We know that thyroid disease is a problem that can arise in special situations or can be a problem secondary to other diseases.
Secondary or tertiary types of hypo or hyperthyroidism are treated as same as primary cases of hypo or hyperthyroidism. During thyroid replacement TSH cannot be relied upon. In these cases free T4 is used. For these situations the replacement of deficient hormones might always mean a solution.
Central hyperthyroidism is the consequence of a TSH secreting pituitary tumor or a TSH resistance. These cases are pretty rare. In the first one of the cases mentioned earlier which is TSH secreting pituitary tumor also called macroadenoma, the recommended treatment is hypophysectomy followed by external radiotherapy. A determining role in pre-operative preparation it has the treatment called octreotide. Until the present no ideal treatment for selective pituitary resistant hyperthyroidism is known. Different treatments such as antithyroid drugs, bromocriptine and T3 are used. This treatment’s mission is to control thyrotoxic symptoms, not the nominalization of thyroid parameters.
Subclinical thyroid diseases can increase atherogenicity in cases of hypothyroidism. Nowadays the possibility of treating this kind of patients increases. If we were not living these times of lipid awareness a number around 5 percent of the thyroid disease patients were developing overt hypothyroidism. A lot different from subclinical hypothyroidism, subclinical hyperthyroidism is defined as a normal thyroid hormone concentration. Beside that an undetectable serum TSH concentration is a characteristic for subclinical hyperthyroidism. These are the reasons why subclinical hyperthyroidism needs to be distinguished from sick ruthyroid syndrome or any secondary or tertiary hypothyroidism. Treatment is needed in these cases because the increased incidence of atrial fibrillation and because of a decrease in bone mineral density.
Another problem caused by thyroid is the enlargement of the thyroid gland that affects the trachea, the laryngeal nerve and the esophagus. The way of affecting these parts of a human’s body is through pressure. A more serious problem that may occur is retrosternal goiter that causes a high pressure effect over the vascular structures in the superior mediastinum. If these problems are noticed in time there might be a chance for feeling better, but not after RAI that is contraindicated, but after surgery.
Thyroid eye disease is another secondary problem that may develop from thyroid cancer. The specific problems seen in thyroid eye disease are visual acuity, rapidity and severity of eye symptoms and systemic thyroid status. Fortunately this problem is rarely seen.
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