Hypothyroidism: Causes, Symptoms, and Treatment 2023

Thyroid reports often raise these questions. Thyroid dysfunction—particularly hyperthyroidism—is covered here.

Physiology

The butterfly-shaped thyroid gland is located in the neck before the windpipe. It produces T4 and T3 thyroid hormones. T4 hormone is generated in excess of T3, however tissue levels convert T4 to more active T3.

To prevent disease, the diet must have enough iodine for thyroid hormone. TSH hormone from the pituitary gland (brain) regulates the thyroid gland. Insufficient T4 or T3 synthesis raises pituitary TSH levels. In hypothyroidism. In hyperthyroidism, high T4/T3 levels lower TSH.

Hyperthyroidism (thyrotoxicosis)

Despite being used interchangeably, hyperthyroidism and thyrotoxicosis are different. Thyrotoxicosis is a lab result of high T4 and T3 with suppressed TSH. Hyperthyroidism, thyroiditis, and hypothyroidism overtreatment cause this.

In hyperthyroidism, the thyroid gland overproduces T4 and T3 hormones and low TSH. Thyroiditis releases 3-6 months of thyroid hormone into the circulation quickly, creating a similar appearance (although the gland is not hyperfunctioning).

Fortunately, hyperthyroidism is rarer than hypothyroidism. Thyrotoxicosis symptoms include

• Hyperthyroidism symptoms
• Unexpected weight reduction
• Hand shakes
• Palpitation-healing heartbeat
• More stools
• General weakness
• Weak muscles
• More Signs
• Thyroid goiter
• Eye symptoms—redness, inflammation, protrusion
• Fever, neck ache
• The following conditions can cause thyrotoxicosis.

Graves’ Disease—Auto-antibodies such TRAb (TSH receptor antibody) cause the thyroid to overfunction, causing goiter, high T4 and T3, and low TSH. Redness, irritation, soreness, protrusion, and double vision are caused by the TRab antibody.

Toxic multinodular goiter – Autonomy (pituitary regulation loss) can cause hyperthyroidism in long-term goiters. Usually elderly patients.

Hyperthyroidism caused by a toxic nodule. Tc or Iodine 123 scans can detect them. Radioactive iodine ablation works.

Thyroiditis (thyroid gland inflammation) causes abrupt thyroid hormone release, causing weight loss, tremor, palpitation, neck pain, and fever. Post-viral or postpartum thyroiditis. Clinical and lab tests diagnose. Steroids and painkillers work.

Hyperemesis gravidarum – High HCG hormone levels in pregnant women can cause temporary thyrotoxicosis. Early-pregnancy vomiting usually resolves by 12 weeks.

Other reasons – Drugs like amiodarone, lithium, and others might interfere with thyroid function or lab testing, causing false findings. TSH-producing pituitary tumors and HCG-producing germ cell tumors (choriocarcinoma) are rare causes of hyperthyroidism.

Investigations

Thyroid profile—TSH, T4, and T3.

Graves’ disease is TRAb-positive.

Tc (Technetium scan) or I123 scan: Graves, toxic multinodular goiter, and toxic nodule. Thyroiditis negative

Ultrasound and FNA thyroid in nodular goiters

Anti-thyroid drugs: methimazole, carbimazole, propylthiouracil

Beta-blockers or diltiazem control symptoms and heart rate.

Radioactive iodine ablation—Patients with graves, toxic nodules, or toxic multinodular goiter can be administered radioactive iodine, which produces Gamma radiation and kills hyperactive thyroid cells, rendering them hypothyroid and easier to control.

Surgery for large goiter patients unfit for anti-thyroid medications and radioactive iodine.

Steroids plus anti-inflammatories for thyroiditis

Follow up

Initial monitoring of symptoms and thyroid levels requires thorough follow-up every 1-2 months. Longer intervals can be suggested after initial control. Antithyroid medications can cause long-term remission. Patients should not use anti-thyroid medicines without supervision since problems can arise.