Thyrotoxicosis is one of the most common endocrine diseases. 6,000 - 8,000 people fall ill in our country every year. It mostly affects people in their 30s and 40s, with the incidence in women being much higher than that in men. What are the causes of hyperfunction of the thyroid gland, what are its symptoms and is the disease treatable - these questions are answered by Dr. Hristo Chalakov, head of the Department of Endocrinology and Metabolic Diseases at the "Uni Hospital" Medical Center.
Dr. Chalakov, what is behind the diagnosis of thyroid hyperfunction?
- Hyperfunction of the thyroid gland or hyperthyroidism is a type of thyrotoxicosis - the presence of an increased amount of thyroid hormones tri- and tetraiodothyronine - designated as T3 and T4, in the circulation, the result of increased production. The excess of hormones can also be a fact in processes with the breakdown of the gland, but then we do not have increased production, but thyrotoxicosis after the outflow of hormones from the reserve pool in the gland.
What are the causes of the disease?
- The disease could be triggered on the basis of genetic predisposition in conditions of acute or chronic cumulative stress or viral/bacterial infection. The female sex is 4-6 times more affected.
Are there different forms of hyperthyroidism?
- Yes, the most common forms are autoimmune thyroid diseases, the most familiar being Basedov's disease and Hashimoto's thyroiditis in its hyperthyroid phase (Hashitoxicosis). There are also toxic adenoma (hypersecreting benign tumor) and Basedoficinalis goiter (multinodular hypersecreting goiter), as well as other rarer forms.
What are the most common symptoms?
- The symptoms can be dozens, but the most common are increased nervousness, rapid fatigue, hand tremors, palpitations with an accelerated pulse, sweating, weight loss, decreased heat tolerance, etc. But complaints can be absent or scarce and atypical, as often happens with toxic adenoma, affecting more often the elderly and presenting with depression, loss of appetite, heart rhythm disturbances.
What are the complications of thyrotoxicosis if not treated on time?
- In untreated thyrotoxicosis, although rare, complications can occur that seriously impair a person's quality of life and even be life-threatening. Among them are thyrotoxic crisis and thyrotoxic heart with heart failure, which require hospitalization and emergency treatment.
How is the disease diagnosed?
- The disease is diagnosed through the examination of hormones. Most often it is sufficient to examine free T4 and TSH and less often free T3. There is a negative inverse logarithmic relationship between thyroid hormones - cT4 and cT3 and their controlling TSH, i.e. a two-fold increase in T4 reflects a 100-fold decrease in TSH and vice versa. It is important to note that T4 and T3 may be normal according to the reference values, but since they are no longer normal for the individual, the TSH deviates below the levels set by the relevant laboratory. The condition is referred to as subclinical thyrotoxicosis
Of course, there are deviations from the above rule of negative feedback, but these are related to much rarer conditions that are challenging for the endocrinologist and he should be aware of them. Other tests useful for diagnosis are certain types of antibodies and, of course, a thyroid ultrasound.
What is the treatment and prognosis of patients with thyrotoxicosis?
- The treatment is with means that suppress the production of thyroid hormones, and in certain cases with Hashitoxicosis, they are combined with thyroid hormones ("sandwich therapy") in order to reduce the amplitude of oscillations from the change in function during the course of treatment. The duration is different, it is determined by additional parameters - ultrasound picture, certain antibodies, and it can end in six months or two years. For cases not in remission after two years of treatment, my personal opinion is to consider other treatment approaches such as surgery or radioiodine treatment. Patients are diagnosed for 10 years.
Many of your colleagues fear that the covid pandemic will delay the diagnosis and, accordingly, the treatment of patients with serious diseases. What is the situation in your ward?
- No change in the number of incoming cases with thioreotoxicosis per month, nor late diagnoses.
