Hyperthyroidism Hyperthyroidism, commonly known as overactive thyroid, is a clinical syndrome characterized by excessive production of thyroid hormones by the thyroid gland, leading to increased metabolic activity in the body. This condition results in heightened excitability and accelerated metabolism in the nervous, circulatory, and digestive systems. Major clinical manifestations often include increased appetite, weight loss, palpitations, and sweating.

Hyperthyroidism, or overactive thyroid, is a condition in which the thyroid gland produces an excessive amount of thyroid hormones, leading to a state of thyrotoxicosis. This condition results in an accelerated metabolic activity, heightened excitability of the nervous, circulatory, and digestive systems, and overall hypermetabolic clinical syndrome. Common clinical manifestations include increased appetite, weight loss, palpitations, and excessive sweating.

Classification of hyperthyroidism is challenging, and there is currently no clear-cut categorization. In clinical practice, hyperthyroidism is commonly classified into primary hyperthyroidism and secondary hyperthyroidism based on the location of the pathology, or into clinical and subclinical hyperthyroidism based on the degree of thyroid hormone excess.

Classification based on the location of the pathology

Primary Hyperthyroidism

Refers to hyperthyroidism caused by a pathology within the thyroid gland itself. Conditions such as Graves' disease, multinodular toxic goiter, and hyperfunctioning adenomas fall under primary hyperthyroidism. Due to increased synthesis of thyroid hormones by the thyroid gland, there is a feedback inhibition of pituitary secretion of thyroid-stimulating hormone (TSH), resulting in decreased levels of TSH in the blood.

Secondary Hyperthyroidism

Less common, this type is caused by an increased secretion of TSH from the pituitary gland, which in turn stimulates the thyroid gland to produce an excess of thyroid hormones.

Classification based on the degree of hyperthyroidism

Clinical Hyperthyroidism

Characterized by low serum levels of thyroid-stimulating hormone (TSH) below the normal range, accompanied by elevated levels of triiodothyronine (T3) and thyroxine (T4), often presenting with typical symptoms of hyperthyroidism.

Subclinical Hyperthyroidism

Indicated by low or undetectable serum TSH levels, with T3 and T4 levels within the normal range, and with either absent or mild symptoms of hyperthyroidism.

Weight loss and thinning, even when appetite has not decreased or has increased compared to before.

Increased appetite, accelerated bowel movements, increased frequency of bowel movements, or diarrhea.

Persistent rapid heartbeat, usually exceeding 100 beats per minute, with palpitations.

Some patients may experience arrhythmias such as premature atrial contractions, atrial fibrillation, and feelings of restlessness and discomfort.

Nervousness, anxiety, insomnia, irritability, and difficulty concentrating.

Tremors in the hands, which can significantly impact normal work and daily life.

Excessive sweating and intolerance to heat.

Female patients may experience changes in the menstrual cycle, often presenting as prolonged menstrual cycles, reduced menstrual flow, or even amenorrhea.

Most patients may have varying degrees of thyroid enlargement, with severe cases presenting with a visibly enlarged neck.

Common changes in the skin include thinning, smoothness, and warmth.

Some patients may experience hair loss, thinning of hair, and increased fragility.

Hyperthyroidism does not have an "acute phase" in terms of disease progression. Clinically, thyroid storm is considered the acute and severe phase of hyperthyroidism, which requires emergency medical treatment and timely rescue measures.

Thyroid storm is more common in untreated or inadequately treated hyperthyroid patients and necessitates prompt rescue measures. First and foremost, rapid correction of water, electrolyte, and acid-base imbalances is essential to stabilize vital signs. Simultaneously, the synthesis and release of thyroid hormones should be suppressed, and stress responses should be counteracted using medications such as propylthiouracil, iodine, propranolol, and glucocorticoids. If necessary, blood levels of thyroid hormones can be reduced through dialysis.

For patients with complications and comorbidities, symptomatic treatment should be provided, including oxygen therapy and infection prevention. Patients with high fever should undergo physical cooling, and the use of acetylsalicylic acid drugs (such as aspirin) should be avoided, as they can increase levels of free thyroid hormones in the blood.

Diet

Patients with hyperthyroidism have increased basal metabolism and higher energy consumption, and thus should ensure an adequate calorie intake. They should be provided with a diet rich in high calories, vitamins, proteins, and minerals.

Recommended diet

Adequate intake of staple foods, along with high-quality proteins such as dairy products, eggs, and lean meats.

Increased consumption of fresh vegetables and fruits to supplement vitamins.

Encouragement of increased fluid intake, with a recommended daily intake of 2000ml to 3000ml to compensate for the loss of fluids due to sweating, diarrhea, and rapid respiration. However, patients with concurrent heart disease should avoid excessive fluid intake to prevent exacerbation of edema and heart failure.

Dietary restrictions

Avoidance of stimulating foods and beverages such as strong tea and coffee to prevent overstimulation of the patient's mental state.

Reduced intake of coarse fiber to decrease the frequency of bowel movements.

Avoidance of foods rich in iodine, use of iodine-free salt, and avoidance of seaweed, sea fish, and nori.

Exercise

Patients with hyperthyroidism should engage in regular exercise, as it can help improve their quality of life, maintain good muscle tone, protect the cardiovascular system, and reduce the patient's appetite. Furthermore, weight-bearing exercise can effectively maintain bone density in patients with Graves' disease.

Lifestyle

Patients with hyperthyroidism should maintain regular routines, refrain from smoking and excessive alcohol consumption, avoid staying up late, reduce eye strain, and limit the use of electronic devices such as mobile phones and televisions. They should wear tinted glasses to protect their eyes from sunlight and wind, and use eye drops to alleviate dryness and itching.

Patients with hyperthyroidism should control their emotions, avoiding arguments, anger, and excitement. Family members and friends should show understanding and avoid mentally stimulating the patient.

Pregnant women with hyperthyroidism have an increased risk of miscarriage, preterm birth, preeclampsia, and placental abruption, and are more likely to have fetal growth restriction, intrauterine fetal or neonatal hyperthyroidism. Therefore, it is not advisable for uncontrolled hyperthyroid patients to become pregnant.

If a patient's hyperthyroidism is effectively controlled, they can consider pregnancy after consulting a healthcare professional. During pregnancy, thyroid function and fetal development should be regularly monitored.

Proper Diet

Maintain an appropriate intake of iodine in the diet, as both iodine deficiency and excess can lead to hyperthyroidism.

Avoid Emotional Stressors

Some Graves' disease patients have a history of significant emotional stress or trauma before the onset of the disease. Therefore, attention should be paid to maintaining a balance between work and rest, timely release of negative emotions, and seeking professional psychological help when necessary.