The thyroid is an endocrine gland that is located under Adam's nut and thyroid cartilage and supported on the trachea. Its weight in the adult oscillates, in normal conditions, between 15-30 grams and has a butterfly shape due to the two thyroid lobes that are united by the ITSMO. The thyroid gland presents multiple functions between them regulation of metabolism, temperature and body growth as well as the heart rate and neurological development among others, by secretion of a series of thyroid hormones and under hypothalamus/hypophysarian control (TRH/TSH). The main hormones segregated by the thyroid gland are thyroxine (T4) and triiodothyronine (T3), which use iodine for their correct regulation (increase or decrease in their levels) and obtain it through the iodide -shaped diet.
Hyper and hypothyroidism
Hyperthyroidism is the clinical situation derived from an excess thyroid hormones and T4 produced by the thyroid gland (hyperproduction, glandular destruction or exogenous contribution) or by excessive secretion of TSH.Graves-Basedow disease is the most frequent cause of hyperthyroidism and is characterized by the classic triad: diffuse goiter, hyperthyroidism and ophthalmopathy, being more common in women between 30 and 40 years of age.
The diagnosis is based on the suspicion of this pathology through a physical examination of the patient where we can show nervousness, tremor, sweating and palpitations, as well as weight loss and hyperactivity among others, plus confirmation by blood analytics of high levels of T4 and levels Decreased TSH. On some occasions, thyroid collection or ultrasound gammography is required.
To carry out the treatment, it is necessary to reduce thyroid hormones and there are 3 possibilities: medical treatment, radio or surgery.
The initial step of the treatment consists of the administration of antithyroid drugs such as metimazole, carbimazole or propiltiouracil that decrease or block the effects of excess thyroid hormone. It is generally used in young patients or pregnancy, however the duration of treatment is usually prolonged over time and has low healing index despite being a non -destructive and low -cost approach. On some occasions it is useful to administer betabloqueante drugs to quickly reduce associated symptoms.
The radio is based on the destruction of the thyroid gland selectively, reaching eutiroidism in the first months, however, a state of hypothyroidism that can be transitory may appear. It is used in all patients over 40 years of age or in hyperthyroidism refractory to medical treatment in patients over 20 years. Contraindicated in pregnancy and breastfeeding.
Finally, surgical treatment is indicated in large bocios or severe ophthalmopathy, failure of medical treatment, suspected cancer as well as in pregnancy.It is the treatment that presents the highest healing index, obtaining a state of eutiroidism and disease control before. But since it is an invasive treatment, it can trigger in other complications such as bleeding (the most frequent), recurrent nerve injury or transient hypopaloidism.
As well as with the administration of Radio As and with surgery, the patient has to establish a replacement treatment for life for the control of thyroid hormone levels.
Hypothyroidism is a thyroid disorder that causes a decrease in the number of thyroid hormones and is initially characterized by weight gain and tiredness followed by muscle weakness, pain, depression as well as bradycardia among others.
There are three types of hypothyroidism:
- Primary: Pathology at the thyroid gland level. The most frequent.
- Secondary: pituitary pathology. No TSH production.
- Tertiary: Hypothalamic pathology. No TRH production or thyrotropin.
Hashimoto's thyroiditis is the most frequent cause of hypothyroidism, however, it can also appear as a consequence of medical treatment for hyperthyroidism as well as with the administration of radio asks and thyroid surgery previously commented. Other risk factors are female sex, age over 60, autoimmune disease, some medications such as lithium as well as pregnancy.
For the diagnosis, a physical examination as well as blood test is necessary where low levels of thyroid hormones are identified. For treatment, levothyroxin is administered as a substitute treatment, orally managed, allowing hormonal level control, adjusting the dose individually. It is necessary to carry out bi or quarterly controls to check the levels, being life treatment.
In conclusion, thyroid pathology (excess or defect of hormal levels) is a frequent pathology in society and in our endocrine surgery unit HLA Vistahermosa, with extensive experience in endocrinological surgery, we offer a wide range of treatments, offering the patient the best the best Therapeutic option based on its symptomatology and comorbidity, as well as depending on the benign or malignant nature of existing pathology.
