Along with Graves ‘ disease, thyroid autonomy is the most common cause of hyperthyroidism (overactive thyroid gland) and is characterized by autonomous areas in the thyroid gland that produce thyroid hormones independently of the hormonal control by the pituitary gland. About 5 percent of the Central European population is affected by thyroid autonomy, with women being affected more often than men at a ratio of 5:1.
What is thyroid autonomy?
Thyroid autonomy is a disease of the thyroid gland in which specific tissue areas (adenomas) or the entire tissue have diffusely escaped the control of the pituitary gland, so that thyroid hormones are produced uninhibitedly. See deluxesurveillance for Mesothelioma Guide.
If this autonomous hormone production exceeds the needs of the human organism, depending on the mass and activity of the autonomous areas and the individual iodine intake, a subclinical (latent) and later manifest hyperthyroidism develops, which is manifested by weight loss, tachycardia, psychomotor restlessness, among other things as well as diarrhea and cycle disorders.
In about 50 percent of cases, several areas (multifocal autonomy), in over 30 percent a single area (unifocal autonomy) and in about one sixth the entire thyroid tissue are affected by diffusely distributed cell islets (disseminated autonomy).
Thyroid autonomy is most commonly due to iodine deficiency. Due to this deficiency, the thyroid can no longer produce enough hormones and tries to compensate by enlarging (goiter or goiter formation).
As the goiter increases in size, there is an increased risk of developing nodules, which can escape the control of the pituitary and develop autonomic areas. In addition, unifocal thyroid autonomy can be associated in about 80 percent of cases with a mutation in the TSH receptor gene, leading to increased growth and hormone production by thyrocytes (hormone-producing follicular epithelial cells).
In general, about 30 point mutations are now associated with the development of thyroid autonomy. The autonomy efforts of the affected thyroid tissue are probably also catalyzed by an exogenous supply of high-dose iodine in the form of iodinated contrast media or disinfectants and drugs (including amiodarone), which can also cause the development of hyperthyroidism (overactive thyroid).
Symptoms, Ailments & Signs
Thyroid autonomy develops extremely slowly and over a long period of time. The symptoms are often only noticed in old age. Typical here is the formation of a nodular goiter, which may also lead to breathing and swallowing difficulties due to the narrowing of the trachea and esophagus.
Depending on the functional status of the thyroid gland, symptoms of an overactive thyroid gland can occur. Thyroid autonomy can be asymptomatic or have significant symptoms. The thyroid hormones are crucial for the normal function of the cells. In excess, they negatively affect metabolism, which aggravates the action of the sympathetic nervous system. As a result, various bodily processes are accelerated and an overdose of adrenaline can be detected in the blood.
Some of these symptoms include nervousness, irritability, increased sweating, racing heart, trembling hands, anxiety, trouble sleeping, thinning skin, fine, brittle hair, and muscle weakness – especially in the upper arms and thighs. Frequent bowel movements associated with diarrhea can also occur.
Weight loss, sometimes significant, can occur despite a high appetite. Although ten percent of people with an overactive thyroid experience weight gain, vomiting can occur. For women, menstrual flow may vary in frequency and menstrual periods may occur less frequently or with longer cycles than usual.
Diagnosis & History
In many cases, the diagnosis of thyroid autonomy begins with a determination of the TSH value in the serum in order to exclude hyperthyroidism and to be able to assess the thyroid function. If the TSH value is low, the parameters of the peripheral thyroid hormones thyroxine (T4) and triiodothyronine (T3) are usually also determined.
In addition, the thyroid volume and morphological or nodular changes can be detected in the context of a sonography. The diagnosis of thyroid autonomy is finally backed up by scintigraphy, in which iodine-131 or Tc99m pertechnetate are administered, which accumulate in the affected areas of the thyroid gland and make the affected areas visible in the scintigram. Thyroid autonomy should be differentiated from Graves’ disease by means of an autoantibody test.
Thyroid autonomy cannot be cured, but has a favorable prognosis if diagnosed in good time and treatment is started early. If left untreated, thyroid autonomy with latent hyperthyroidism and excessive iodine intake can lead to a thyrotoxic crisis (life-threatening metabolic disorders).
Thyroid autonomy can cause a variety of complications. The breathing and swallowing difficulties that typically occur can lead to shortness of breath and aspiration – both of which are associated with further complications. Weight loss can cause dehydration and deficiency symptoms. This leads to a decrease in physical and mental performance, often also to mental suffering.
The inner restlessness contributes to the formation of depressive moods and anxiety disorders. If the thyroid autonomy remains untreated, chronic gastrointestinal complaints can set in. In rare cases, intestinal cysts form or even gastric cancer develops. Accompanying this, cardiac arrhythmias can occur which, in the case of corresponding previous illnesses, can lead to a heart attack and, under certain circumstances, to the death of the patient.
