Hyperthyroidism – Graves’ disease

Hyperthyroidism indicates increased thyroid function with the presence of increased production of thyroid hormones T4 and/or T3.

This chronic disease is prone to recurrence. The disorder can arise from or outside the thyroid cells themselves or from supervisory structures, such as the pituitary gland and hypothalamus.

Increased synthesis of thyroid hormones is most often caused by Basedow-Graves disease (about 60% of cases), Hashimoto’s disease and TSH receptor disease (due to mutations in the TSHR – Thyroid Stimulating Hormone Receptor gene).

This is followed by autonomic thyroid disorders (toxic adenoma, multinodal goiter), increased release of hormones due to the destruction of thyroid tissue (infectious thyroiditis, thyroid cancer, metastases, delayed diseases, radiation in the head and neck area), drug administration, paraneoplastic syndromes (ovarian tumors that partially contain thyroid tissue) and T4-producing thyroid cancer.

The term subclinical (latent) hyperthyroidism refers to a condition in which there is a reduced TSH value with still normal T4 and/or T3 values.

A special form of the disease, in which there is an increase in T3 levels with a normal T4 value and a reduced TSH value, is called isolated T3 hyperthyroidism. This phenomenon is rare and often represents a laboratory introduction to the definitive clinical form of hyperthyroidism. The symptomatology varies from mild forms to extremely conspicuous presentation, such as a thyrotoxic crisis or a storm.

Patients most often present with symptoms of accelerated metabolism, including sweating, increased appetite with weight loss, and heat intolerance.

Other symptoms include general weakness, restlessness and hyperreactivity, irritability and nervousness, frequent urination and diarrhea, sleep disturbance, bulging of the eyeballs (exophthalmos), rapid heartbeat with a palpitating sensation, increased blood pressure, heart rhythm disturbances, neurological symptoms such as muscle weakness, trembling hands, and disorders of consciousness.

Also, eye irritations and skin changes can occur.

A thyrotoxic crisis (thyrotoxic storm) is an extreme form of hyperthyroidism with a sudden onset of symptoms, including high body temperature, restlessness, unrest, loss of muscle mass, and rapid heartbeat. It is often accompanied by heart rhythm disturbances, liver enlargement and jaundice. If left untreated, it can lead to serious complications, including cardiac arrest and fatal outcome.

Hyperthyroidism is diagnosed when laboratory blood tests show high levels of thyroid hormones (T4 and/or T3) and very low levels of thyroid stimulating hormone (TSH) secreted by the pituitary gland.

Elevated thyroid hormone levels and low TSH levels indicate increased thyroid function.

The most common cause of hyperthyroidism is Graves’ disease, which is characterized by an enlarged thyroid gland (goiter or goiter), protruding eyeballs (ophthalmopathy), and sometimes skin changes.

Other causes include nodular toxic goiter, when multiple nodules in the thyroid gland secrete too much thyroid hormone, and toxic adenoma, where one node in the thyroid gland secretes an excessive amount of thyroid hormone. Hyperthyroidism can cause a significant enlargement of the thyroid gland, which can press on surrounding structures and cause difficulty swallowing and breathing.

An endocrinologist, a specialist in thyroid diseases, performs the first assessment and treatment of patients with hyperthyroidism. Additional tests, including scintigraphy, may be ordered to better understand the condition of the thyroid gland and determine the optimal therapeutic approach.

Patients with hyperthyroidism are usually initially treated with antithyroid drugs such as methimazole and/or propylthiouracil. These drugs prevent the secretion of thyroid hormones in the thyroid gland. Although they are effective, they often need to be taken over a longer period of time to achieve remission, and the possibility of side effects exists.

More permanent treatment options include:

1. Treatment with radioactive iodine: It is used to destroy diseased thyroid tissue and may be effective in treating some patients with hyperthyroidism. However, patients with ophthalmic problems in Graves’ disease and compression symptoms are often not candidates for this treatment.
2. Surgical treatment: It is considered when nodules are present in an enlarged thyroid (known as eye disease) or if it is desirable to avoid radioactive iodine. In the case of Graves’ disease or polynodose toxic goiter, the entire thyroid gland is usually removed. In patients with toxic adenoma (one toxic node), surgeons usually remove only half of the thyroid gland.

Our surgeons specialize in thyroid surgeries and have experience in treating hyperthyroidism caused by these conditions. They apply the latest surgical techniques, including monitoring of the recurrent laryngeal nerve, to safely remove all or part of the thyroid gland, achieving a permanent cure of hyperthyroidism.

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That is why we have gathered a team of top experts, specialists and subspecialists who are the backbone of our multidisciplinary centers and specialist clinics.

Our goal is to achieve a safe and long-term good result through a successful diagnosis and selection of individual treatment, with timely monitoring of the patient.

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