Thyroid gland; It is responsible for producing, storing and releasing thyroid hormones into the blood as needed. Thyrotoxicosis is a general term that refers to excess thyroid hormone in our blood, regardless of its source. Hyperthyroidism is an excess of thyroid hormone caused by our thyroid gland producing more hormone than necessary. Hyperthyroidism is thyrotoxicosis caused by the thyroid gland.
From the diseases that cause hyperthyroid thyrotoxicosis; Graves' disease and hormone-active goiters with single or multiple nodules (lump/lump) are among the most common. These three diseases are the most common causes of thyrotoxicosis. Since thyrotoxicosis with or without hyperthyroidism will affect treatment and follow-up options, a differential diagnosis should be made.
Although the signs and symptoms are common to all thyrotoxicosis, they are specific in Graves' disease (GD). The symptoms are due to an increase in our body metabolic rate. We can compare this situation to performing a 'long-winded' folk song at a 'play-style' speed. If thyroid hormones are the conductors of the orchestra, our organs are like the members of this orchestra. While the conductor quickly shakes the baton in his right hand and accelerates the tempo of the music, he increases the sound by moving his left hand from bottom to top with his palm facing up. Increased thyroid hormones also force our organs to work faster.
Despite the increase in appetite, weight loss may occur due to the acceleration of metabolism. It depends on the rapid functioning of the nervous system; Insomnia, lack of concentration, irritability, tremors in the hands, weakness, and excitement may develop. Due to high speed operation; Palpitations that develop due to accelerated heartbeat, excessive sweating due to increased body temperature, and diarrhea in the gastrointestinal system may occur. GH; It develops due to antibodies that fight against the thyroid gland due to an inherited disorder in the immune system (autoimmune disease). The most common and important features are; 2-3 times enlargement of the thyroid gland and eye findings; It is a lively look, eyes projecting forward, and the eyelid not closing completely.
It is easy to diagnose. TSH has decreased and thyroid hormones (T3-T4) have increased excessively. In GH; antibodies are high. Thyroid with ultrasonography The presence of growth and/or nodule in the gland should be investigated. In patients presenting with similar complaints; Thyroid scintigraphy should be performed to distinguish thyrotoxicosis with or without hyperthyroidism.
In the treatment of thyrotoxicosis with hyperthyroidism; Today, there are three different methods: antithyroid drug (ATI), surgical treatment (CT) and radioactive iodine (RAI) treatment. All three are not perfect treatment methods and have positive and negative aspects. Treatment selection; Factors such as the presence of an experienced surgeon, the patient's age and gender, the severity of the disease, the size of the thyroid gland, patient compliance, comorbidities and the presence of thyroid nodules affect it.
Surgery quickly eliminates the disease and It has the privilege of having a low recurrence rate. Cases where CT is absolutely necessary in Graves' disease: large goiter, pressure symptoms, suspected cancer, serious eye findings and high antibody levels. Cases where CT is recommended: pregnancy and breastfeeding, ATI; Non-response, development of side effects or recurrence, drawbacks of RAI treatment, patient request and child age group. In Graves' patients, CT should come to the fore as there is a risk of cancer in the presence of a palpable nodule. CT, which can reduce the hyperthyroidism rate to zero, is recommended for patients with progressive eye findings. The most important benefit of CT is that the patient can return home within a day after the thyroid hormones are normalized and there is generally no need for any other treatment other than thyroid hormone supplementation. With CT performed by experienced surgeons, the chance of curing the disease is more than 95 percent, but the rate of development of important risks such as vocal nerve paralysis and low calcium is less than 1-2 percent. Stay cheerful and well-being.
Read: 0
