The thyroid gland is a butterfly shaped endocrine gland which is normally located in the lower front of the throat. Making thyroid hormones is the job of the thyroid gland, which are secreted into the blood and then carried to every tissue in the body. The hormone secreted by the thyroid helps the body to use energy, stay warm and keep the brain, heart, muscles, nerves and other organs working smoothly and normally. The thyroid disease is due to the mal-function of thyroid glands as well as thyroid hormones. The major thyroid hormone secreted by the thyroid gland is thyroxine, which also called T4 because it contains four Iodine atoms. This happens mainly in the liver and in certain tissues where T3 works, such as in the brain. The quantity of T4 produced by the thyroid gland is controlled by another hormone secreted by the pituitary gland, called thyroid stimulating hormone or TSH.
The thyroid diseases are the syndrome of characterised syndrome of hyperactivity or hypo-activity of the thyroid gland associated with excessive or less utilisation of thyroxin hormone.
When hyperthyroidism is associated with goitre and ocular signs it is called Graves’ disease . When hyperthyroidism is associated nodular goitre it is called secondary thyrotoxicosis. When goitre is absent but the features of hyperthyroidism is present is called masked hyperthyroidism. Sometimes features of exophthalmos may precede, follow or concurrently be present with thyrotoxicosis which is called malignant ophthalmoplegia. In rare cases when serumT4 level is normal but serumT3 level is elevated, this type hyperthyroidism is called T3 thyrotoxicosis. Thyrotoxicosis has been found in case of thyroiditis, stroma ovaries and after intake of iodine containing drugs.
The exact cause of this disease is not yet known well. The recent evidences indicate that the disease is due to an imbalance in thyroxin homeostasis between thyroid hormones and peripheral tissues. Mental stress and strain, psychic trauma etc. probably act via cortico hypothalamic pathway and liberate human specific thyroid stimulator namely HSTS. This in turn stimulates the hypothalamus to liberate TRH which stimulates the anterior pituitary to secrete TSH which acts on the thyroid glands and produces excessive T3 or T4 or both. TSH also stimulates hormone rerelease and can produce thyroid hyperplasia. All these indicate that Graves’ disease is possibly due to cell mediated immunity(CMI). So on by feedback mechanism TSH level is diminished, but in rare condition of pituitary tumour producing both acromegaly and thyrotoxicosis TSH level is persistently elevated.
The clinical features of this type of thyroid diseases are as follows:
1. Cardiovascular system :
b) Tachycardia (pulse rate may be about 120 per minute or above.
c) Rise of systolic blood pressure.
d) Enlargement of heart due to hyperkinetic circulation.
e) Sometimes shows the features or refractory cardiac failure.
2. Neurological system :
a) Tremor is the most prominent feature of thyroid disease and fine in type, found in outstretched fingers and protruded tongue.
b) Anxiety neurosis. There may have lack of concentration, restlessness and irritability, delirium and also insomnia.
c) Muscular wasting and weakness resulting in difficulty in climbing upstairs.
3. Alimentary system :
a) Appetite is increased but in spite of this, patient loses weight and that is a cause of surprise to the patient.
b) Increased thirst.
c) Occasional attacks of diarrhoea.
d) May be present nausea and vomiting.
e) Rarely jaundice is present.
4. Ocular system :
a) Exophthalmoses are present in 80% of cases.
b) Widening of palpebral fissure.
c) Lagging of the upper eye-lids on looking downwards.
d) Lack of convergence.
e) Infrequent blinking
f) No wrinkling of forehead on looking up.
g) Periorbital oedema.
5. Change of skin:
a) Skin is thin, smooth and silky.
b) Hairs very thin and sparse.
c) Profuse sweating.
d) Moist and warm hands.
e) Hyper pigmentation.
f) Spider angicoma and gynaestiaoma.
g) There may be bilateral hard non-pitting swelling called pertibial myxoedema.
6. Changes of Nail :
a) There may be onycholysis and separation of skin from nail.
b) Rarely there may be clubbing.
7. Metabolic changes :
a) Increased BMR up to +40%
b) Negative nitrogen, calcium and iodine balance.
c) Blood cholesterol is diminished less than 100 mg per 100 cc of blood.
d) Hyperglycaemia and transit glycosuria may develop which is called thyroid diabetes.
