Thyroid Cancers
The most common endocrine system cancers are ovari...
The condition that occurs as a result of excessive hormone synthesis by the thyroid gland is called hyperthyroidism, and the condition that develops due to non-thyroidal reasons or thyroid follicle destruction is called thyrotoxicosis. Although there are many causes of hyperthyroidism, Graves' disease, toxic multinodular goiter and solitary thyroid adenoma are particularly important from a surgical perspective. In diagnosis; Decrease in serum TSH levels, increase in serum T3 and T4 levels, and increase in iodine uptake are helpful.
In patients with hyperthyroidism; Psychological changes such as irritability, emotional instability, aggressive behavior, distress and sometimes delusions, insomnia, increased sweating, intolerance to heat, facial redness (due to vasodilatation caused by increased thyroid hormones in circulation), thinning of the skin and hair, loss and softening of the nails, pretibial myxedema, Neuromuscular disorders such as thirst, weakness, weakness in shoulder muscles and difficulty climbing stairs (the most common neuromuscular symptoms are tremor and proximal neuropathy), weight loss despite increased appetite, weight loss, resting tachycardia, palpitations, atrial fibrillation (hyperthyroidism is among the main causes of atrial fibrillation approximately 100% of the time). (3rd place with a ratio of 5-15), there are symptoms such as dyspnea, leg swelling, diarrhea, steatorrhea, vomiting, anorexia, and findings such as goiter, tremor, eye findings, splenomegaly, gynecomastia, palmar erythema and hypercalcemia due to increased bone metabolism.
It is the most common form of hyperthyroidism, with a rate of 85%. Although the exact cause is unknown, it is considered to be a systemic autoimmune disease. It is most common between the ages of 40-49 and in women (6-7 times more common). The thyroid is diffusely and symmetrically enlarged.
Treatment includes medical treatment with antithyroid drugs, ablation therapy with radioactive iodine 131, and surgery (subtotal or total thyroidectomy).
The patient must first become euthyroid with antithyroid treatment. The most commonly used drugs are the thionamides propylthiouracil (PTU) and methimazole (Tapazole).
In cases where there is no response to these medications, radioactive iodine treatment or surgery may be applied.
Radioactive iodine treatment can be applied in patients who do not provide long-term remission with drug therapy and who have recurrence of the disease after subtotal thyroidectomy and who cannot tolerate the surgery.
The surgery involves bilateral subtotal lobectomy or lobectomy on one side and subtotal lobectomy on the other side. With surgical treatment, hyperthyroidism resolves immediately in approximately 97% of cases. Total thyroidectomy should only be performed in patients with advanced disease and large goiters to prevent recurrence.
Clinical findings of ophthalmopathy are detected in approximately 50% of Graves' patients. With CT, this rate exceeds 90%. Among the findings; eyelid retraction, eyelid stinging, proptosis, increased intraocular pressure, external ophthalmoplegia, supraorbital and infraorbital swelling, less commonly congestion and edema, corneal ulcers, diplopia are seen and may result in blindness.
(Plummer's disease)
Hyperthyroidism is a late finding of multinodular goiter (MNG). In treatment; After the euthyroid state is achieved with PTU and metamizole, radioactive iodine is administered to elderly patients who cannot tolerate surgery or surgery.
It occurs when an autonomously functioning solitary dominant nodule secretes excess thyroid hormone, independent of TSH. It is observed more frequently in people aged 20-40. It is almost always benign (follicular adenoma). The preferred treatment option, especially in young people, is surgery.
In Hashimoto's thyroiditis, autoantibodies developing against thyroid follicles cause follicle damage and the released hormones temporarily create a hyperthyroidism-like picture. It is common between the ages of 30-50. Only beta blockers are sufficient.
The thyrotropic effect of increased human chorionic gonadotropin (hCG) in hydatidiform molar pregnancy, choriocarcinomas, or embryonal carcinoma of the testicle produces hyperthyroidism. In ovarian tumors, the presence of ectopic thyroid tissue in the teratoma is called struma ovari and approximately 100% of the patients have clinical hyperthyroidism.
Pregnant women may also develop hyperthyroidism due to high hCG levels or high thyroid-stimulating hCG.
It is a life-threatening condition and requires urgent treatment. If left untreated, mortality is around -15. High doses of PTU (200-250 mgX 6), iodine and beta blockers are used in the treatment.