The bones can also be damaged in a chronic course – this leads to osteoporosis and inflammatory bone diseases. Depending on the type of therapy, complications can also arise during the treatment. Radioiodine therapy is associated with problems in the gastrointestinal tract and often also causes circulatory problems, dehydration and fatigue. Removal of the thyroid can cause allergic reactions, infections, hoarseness, and difficulty swallowing, among other things. Cardiac arrest occurs very rarely.
When should you go to the doctor?
Thyroid autonomy must always be treated by a doctor. It is a serious condition that cannot heal itself. In order to prevent further complications and symptoms, a doctor should always be consulted in the event of thyroid autonomy. Early diagnosis and treatment always have a positive effect on the further course of the disease. A doctor can be consulted if the person concerned suffers from severe swallowing difficulties. It can also cause breathing difficulties.
In most cases, these symptoms appear for no particular reason and do not go away on their own. Furthermore, it is not uncommon for an overactive thyroid gland to indicate thyroid autonomy and should be examined. Diarrhea, insomnia and anxiety are also common. These symptoms also often indicate thyroid autonomy and must be treated by a doctor. A general practitioner can be consulted for this. Further treatment is then carried out by a specialist.
Treatment & Therapy
Various therapeutic measures are available for the treatment of thyroid autonomy, depending on the severity and progression of the disease. If the metabolism is euthyroid (normal hormone production) and there are no clinical symptoms, thyroid autonomy can often be easily observed. Prophylactic therapy with levothyroxine or a combination of levothyroxine and iodide should be considered, particularly in the case of goiter formation.
Therapeutic measures are definitely initiated as soon as latent hyperthyroidism is detected, since this can have an unfavorable long-term effect on the heart (atrial fibrillation) and bones (osteoporosis). For this purpose, antithyroid drugs (carbimazole, propylthiouracil, thiamazole) are used, adapted to the individual functional situation, to inhibit hormone production and normalize the thyroid function.
Since thyroid autonomy does not show remissions (regression) and there is an increased risk of thyrotoxic crises, thyrostatic therapy is in most cases only used as a temporary bridge until the choice of the definitive form of therapy (radioiodine therapy, thyroid resection), in which the autonomous tissue areas are eradicated, applied.
While the autonomous tissue areas are surgically removed as part of a resection via an access via the neck, orally applied radioactive iodine-131 usually induces the death of the affected person during radioiodine therapy, which is particularly recommended for multifocal or disseminated forms of thyroid autonomy and goiter formation tissue.
Since thyroid autonomy can be traced back to a permanent iodine deficiency in most cases, the disease or the growth of the organ and the formation of nodules and goiter can be prevented by adequate iodine intake. A daily amount of iodine of 180 to 200 micrograms is recommended to prevent a long-term deficiency and thus thyroid autonomy.
Thyroid autonomy favors hyperfunction. The production of endogenous hormones is disturbed. The result is physical discomfort. The early administration of iodine preparations counteracts autonomy. Follow-up care is advisable to counteract hyperthyroidism. In addition, the cold knots must be checked regularly.
Noticeably enlarged tissue or development into hot nodules requires surgical intervention. The degenerated parts are removed from the thyroid gland. The aim is to stabilize the hormonal balance. Your thyroid levels should be back in the normal range. Thyroid autonomies lead to weight loss, heart palpitations and psychological problems. Difficulty swallowing and breathing are caused by thyroid nodules.
Many patients also complain of a feeling of pressure in the neck. The doctor treats the symptoms with medication. As part of the aftercare, he checks the effect. If necessary, he prescribes more suitable medication or changes the dosage. In the case of a thyroid operation, the well-known postoperative follow-up checks apply. The patient remains in the hospital until discharge.
This also ends the aftercare. Even after a successful operation, the family doctor checks the size of the thyroid gland. Blood tests provide information on hormone levels. Treatment and aftercare start again if the symptoms return. Abnormal findings require further surgery. Alternatively, iodine therapy can help.
You can do that yourself
In the case of thyroid autonomy, the affected person can strengthen his or her organism by eating food containing iodine. In order to reduce the prevailing iodine deficiency in a natural way, the consumption of seaweed, cod, haddock or pollock is advisable. In addition, regular consumption of herring, mushrooms or broccoli should be included in the menu. Peanuts and pumpkin seeds also help to supply the body with more iodine.
Meals should also be seasoned regularly with salt containing iodine. Foods such as spinach and fatty cow’s milk also contain an increased proportion of iodine, which can have a positive influence on the course of the disease in the case of thyroid autonomy.
Before consumption, however, any intolerances must be checked to avoid complications or side effects. To reduce swallowing difficulties, care should be taken to ensure that the food is broken up sufficiently during the chewing process. The grinding process of the teeth should be optimized and improved. It is important to check the weight so that no unwanted weight loss occurs and possible deficiency symptoms can be reduced.
Mental techniques are recommended to reduce inner restlessness. Autogenic training, meditation or yoga have a strengthening effect on the mental power of those affected. They also reduce stressors and promote well-being.