Hyperthyroidism is a condition where the thyroid glands work excessively, resulting in large amounts of thyroid hormones. Hyperthyroidism can be found in the form of Graves' disease, toxic nodular goiter or hyperthyroidism secondary.
GRAVES DISEASE
Graves' disease (goiter difusa toksika) believed to be caused by an antibody that stimulates the thyroid to produce excessive hormones torid.
Graves' disease patients have typical symptoms of hyperthyroidism and 3 special additional symptoms:
The entire gland is stimulated, so that the gland is enlarged, causing a lump in the neck (goiter, goiter)
Eksoftalmus (protruding eyes).
This occurs as a result of accumulation of substances in the eye orbit.
Protrusion of the skin over the shin.
The muscles that move the eye is not able to function properly, making it difficult or impossible to move the eye normally or difficult to coordinate eye movements, resulting in double vision. The eyelids can not close completely, so that the eyes are exposed to foreign objects and experiencing drought.
These eye changes can occur many years before other symptoms occur (an early sign of Graves' disease) or can also appear after other symptoms arise. Eye symptoms can even occur or get worse after the release of this excessive hormone tiorid successfully treated and controlled.
Eye symptoms can be reduced by:
- Placing the head at a higher position in bed
- Provide eye drops
- Sleeping with eyelids closed, with the help of plaster
- Taking diuretics (sometimes).
Double vision can be corrected with prism glasses. If the above measures do not help, may need to be given corticosteroid medication, X-ray therapy or eye surgery. Substances that are buried in the back of the eye also can accumulate in the skin, usually on the shins. Thickening in the area can feel itchy and red and feels hard when pressed with finger. Thickening of the skin can also occur before or after the other hyperthyroidism symptoms appear. To reduce itching and skin hardness, can be given corticosteroid cream or ointment. This disorder often disappears by itself a few months or several years later.
Nodular goiter Toksika
In nodular goiter toksika, single or multiple nodules in the thyroid produces too much hormone tiorid and are beyond the control of TSH (thyroid-stimulating hormone. Nodule is really a benign thyroid tumors and not associated with bulging eyes and skin disorders in Graves' disease.
Secondary Hyperthyroidism
Hyperthyroidism can be caused by a pituitary tumor that produces too much TSH, that stimulates the thyroid to produce excess thyroid hormone. Other causes include pituitary resistance to thyroid hormone, so the pituitary gland produces too much TSH.
Women with hydatidiform moles (molar pregnancies) bus also suffered from hyperthyroidism due to excessive stimulation of the gland due tirois levels of HCG (human chorionic gonadotropin) is high in the blood. If the pregnancy is over and the wine HCG not found in the blood, then it will disappear hyperthyroidism.
CAUSE
The cause of hyperthyroidism are:
Immunological reactions
Thyroiditis
Toxic thyroid adenoma
SYMPTOMS
In hyperthyroidism, whatever the cause, there is increased body functions:
- The heart beats faster and heart rhythm abnormalities may occur, which can cause palpitations (heart palpitations)
- Blood pressure tends to increase
- Patients feel warm despite being in a cool room
- The skin becomes moist and prone to excessive sweating
- Hand showed tremors (shaking) smooth
- Patients feel nervous, tired and weak, although not doing heavy
- Appetite increased, but the reduced weight
- Difficulty sleeping
- Frequent bowel movements, sometimes accompanied by diarrhea
- There is a change in the eye: swelling around the eyes, increased tear formation, irritation and sensitivity to light. These symptoms will soon disappear after the release of thyroid hormones under control, except in Graves' disease causes specific eye disorders.
COMPLICATIONS
Thyroid storm is a very excessive activity of the thyroid gland, which occurs suddenly.
Thyroid storm can cause:
- Fever
- Muscle weakness and exceptional wrinkles.
- Anxiety
- Changes in mood
- Confusion
- Change in consciousness (even coma occurred)
- Enlargement of the liver accompanied by mild jaundice.
Thyroid storm is a very dangerous state of emergency and requires immediate action. Heavy pressure on the heart can cause heart rhythm irregularities which can be fatal (arrhythmias) and shock.
Thyroid storm usually occurs because hyperthyroidism is not treated or because of inadequate treatment, and can be triggered by:
- Infection
- Trauma
- Surgery
- Uncontrolled diabetes
- Fear
- Pregnancy or childbirth
- Do not continue the treatment of thyroid
- Other stress.
Thyroid storm is rare in children.
Diagnosis
Vital signs (temperature, pulse, respiratory rate, blood pressure) show increased heart rate. Systolic blood pressure can be increased. Physical examination may reveal enlarged thyroid gland or goiter.
To assess thyroid function examination:
- Serum TSH (usually decreased)
- T3, T4 (usually increased).
TREATMENT
Hyperthyroidism can usually be treated with medication, the other option is surgery to remove the thyroid gland or radioactive iodine. Each treatment has advantages and disadvantages.
In order to work properly, the thyroid gland requires a small amount of iodine; an excessive amount of iodine can reduce the amount of hormone that is made and prevents the release of thyroid hormones. Therefore, to stop the release of excess thyroid hormone, can be given high doses of iodine.
Iodine is particularly useful if hyperthyroidism should be controlled (eg in case of thyroid storm or prior to surgery).
Iodine is not used in routine treatment or long-term treatment.
Propiltiourasil or metimazol, was the drug most often used to treat hyperthyroidism. These drugs slow the thyroid function by reducing the formation of thyroid hormone by the gland. Both drugs were given by mouth (swallowed), starting with high doses, then is adjusted with the results of blood tests of thyroid hormones.
This medicine can usually control the thyroid function within 6 weeks to 3 months. Higher doses can accelerate the control of thyroid fungis, but the risk of side effects also increases. Side effects that occurred could be an allergic reaction (skin rash), nausea, loss of taste and suppression of the synthesis of red blood cells in bone marrow. Bone marrow suppression can lead to reduced number of white blood cells, so that patients are very susceptible to infection.
In pregnant women, use more secure than propiltriurasil metimazol because fewer drugs to the fetus. Medications beta blockers (eg propranolol) help control some symptoms of hyperthyroidism. These drugs are effective in slowing a rapid heart rate, reduce shaking and controlling anxiety. Beta blockers are particularly useful in dealing with thyroid storm and patients who have symptoms that interfere with or dangerous, which the Hyperthyroidism can not be controlled by other drugs. But beta-blockers do not control the abnormal thyroid function.
Hyperthyroidism can also be treated with radioactive iodine, which destroys the thyroid glands. Radioactive iodine by mouth gives a very small effect on the body, but provides considerable influence on the thyroid gland. Therefore the dose is adjusted so that only destroys a small amount so that the formation of thyroid hormones back to normal, without too much reduced thyroid function.
Most of the use of radioactive iodine in the end cause hypothyroidism. About 25% of patients had hypothyroidism within 1 year after administration of radioactive iodine. Radioactive iodine is not given to pregnant women because it can pass through the placental barrier and can damage the fetal thyroid gland.
At thyroidectomy, thyroid gland surgically removed.
Surgery is the treatment of choice for:
- Young people
- Patients who has very large goiter.
- Patients who are allergic to the drug or drug-induced side effects.
After undergoing surgery, hypothyroidism can occur. The patient was given hormone replacement therapy throughout his life. Other complications of surgery are vocal cord paralysis and damage to the parathyroid glands (small glands behind the thyroid gland that controls calcium levels in the blood).
No comments:
Post a Comment