Hyperthyroidism (Toxic Goiter)
Hyperthyroidism is a disease caused by the secretion of excessive thyroid hormone (T4 and T3) from the thyroid gland. This disease is also called 'thyrotoxicosis'.
The diseases that cause hyperthyroidism are:
1.Graves disease, p>
2.Toxic nodular goiter (Toxic Goiter),
3.Inflammations of the thyroid gland (Thyroiditis),
4. Excessive iodine intake (by patients with nodules consuming too much iodized salt or iodized cough syrup)
5. Taking too much thyroid hormone (with excessive taking of drugs such as Levotiron, Tefor or Euthyrox).
'Graves disease' It is an 'autoimmune' disease of the thyroid gland of unknown cause. In other words, the body becomes alienated from the thyroid gland and produces a substance called 'TSH receptor antibody', which stimulates the thyroid gland and causes excessive hormone production. It is not yet known why these substances are formed. In these patients, 'toxic goiter' and protruding eyes (ophthalmopathy) may occur. Most patients with hyperthyroidism (70-80%) have 'Graves disease'. Apart from this, hot nodules can also cause 'hyperthyroidism'. Hyperthyroidism occurs in 5% of patients with hyperthyroidism due to hot nodule. During inflammatory conditions of the thyroid gland (thyroiditis), 'hyperthyroidism' may develop in the first stage of the disease. In some inflammatory conditions, neck pain may occur and some patients develop fever.
What complaints and findings develop in a patient with hyperthyroidism?
1.Weight loss
2.Weakness in muscles
3.Trembling in hands
4.Difficulty sleeping
5.Palpitation
6 .Thinning and loss of hair
7.Thinning of the skin, dampness and excessive sweating
8.Increased bowel movements and sometimes diarrhea
9.Nervousness
10. Eyes projecting forward
11.Irregularity in menstruation
12.Enlargement of the thyroid gland (goiter)formation
13th Inability to tolerate the age
14. Breast enlargement in men
15.Bone resorption (Osteoporosis)
With what examination is hyperthyroidism diagnosed? Is it revealed?
To diagnose hyperthyroidism, thyroid hormones (T4 and T3) and TSH levels are checked in the blood. If free T4 and free T3 levels in the blood are high and TSH is low, a diagnosis of "hyperthyroidism" is made.
What happens if hyperthyroidism is not treated at all?
If hyperthyroidism is not treated, the patient continues to lose weight; Heart arrhythmia, heart failure, and thyroid crisis during inflammation or infection, resulting in shock and death, may occur. Therefore, hyperthyroidism is a disease that must be treated.
What are the treatment options for hyperthyroidism patients?
There are 3 methods in the treatment of hyperthyroidism:
1.Medication treatment,
2.Atom (Radioactive iodine)treatment,Surgery (surgery).
one. Drug Treatment:All patients with hyperthyroidism are first started on drug treatment to bring the high thyroid hormones in the blood to normal levels. Your doctor adjusts the dose of the medicine according to the severity of the disease. You will be called for a check-up again 6-8 weeks after starting drug treatment and the drug dose will be adjusted according to the condition of your hormones. In this way, checks are made every 1.5-2 months, drug treatment is continued for at least 9 months - 1 year, and the drug can be discontinued according to your doctor's decision. If the medicine is stopped without the doctor's knowledge, the disease will flare up again. Thus, the treatment done up to that time will be wasted. Therefore, drug treatment should not be stopped without consulting your doctor. If you develop a fever and a sore throat during drug treatment, you should consult your doctor immediately. This may have occurred due to a decrease in white cells (leukocytes) in the blood. If this very rare situation occurs, the medications are discontinued and surgical treatment or atomic treatment is recommended. During treatment, your liver may be affected and there may be slight elevations in liver-related blood levels. However, this may also occur due to the effect of hyperthyroidism. Therefore SGOT (AST) and SGPT (ALT) Enzyme levels called enzyme levels should be monitored frequently and if enzyme levels increase with treatment, the medications should be discontinued and surgery should be recommended to the patient or atomic therapy should be started. After the medications are stopped by your doctor, the disease may recur at a rate of 30-50% in the first 6 months, even after the medication is discontinued. It is necessary to go for a check-up again. If the patient has a 'hot nodule', surgery or atomic treatment is performed after the hormone levels are brought to normal levels with medications. If the disease flares up again after the medication is stopped in patients whose disease improves with drug treatment, surgery or atomic treatment is performed. One thing that patients with hyperthyroidism should pay attention to is iodized salt. is that they do not eat. Patients with hyperthyroidism should eat non-iodized salt. Since the disease is difficult to heal in smokers and eye disease occurs, the patient must quit smoking.
Which hyperthyroid patient is more likely to experience 'recurrence'?
1.Big in goiters,
2.In young patients,
3.In patients with high blood flow in the thyroid gland,
4.In patients whose disease is severe at the beginning,
5.Those who initially had ophthalmopathy (protruding eye),
6.Those who smoke,
7.Those who use iodized salt or drink excessive amounts of iodized cough syrup,
8.In patients with high blood antibody levels
9.In patients who need high doses of antithyroid drugs to normalize hormones. In patients whose low TSH levels do not improve
2. Atom (Radioactive Iodine) Treatment:In patients whose hormones reach normal levels with drug treatment, the drugs are tapered and discontinued. If the disease recurs after the medications are stopped, surgery or atomic treatment is considered. Radioactive iodine therapy is also a preferred treatment option in patients with 'hot nodules' and high blood hormone levels. In these patients, hormone levels are first brought to normal with medications and then atomic therapy is performed. Atomic treatment is given in organized Nuclear Medicine units. Although the name of atomic therapy is frightening, it does not have a carcinogenic or harmful effect on the reproductive system. However, women are allowed to become pregnant after 6 months. Patient receiving atomic therapy 80-90% of patients develop permanent hypothyroidism (thyroid gland insufficiency) within the first year and must take thyroid hormone medication such as Levotiron, Tefor or Euthyrox for life. Patients need to know and accept this from the beginning.
What should patients receiving atomic therapy pay attention to?
1. Avoid close contact in the first 5 days in order to protect healthy people around them. should be avoided.
2.Close contact with newborns, children (children under 8 years of age) and pregnant women is prohibited. However, they can sit in the same room.
3. If the patient has a baby, breastfeeding is prohibited.
4.After using the toilet, the toilet should be cleaned twice and hands should be washed thoroughly.
5.In the throat. Although aspirin or other similar medications may be helpful if you experience pain or neck pain, do not take these medications without consulting your doctor.
6. If you experience nervousness, tremors or palpitations in the hands, be sure to consult your doctor.
3. Surgery (Surgery) Treatment:Surgery is recommended for patients who are resistant to drug treatment, who have relapsed despite drug treatment, who are suspected of having cancer, and who have large goiter. Almost all or all of the thyroid gland is removed surgically. Hormone levels should be ensured to normalize with preoperative medication. Surgery is also a preferred treatment option for patients with hot nodules and a large nodule diameter.
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