Hyperthyroidism and Hypothyroidism (first part ) بالانجليزية

The thyroid gland is situated at the front of the neck and resembles a butterfly due to its bilobular form. It is one of several glands connected to the endocrine system which is in charge of producing and secreting the thyroid hormones, thyroxine (T4) and triiodothyronine (T3). These hormones production is regulated by the pituitary gland, which is located in the brain. As the pituitary gland produces thyroid stimulating hormone (TSH), which causes the thyroid to create T3 and T4. These hormonal agents influence growth and development, metabolism, and other organ-specific processes. 

Regarding metabolism: Thyroid hormones are considered to be calorie-producing since they cause the body to burn oxygen and produce heat. They boost gluconeogenesis, enhance glucose uptake, accelerate protein catabolism, and promote lipid metabolism. With regard to other organ-specific effects, They affect cardiac function by decreasing peripheral vascular volume and increasing cardiac output, heart rate, myocardial contractility, and blood volume. They promote the synthesis of growth factors, cytokines, and other substances that promote the formation and growth of bones. In addition, thyroid hormones stimulate the gastrointestinal tract's enhanced motility and heighten the central nervous system's adrenergic activity and sensitivity. These hormones are crucial in the early stages of foetal life to support normal growth and brain development because they also promote cell differentiation, growth, and maturation.

The five most prevalent forms of thyroid disease are goitre, thyroid cancer, hypothyroidism, hyperthyroidism, and thyroid dysfunction.

Hyperthyroidism: This disorder is characterised by an overproduction of thyroid hormones. The clinical condition of elevated thyroid hormone concentrations is called thyrotoxicosis. The body's metabolism increases as a result, resulting in a range of symptoms.

Concerning the causes of hyperthyroidism: autoimmune disease (Grave's disease), meaning that the immune system creates an antibody that triggers the overproduction of thyroid hormone (T3 and T4). It is the most typical reason why hyperthyroidism occurs. Additional causes include excessive intake of exogenous thyroid hormones, pituitary adenoma that produces TSH, thyroid nodules, and thyroiditis.

Hyperthyroidism typically manifests as follows: heat intolerance, diaphoresis, flushed skin, increased appetite, muscle wasting, loss of weight , exophthalmos, palpitations, tachycardia, shortness of breath, restlessness, nervousness, fatigue, hyper defecation, anxiety, irritability, agitation, tremors of the hands, irregular or non-existent menstrual periods in some women, and weakness, particularly in the upper arms and thighs, which makes it difficult to climb stairs or get out of a chair

The treatment of hyperthyroidism may include the use of antithyroid medications to prevent thyroid hormone production or thyroidectomy or radioactive iodine to lessen hyperfunctioning thyroid tissue. Regarding taking antithyroid medications, it is advised that free-T4 (fT4) be measured four weeks after starting treatment and then every four to eight weeks until euthyroid levels are reached. When utilised radioactive iodine, it causes the thyroid to "ablate," or be destroyed. It is given orally and takes six to eighteen weeks to start working. The majority of persons who have their thyroid glands ablationed will require thyroid supplements for the rest of their lives. In terms of thyroidectomy, it is recommended in the following situations: the thyroid gland is so big that it is obstructing the airways; the patient does not wish to utilise radioactive iodine and the antithyroid medications are not tolerated; or there is a thyroid gland nodule that may be cancerous. Though, because of the potential for harm to the voice box's nerves and the parathyroid glands, which control the body's calcium balance, thyroidectomy is not the first choice. Often doctors prescribe β-blockers to assist suppress the symptoms of hyperthyroidism until the other therapies start working. 

Hypothyroidism: Hypothyroidism is the result of the tissues not receiving enough thyroid hormones. The principal causes of hypothyroidism are primary causes, meaning that disorders of the thyroid gland itself, such as thyroid nodules or tumours, autoimmune thyroiditis (Hashimoto's), and transient thyroiditis. The secondary causes are problems related to the pituitary gland including pituitary tumours, post-partum pituitary necrosis (Sheehan's syndrome), and trauma. Another reason for hypothyroidism is neonatal hypothyroidism, which is often referred to as cretinism or congenital hypothyroidism. This condition, which affects new-borns, is caused by either athyreosis, the total absence of the thyroid gland, or problems in the synthesis of thyroid hormones. Other causes including iatrogenic which caused by drugs, post-thyroidectomy, post-radioactive iodine treatment, and excess or lack of iodine.

The thyroid hormone level and the rate at which it fell determine the symptoms. While some people experience severe symptoms or, very infrequently, even life-threatening symptoms, others have none at all. The common symptoms of hypothyroidism are categorised as follows: a- general symptoms including weakness, apathy, weight gain, fatigue, sluggishness, and cold intolerance. Among the changes to the skin are: Less perspiration, thick, dry skin, thin and coarse hair; eyebrows may fall out; brittle nails. In Eyes: Small oedema surrounding the eyes. For Heart: Enlarged heart, bradycardia, and reduced cardiac function leading to exhaustion, breathing difficulties during exercise, ankle oedema, and elevated blood pressure. For the respiratory system: sleep apnoea, hoarse voice, tongue swelling, and weaker respiratory muscles and impaired lung function. Constipation in the gastrointestinal tract. Abnormalities in the menstrual cycle in the reproductive system. Symptoms also include mental health issues like mental impairment and sluggishness. In cases of severe hypothyroidism, a potentially fatal condition known as myxoedema coma—which results in unconsciousness and low body temperature—can be brought on by trauma, infection, exposure to cold temperatures, and certain drugs.

Controlling symptoms and bringing blood levels of TSH and T4 back into the normal range are the main objectives of treatment. Levothyroxine (T4) is typically taken once a day as a substitute for thyroid hormones. It is advised that thyroid replacement medication be taken without food. Iron pills, calcium supplements, antacids, and high-fiber diets all impede absorption. In order to ensure that the recommended dosage is sufficient, follow-up blood tests must be performed every 6 to 8 weeks. once the ideal dosage has been established, levels are typically reassessed annually. Most people need therapy for the rest of their lives. Recall that taking excessive amounts of thyroid supplements might be risky because they can hasten the loss of bone (osteoporosis) and induce atrial fibrillation (an irregular heartbeat).

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