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The thyroid is a gland found in the anterior region of the neck and is responsible for producing and releasing thyroid hormones. Thyroid hormones (called free triiodothyronine and free thyroxine, free T3 and free T4, respectively) are essential for the functioning of various organs, including the brain and the heart, since they participate in many metabolic processes necessary for life.

Sometimes, the functioning of the thyroid gland can be altered for many reasons and this is reflected in alterations in hormonal values. There are situations in which an excess of thyroid hormones is produced, calling this condition hyperthyroidism.

Excess thyroid hormones is a frequent condition that generates symptoms (some of them severe) and that is why you should know how it is diagnosed and what is the recommended medical treatment.

Why does hyperthyroidism occur?

There are several conditions that can cause hyperthyroidism. Among these, autoimmune causes stand out, such as Graves' disease, where autoantibodies are produced that act against thyroid cells and stimulate their functioning.

Other causes are multinodular toxic goiter or Plummer's disease (characterized by multiple thyroid nodules that increase thyroid hormone synthesis) and toxic adenoma, which is a single solid nodule or tumor, producing an excess of thyroid hormones.

How to diagnose hyperthyroidism?

The diagnosis is based on the questioning of the patient's symptoms and the study of thyroid hormones in a blood sample. The doctor can also detect hyperthyroidism in the early stages when the patient does not present relevant symptoms, however, most patients reveal symptoms of excess thyroid hormones.

Some of these symptoms of hyperthyroidism are anxiety, hair loss, sleep disorders (insomnia), tachycardia (feeling of palpitations), hyperactivity, heat intolerance, tremors in hands and muscles, weight loss, alteration in the menstrual cycle and in Some patients have bulging of the eyes (known as exolphthalmus or proptosis).

One of the most relevant symptoms is tachycardia, which in elderly people can even generate arrhythmias such as atrial fibrillation.

When the patient presents with any of these symptoms, it is the doctor's duty to request the levels of thyroid hormones within the complementary studies of the patient. The doctor in his physical examination must also evaluate by inspection and palpation, the neck and thyroid gland for goiter or thyroid nodules, and in the cardiovascular system, he must rule out the presence of cardiac arrhythmias.

Thyroid hormones are measured in a blood sample, in the morning hours, during the fasting of the patient. If the values ​​of free T4 (thyroxine) and free T3 (triiodothyronine) are elevated and TSH (thyroid stimulating hormone) is decreased, then we are in the presence of hyperthyroidism.

Once hyperthyroidism is diagnosed, further studies may be ordered to determine the real cause of this disorder. The doctor will indicate the performance of other blood tests to rule out if the cause is autoimmune (for which anti-peroxidase and stimulating thyroid antibodies are indicated), in addition to a thyroid ultrasound in order to rule out the presence of increased volume of the thyroid (goiter), nodules or tumors.

In some cases, more specialized tests will be ordered to assess thyroid function such as thyroid scan (or scintigraphy) to measure the thyroid's uptake ability from radioactive iodine and technetium.

What is the recommended medical treatment for hyperthyroidism?

The goals of treatment to control hyperthyroidism are based on controlling the symptoms and associated complications, and on the other hand, controlling the production of thyroid hormones and treating the underlying cause that is producing the disease.

For the treatment of cardiovascular symptoms, the main focus is on controlling tachycardia and arrhythmias. For this, anti-arrhythmic drugs such as beta-blockers (bisoprolol, carvedilol, among others) are used, being necessary another type of anti-arrhythmic, in some cases of atrial fibrillation (such as amiodarone).

An advantage of beta-blockers is that they also have effects on neurological symptoms, as some act on receptors on neurons.

For the treatment of hyperthyroidism are anti-thyroid medications: methimazole and propylthiouracil, which decrease the production of thyroid hormones. These medications should be titrated every four weeks until thyroid function normalizes.

This treatment should be continued until definitive treatment with radioactive iodine or thyroidectomy (removal of the thyroid) is defined.

In hyperthyroidism, the treatment of choice is radioactive iodine because it is administered orally in a single dose and causes persistent destruction of thyroid cells for months or years. However, in some cases where radioactive iodine is not indicated, thyroidectomy is the indicated treatment.

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