What is hyperthyroidism (toxic goiter)?

Hyperthyroidism should be suspected when increased thyroid hormone synthesis is detected. Thyroid hormone levels in the blood are high.

WHAT CAUSES HYPERTHYROIDISM?

Diseases causing hyperthyroidism include Graves’ disease, toxic multinodular goiter, and toxic adenoma. Here, we are going to discuss the diseases that can be treated with surgery.

Graves’ disease is an autoimmune disease of unknown origin and characterized by the presence of TSH antibodies. Thyroid hormone secretion from the thyroid gland increases under the effect of these antibodies. Consequently, symptoms appear and injury occurs in target organs.

These changes result in heat intolerance, excessive sweating, moist skin, irregular sleep, palpitations, tremor in hands, irregular menstrual cycles, diarrhea, and infertility. In addition to these findings, eye problems (enlargement and protrusion of eyes) are observed in Graves’ disease.

Toxic multinodular goiter is usually seen in patients over the age of 50 and often in patients with a history of multinodular goiter. Symptoms and signs are similar to those of Graves’ disease. However, they are less severe and no extrathyroidal symptoms occur.

Toxic adenomas usually develop in young patients. Only one nodule is functional in this disorder.

HOW IS DIAGNOSIS MADE AND TREATMENT CARRIED OUT IN TOXIC GOITER?

Thyroid function tests are performed in these patients. These tests reveal that the levels of TSH are low but levels of one or both of the T4 and T3 hormones are high. Besides, USG and thyroid scintigraphy findings contribute to making the diagnosis.

In Graves’ disease, treatment options include antithyroid hormone therapy, radioactive iodine therapy, and surgery. A joint decision on the treatment strategy in a multitask team comprising a surgeon, endocrinologist, and nuclear medicine specialist will facilitate the treatment success. After scheduling the surgery, the patient should be prepared for surgery. It is aimed that the patient with Graves’ disease should achieve the euthyroid state (normal thyroid hormone level) before surgery. Surgical treatment is performed in symptomatic patients, in patients suffering from considerable compression effects, when thyroid cancer is suspected, in women planning pregnancy in 4-6 months, in patients with moderate or severe Graves’ disease, and in the presence of thyroid cancer, a simultaneously existing large cold nodule, accompanying parathyroid diseases requiring surgery, and high antibody levels. Also, surgery is performed in patients refusing to receive radioactive material. Total thyroidectomy or near-total thyroidectomy should be performed in surgery.

Treatment of toxic multinodular goiter involves administering radioactive iodine to the patient and performing surgery. Antithyroid medications do not provide permanent treatment outcomes. Drug therapy is only temporarily used for preparing the patient for surgery or radioactive iodine therapy.

Treatment options for toxic adenoma include treatment with RAI and surgery. If surgery is indicated for treating toxic adenomas, the patient should be prepared for surgery. Firstly, it is aimed that the patient achieves a euthyroid state before the surgery.

Total and near-total thyroidectomy are the correct options for treating toxic multinodular goiter. The likelihood of recurrence is extremely low. In toxic adenomas, a unilateral lobectomy and isthmectomy can be performed safely if the contralateral side of the thyroid gland is found normal in the pre-operatively performed thyroid ultrasound. If there is a nodule on the opposite side, surgery will be the same as performed in toxic multinodular goiter.