Hyperthyroidism therapy
Synonyms in the broadest sense
Hyperthyroidism, Graves disease, immunogenic hyperthyroidism, iodine-deficient goiter, goiter, hot nodules, autonomic nodules
Medical therapy
The thyrostatic (anti-thyroid) therapy stops the overproduction of hormones in the thyroid.
All patients with an overactive thyroid (hyperthyroidism) receive until normal thyroid function (= euthyroidism) is achieved.
Are you interested in drug therapy for an overactive thyroid? See the next article for full details: Antithyroid drugs
Sulfur-containing anti-thyroid agents such as thiamazole (e.g. Favisatn ®), propylthiouracil (e.g. Propycil®) or carbimazole (e.g. Car®) inhibit the formation of thyroid hormone precursors. It must be taken for 6-8 days before the effect occurs (= latency period).
Another group of anti-thyroid drugs are the perchlorates, such as Sodium perchlorate (e.g. Irenat®). They prevent iodine from being absorbed by the thyroid gland so that hormone production is impaired. These drugs work quickly so that they take effect more quickly.
Possible side effects of thyrostatic therapy are allergic reactions with rashes, fever, joint or muscle pain.
In addition, the number of white blood cells (= leukocytes) and the number of blood platelets (= thrombocytes) can fall, which is why regular blood counts must be checked during drug therapy.
After stopping the medication, especially in Graves' disease, the thyroid gland becomes overactive again, which is why when euthyroidism, i.e. normal thyroid function, radioiodine therapy or surgery.
If the patient has Graves' disease, hypothyroidism must be avoided at all costs, as existing endocrine orbitopathy (see hyperthyroidism) can worsen under these conditions.
If the heart rate increases, ß-blockers can be administered independently of the thyrostatic therapy, as these include inhibits the conversion of the thyroid hormone T4 into the hormone T3, which is the more active form of the two hormones.
More about this at: Thyroid medication
surgery
Surgical therapy is carried out when there is a pronounced enlargement of the thyroid gland (goiter) and displacement of neighboring structures occurs due to the enlarged thyroid gland. If a malignant change in the thyroid gland is suspected (Thyroid cancer), an operation should also be performed. Also the thyrotoxic crisis is an indication for surgical treatment of hyperthyroidism.
Surgery is the procedure of choice when there is an autonomous thyroid area.
After the operation, depending on the size of the remaining tissue, an underactive thyroid can develop, which is why a postoperative (= after the operation) TSH level control is necessary.
Also read: Thyroid Removal.
Note: Operation
It is extremely important that normal thyroid function is maintained with medication prior to surgery, as complications could arise during the operation.
Patients with Graves' disease receive a so-called almost total resection of the thyroid gland: the organ is removed down to a residual volume of 2 ml.
If a malignant thyroid tumor is suspected, the thyroid is completely removed.
After the operation the thyroid hormones must be substituted, i.e. replaced, because the organ can no longer produce or no longer produce sufficient amounts of hormones that the body needs.
Note: surgical complication
A possible complication of thyroid surgery is irritation or injury to the recurrent nerve (=Recurrent nerve of N. vagus), which runs near the thyroid gland. If the patient is irritated or injured during the operation, this can lead to hoarseness and restricted breathing.
An operation is not possible if small and diffusely distributed overfunctional thyroid areas are causing the symptoms or the patient cannot be operated on due to other diseases or restrictions (= inoperability)
Radioiodine therapy with 131 iodine
With this form of therapy, the patient receives radioactive iodine (131 iodine), which is stored in the thyroid gland but cannot be used to form thyroid hormones: it destroys the enlarged thyroid cells due to the radioactive radiation. Thus, hormone-producing cells perish and the excess hormone production is reduced.
This therapy option can be considered for the following patients:
- Patients with Graves' disease
- in the presence of autonomous thyroid areas
- in the event of a relapse (= recurrence) of the hyperthyroidism despite the removal of the thyroid gland
- if the patient cannot be operated on
- if there is steadily worsening endocrine orbitopathy
Patients who are growing or pregnant or breastfeeding should not receive radioiodine therapy. This form of therapy is also not suitable for people who suspect a malignant thyroid tumor (= contraindicated).
Radiation thyroiditis (= radiation-related Inflammation of the thyroid gland), one Hypothyroidism (=Hypothyroidism) or an existing one Hyperthyroidism (Hyperthyroidism) occur.
After the radioiodine therapy, the patient's thyroid function is checked regularly (initially closely, later annually), because a possible hypothyroidism can develop years after the therapy.
Therapy of endocrine orbitopathy
Local measures can be taken to prevent the cornea from drying out: moisturizing eye drop or a watch glass bandage that does that eye keeps moist when the patient can no longer close the lid.
Furthermore, the eye socket can be irradiated and / or a therapy with corticosteroids (e.g. cortisone) to inhibit the autoimmune inflammatory reaction in the eye socket can be carried out.
Complications
The thyrotoxic crisis or. coma (= Loss of consciousness) are complications of an overactive thyroid. This condition often occurs after the administration of iodine-containing drugs or contrast agents X-ray diagnostics on or after stopping thyroid medication that has restricted the function of the thyroid gland.
The crisis or coma in hyperthyroidism has three stages:
In stage I. the patient has an increased heart rate of over 150 beats per minute or there is atrial fibrillation. You sweat more and lose a lot of fluid (desiccosis) and have temperatures of up to 41 ° Celsius.
The patients vomit and have diarrhea; they are also very restless and shivering. Muscle weakness is evident.
In stage II If the affected patients are disoriented in addition to the symptoms mentioned above, have impaired consciousness and do not react adequately to external stimuli (= somnolent).
Stage III is characterized by an additional coma, which can be made more difficult by circulatory failure.
The patients with a thyrotoxic crisis have to be treated in intensive care because the disease is severe.
The causal therapy is the rapid inhibition of the excessive hormone synthesis, which is achieved by the intravenous administration of Anti-thyroid drugs is achieved.
In the case of life-threatening iodine poisoning, the blood plasma can be washed in the form of Plasma process take place or a surgical intervention can be carried out to almost completely remove the thyroid gland.
The therapy of the symptoms consists of the administration of fluids, salts (= electrolytes) and calories via an infusion.
Furthermore will ß-receptor blockers to treat increased heart rate and high blood pressure and physical measures such as the application of cold should reduce the fever.
To one thrombosis To prevent this, drugs are used to Thrombosis prophylaxis administered (e.g. Acetylsalicylic acid: ASS 100).
