the certain site (hillock) of a thyroid gland with the increased secretion. The part of a thyroid gland which remained after operation performs normal function. During removal of the most part of body (a subtotal resection), development of a hypothyroidism is possible, and the patient needs to receive replacement therapy during all life. After removal of a considerable share of a thyroid gland the risk of a recurrence of a thyrotoxicosis considerably decreases.
Treatment of a gipertireoz radioactive iodine
Radioyodoterapiya (treatment by radioactive iodine) consists in acceptance by the patient of the capsule or water solution of radioactive iodine. Medicine is accepted once, has no taste and a smell. Getting to blood, radio iodine gets into cells of a thyroid gland with hyperfunction, collects in them and destroys them within several weeks. As a result of it the sizes of a thyroid gland decrease, secretion of tireoidny hormones and their level in blood decrease. Treatment by radioactive iodine is appointed along with medicamentous. The absolute recovery at this method of treatment does not come, and at patients sometimes remains , but already less expressed: in this case there can be a need of carrying out a repeated course.
To thicket, after treatment radioactive iodine observes a condition of a hypothyroidism (in several months or years) which is compensated by performing replacement therapy (lifelong reception of tireoidny hormones).
Other methods of treatment of a hypothyroidism
At treatment of a gipertireoz can be applied by ß-adrenoblokatory, blocking effect of tireoidny hormones on an organism. The patient can feel better within several hours, despite the excess level of tireoidny hormones in blood. Medicines belong to ß – adrenoblokator: , , , propranolol, having long action. Except for the gipertireoz caused tireoidity, these medicines cannot be used as an exclusive method of treatment. ß - adrenoblokator can be applied in combination with other methods of treatment of diseases of a thyroid gland.
Forecast and prevention of a gipertireoz
Patients with gipertireozy surely have to be under observation of the doctor-endocrinologist. The timely carried-out and adequately picked up treatment allows to restore quicker good health and to prevent development of complications. It is necessary to begin treatment right after diagnosis and not to self-medicate categorically.
The prevention of development of a gipertireoz consists in healthy nutrition, the use of iodinated products, timely treatment of the available pathology of a thyroid gland.