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Thyroid diseases are the domain of women, in whom they occur even several times more often than in men, and pregnancy is a particularly high risk period. Many famous people suffer from it, for example Oprah Winfrey or Kim Catrall, known from “Sex and the City”. The Bushes were particularly unlucky. George HW Bush, his wife Barbara, and even their dog all had Graves’ disease.
The thyroid gland is a small organ (in women its volume should not exceed 20 ml, and in men 25 ml) located on the neck, located in the lower part of the neck. between the cartilages of the larynx and trachea. Although inconspicuous, it plays a very important role in our body, producing hormones that regulate metabolism and affect the work of all the most important systems of our body. Its work is regulated by the pituitary gland, producing thyroid stimulating hormone – TSH, whose task is to stimulate the thyroid gland to produce its own hormones – triiodothyronine (T3) and thyroxine (T4).
The thyroid gland and pituitary gland communicate with each other through the hormones they produce. As thyroid hormone levels rise, this is a signal for the pituitary gland to reduce TSH production. Conversely, when thyroid hormone levels are too low, it causes TSH to be released from the pituitary gland. Sometimes, however, this process is disrupted, which can lead to either the thyroid gland becoming overactive, producing too much of its own hormones (hyperthyroidism), or vice versa, where the thyroid stops producing its hormones (hypothyroidism).
The causes of hyperthyroidism and hypothyroidism can vary, but the most important factor affecting the functioning of the thyroid gland is adequate iodine intake. Iodine is an element necessary for the production of thyroid hormones. The process of their production in our body is very complicated and both deficiency and excess of iodine can lead to hypothyroidism and hyperthyroidism. However, in countries with adequate iodine intake, autoimmune diseases are the main causes of thyroid disease: Graves’ disease, which leads to hyperthyroidism, and Hashimoto’s disease, which leads to hypothyroidism.
Graves’ disease
According to some studies, it is responsible for up to 90 percent. cases of hyperthyroidism worldwide. In Poland, the main cause of hyperthyroidism is toxic nodular goiterwhich is now increasing in frequency the aftermath of iodine deficiency from 20-30 years ago (the obligation to iodize table salt was issued by the ordinance of the Minister of Health and Healthcare, which has been in force since 01.01.1997/30/90). Graves described the disease in the 3s, but it was not until the 4s that it was possible to establish its immunological basis. The culprit here is the immune system, which begins to produce antibodies against the receptor for TSH. These antibodies, mimicking the action of the thyroid stimulating hormone, attach to the thyroid cells, causing them to produce TXNUMX and TXNUMX. The cause of antibodies to the TSH receptor (TRAb for short) is not fully understood.
There are many theories regarding genetic, hormonal (the role of estrogens) and environmental predisposition, such as smoking, which increases the risk of developing the disease up to 8 times. Women get sick 10 times more often than men, and the disease often shows up after childbirth. Over-stimulation of the thyroid gland leads to an increase in the level of T3 and T4 in the blood, which translates into a decrease in TSH levels.
The symptoms of the disease depend on its severity, which varies, showing periods of exacerbation and remission. Most often, hyperthyroidism is manifested by excessive nervousness (which is sometimes confused with anxiety disorders), sweating, palpitations with a heart rate> 90 / min, and heat intolerance. Acceleration of metabolic processes can lead to weight loss, but sometimes people with hyperthyroidism gain weight due to increased appetite. There are also digestive system disorders – more frequent passing of stools and even diarrhea. Quite a typical abnormality is the enlargement of the thyroid gland, i.e. the formation of the so-called will. However, the most characteristic symptom of the disease, occurring in about 10-30% of cases, is the involvement of the soft tissues of the orbits, leading to unsightly exophthalmos, which in rare cases can cause blindness. However, the most dangerous complication of hyperthyroidism seems to be involvement of the circulatory system. Heart rhythm disturbances (atrial fibrillation) and features of circulatory failure may appear, which may even affect very young patients.
Treatment is based on suppressing the excess activity of the thyroid gland. This can be achieved by medication, but sometimes it is necessary to completely destroy the thyroid gland with radioactive iodine or surgery.
Choroba Hashimoto
The disease was first described by a Japanese doctor Hakaru Hashimoto in 1912, the most common cause of hypothyroidism, is essentially the opposite of Graves’ disease. In Hashimoto’s disease, there is chronic inflammation of the thyroid gland caused by autoimmune processes. Patients have antibodies against thyroid peroxidase (abbreviated as anti-TPO) – an enzyme contained in thyroid cells involved in the production of thyroid hormones, or antibodies against a protein present in thyroid cells – thyroglobulin (abbreviated as anti-Tg). The role of these antibodies is not entirely clear, but they damage the cells of the thyroid gland, which reduces the amount of hormones it produces. In blood tests, this causes T3 and T4 levels to fall and TSH levels to rise. The causes of the disease are not fully understood, but also here smoking tobacco is one of the predisposing factors (apart from genetic conditions or excessive iodine intake).
Hormonal determinants are also certainly important, because, as shown by statistical data, women suffer from Hashimoto’s disease up to 15 times more often than men.
The symptoms of the disease depend on the degree of impairment of the thyroid gland and the deficiency of its hormones. The thyroid gland itself may be of normal volume, sometimes there is a goiter, and in some cases the gland is somewhat atrophied. Initially, the disease may be asymptomatic. However, as the thyroid gland progresses, damage to the thyroid gland and the amount of hormones it produces may appear weakness, increased fatigue, drowsiness, problems with concentration and memory. Due to the slowdown in metabolism, people with hypothyroidism tend to gain weight and often complain of feeling cold and freezing hands and feet. The dominant symptom of the digestive system is constipation. The skin becomes dry and pale, hoarseness or dull voice appears. It also happens that the main symptom becomes low mood, or even severe depression. Women develop menstrual disorders and men may develop erectile dysfunction. Blood tests sometimes show anemia and elevated cholesterol levels.
Treatment consists of making up for the deficiency of thyroid hormones. It should be carried out carefully and gradually, especially in the elderly, under the supervision of a specialist endocrinologist
Increased risk pregnancy
In the case of autoimmune thyroid diseases, which are the domain of women, the situation becomes more complicated during pregnancy. Thyroid dysfunction in pregnancy is a fairly common problem and requires special medical supervision. It should be remembered that thyroid hormones play an enormous role in the formation and development of the central nervous system in a developing child, hence the adjustment of the thyroid gland during pregnancy cannot be overestimated. It is also known that Hashimoto’s disease and the presence of anti-TPO antibodies are associated with difficulties in getting pregnant and increasing the frequency of miscarriages. Hence, care for a pregnant woman with Graves’ disease or Hashimoto’s disease should be carried out by both a gynecologist and an endocrinologist who will monitor and adjust the treatment of thyroid disease to the changing needs for thyroid hormones during pregnancy.
Text: lek. Paulina Jurek
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