Trying to understand the condition of thyrotoxicosis means it is also necessary to understand a condition called hyperthyroidism. Thyrotoxicosis is a condition that needs to be immediately examined and treated appropriately to prevent complications.
Thyrotoxicosis is a collection of symptoms due to abnormally excessive activity of the thyroid hormone in the body, and is usually caused by hyperthyroidism. Whereas hyperthyroidism is a medical definition to describe conditions where the thyroid gland produces excessive thyroid hormone. Thyrotoxicosis, which is an excessive amount of thyroid hormone circulating in the body, is closely related to hyperthyroidism. However, thyrotoxicosis can also occur due to other reasons, where the function of the thyroid gland and its production is not impaired, for example due to the release of thyroid hormone from the inflammation of the thyroid gland.
Hyperthyroidism and thyrotoxicosis are basically different. In patients with hyperthyroidism thyrotoxicosis can be found which causes an increase in excessive body metabolism. In addition to fast and irregular heartbeats, being in an overly high thyroid hormone metabolism level can cause you to experience the following symptoms:
- High blood pressure.
- Tremors in the hands (trembling hands).
- Anxiety.
- Excessive sweating.
- Can not stand the heat.
- Hyperactive.
- Muscle weakness.
- Weight loss despite normal or high appetite.
Some of the most common causes of thyrotoxicosis are Grave's disease, toxic multinodular goiter, toxic adenoma, and thyroiditis. Grave's disease is often found in the second and fourth decade age groups, and toxic nodular / multiodular goiters are often found in areas with iodine deficiency. Thyrotoxicosis can also be caused by side effects of drugs such as lithium, alpha interferon, and amiodarone.
Grave's disease generally causes more pronounced thyrotoxicosis symptoms than thyrotoxicosis symptoms caused by other hyperthyroidism conditions. Symptoms of this disorder are mainly related to high levels of thyroid hormone or thyrotoxicosis, which are irregular heartbeat, trembling, anxiety, chest palpitations, difficult weight gain, to menstrual disorders in women. Typical symptoms of Grave's disease that are not seen in other hyperthyroidism diseases are disorders of the eye in the form of exophthalmos (eyes that look like glares), diplopia (double vision), and there is swelling around the eyes.
To diagnose this disease, usually the doctor will do a physical examination and various supporting examinations, such as thyroid function tests, or autoantibody tests. General physical examination and of course examination of the thyroid gland is important to find an enlargement of the gland and evaluate it. The evaluation is to determine the type of enlargement of the gland (single or multiple), assess the consistency of the gland, the pain of the gland or not, and whether enlargement of the thyroid gland has the potential to obstruct the airway or not.
Thyroid function tests including TSH, tri-iodothyronine (T3), thyroxine (T4), and free T4 (FT4) are important to monitor the function and activity of thyroid hormones. To determine the cause of thyroid abnormalities, autoantibodies such as anti-thyroid peroxidase (anti-TPO) and Thyroid Stimulating Antibody (TSab) can also be performed. A significant increase in anti-TPO level followed by an increase in TSab indicates the presence of Grave's disease. Conversely, if anti-TPO and TSab levels are low or even undetectable, this indicates a toxic multinodular goiter or toxic adenoma.
Sometimes special scans such as CT scan of the thyroid will also be needed to determine the type of nodule that is difficult to evaluate from a physical examination. Thyroid scan uses iodine radioactive substances to evaluate the form, function, and possible thyroid cancer. Even though it sounds dangerous, the radioactive dose used for this examination is so small that it is safe to do.
Symptoms of thyroid disease vary in each sufferer, so often this causes difficulties in establishing the diagnosis. See your doctor immediately if you experience the above symptoms to get an examination and appropriate treatment as early as possible.
Treating thyrotoxicosis
After obtaining an accurate diagnosis, thyrotoxicosis will usually be treated by reducing the symptoms and treating the conditions that cause hyperthyroidism itself.
Several types of treatment that might be recommended, including administration:
- Antithyroid drugs such as methimazole and propylthiouracil (PTU) to stop the production of thyroid hormone. Each drug has its own characteristics, PTU can reduce the symptoms of thyrotoxicosis quickly by reducing T3 levels, this drug is usually taken 2-3 times a day, especially in thyroid emergencies such as thyroid storm. PTU may also be given to pregnant women with hyperthyroidism. Methimazole is the antithyroid of choice for Grave's disease. This drug is quite potent, relatively rarely causes side effects, and enough to be taken once a day. But the drawback of this drug should not be given to pregnant women, especially in the first trimester because of the risk of causing disability in the fetus. Side effects that need to watch out for antithyroid treatment include: impaired liver function seen from yellowing skin or eyes, abdominal pain, decreased appetite, agranulocytosis, aplastic anemia, vasculitis, fever, joint pain, rashes, and itching. Monitoring liver function needs to be carried out since starting antithyroid treatment for up to 6 months.
- Surgical removal of part or all of the thyroid gland (thyroidectomy). In patients with thyrotoxicosis who cannot be treated with drugs, this procedure will generally be recommended. This surgical procedure is indicated mainly in severe hyperthyroidism in children, pregnant women who do not show improvement with treatment, people with thyroid with a large gland size, there are severe eye disorders, or in women who want to become pregnant so that the choice of antithyroid drugs is avoided. However, this operation has the risk of causing thyroid disease, thyroid storm. This condition occurs because of an excessive increase in thyroid hormone suddenly at the time of removal of the thyroid gland. The death rate due to complications of thyroidectomy reaches 50%. Other side effects that can also occur are laryngeal innervation, hypoparathyroidism, infection, and bleeding.
- Radioactive iodine (radioiodine) to destroy hormone-producing cells. This therapy is one of the main therapeutic choice methods in the treatment of Grave's disease. According to research, this therapy has a higher cure rate than antithyroid drugs. However, side effects cause a higher risk for eye disorders and hypothyroidism. To prevent complications in the eye, and to treat pain and inflammation in the thyroid after treatment with radioiodine, corticosteroid drugs can be given. This drug can also be used to reduce thyroid hormone activity in the event of a thyroid storm. Radioactive iodine therapy cannot be carried out in children and pregnant or breastfeeding women because it can cause hypothyroidism in the fetus.
- Beta blockers. This drug is the drug of choice to relieve symptoms caused by thyrotoxicosis, especially in the elderly with heart disease. Compared to radioiodine, this drug is recommended to be given to patients with thyrotoxicosis who are pregnant and with the smallest possible dose. This drug should not be given in conditions of dehydration, low blood pressure, or in people with asthma.
In addition to the methods mentioned above, you can also relieve the symptoms of thyrotoxicosis by increasing the consumption of foods containing calcium, sodium, and vitamin D. Discuss with your doctor about what diet, supplements, and exercise are suitable for your condition.
Thyrotoxicosis treatment requires close monitoring and evaluation. Antithyroid drugs and therapeutic methods used to treat this disease have advantages and disadvantages of each. After undergoing treatment, it is important to carry out periodic checks (controls) to evaluate general health conditions and thyroid function. Therefore, you should consult with your doctor to get an appropriate examination and treatment and periodic monitoring to assess the safety and success of therapy.
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