8. Sexual function :
a) Females: – amenorrhoea.
b) Males: – impotency.
9. Mental changes :
10. Other features: –
b) Osteoporosis with collapse of vertebrae.
It is a condition of thyroid disease that diminished production or utilisation of thyroxine in the body. There are two types of hypothyroidism, i.e. primary and secondary.
Primary hypothyroidism : Four types of hypothyroidism and their causes are as follows: –
a) Non-goitrous hypothyroidism: –
(iv) Developmental defects.
b) Goitrous hypothyroidism:
(i) Endemic cretinism.
(ii) Hashimoto’s thyroiditis.
(iii) Maternally transmitted anti-thyroid drugs to the foetus.
(iv) Overdose of anti-thyroid drugs in adults.
c) Dyshormogenesis with or without Penderd’s syndrome.
d) Defects in thyroxin synthesis:
(i) Defect in iodide trapping.
(ii) Iodide organification defect.
(iii) Coupling defect.
(iv) Iodo-tyrosine dehalogenase defect.
(v) Serum iodoprotein defect.
Secondary hypothyroidism :
This thyroid disease is the following types: –
a) Lack of pituitary TSH.
b) Lack of hypothalamic TRF from irradiation, tumour or granulomatous affection.
It is another type of thyroid disease. This is a condition of hypothyroidism beginning in foetal life. It may occur endemically, sporadically or may run in families. Environmental lack of iodine results in endemic cretinism where one or both parents may have a goitre but in sporadic and famillal cretinism no such environmental lack of iodine exists.
Some Clinical Features :-
a) Hairs are scanty and tend to fall.
b) Face is pale with wrinkling on the forehead.
c) The nose is broad and big nostrils.
d) Eyes are pig like.
e) Increased amount of supra-clavicular fat.
f) The limbs are hypotonic and abdomen is pendulous.
g) Skin is dry and coarse.
h) Metabolism is decreased.
i) Genitalia are ill developed.
j) In endemic cretin a goitre is commonly seen.
This thyroid disease is a condition of hypothyroidism occurring in middle aged individuals usually in females. It may occur endemically or sporadically.
Clinical features of myxoedema :
a) Hairs are scanty and tends to fall producing patchy alopecia.
b) The eye brows and eye lashes are deficient especially in outer third.
c) Face is pale and puffy with baggy eye –lids and a characteristic malar flush is present.
d) The skin is dry and thick with minimal sweating.
e) Anaemia is present and may be due to iron deficiency or due to specific lack of thyroxin.
f) In cardiovascular system, pulse rate is slow below 60 per minute, but in advanced cases with cardiac insufficiency there may be tachycardia, blood pressure is low though at times there may be systolic hypertension. Heart is enlarged partly due to dilatation. Angina pain may develop.
g) Metabolism is diminished.
h) Mental changes notice, intelligence is impaired and the memory becomes poor. Questions are answered after a latent period is remarkable. Depression and melancholia may be present.
i) Appetite is poor, thirst is impaired, and absorption of food from the gut is delayed. Constipation is a normal rule.
j) Speech is slow and sluggish, voice is hoarse. Conductive deafness may be present.
k) There may be impotency in males and sterility in females. Menorrhagia is very common in female.
l) Muscular cramps, fatigue, weakness and pain of rheumatism may be present.
Blood tests commonly used to measure TSH, T3, T4 and free T4.
TSH: –Initially thyroid function test is to measure the TSH level in a blood sample. A high TSH level indicates that the thyroid gland is failing due to a problem that is directly affecting the thyroid. But when TSH level is low, usually indicates that the person has an overacting thyroid and so producing too much thyroid hormone. Sometimes a low TSH may result from an abnormality in the pituitary gland.
T3 Tests: – For diagnosis of hyperthyroidism or to measure the severity of the hyperthyroidism T# test are often useful.The hypothyroid patients will have an elevated T3 level. T3 testing :is not quite useful in the hypothyroid patient. Patients can be severely hypothyroid with a high TSHand low FT4, but have a normal range of T3.In some special condition, such as the time of pregnancy or while taking the birth control pills, levels of total T3 and T4 may be high due to estrogens increase the level of the binding proteins.
T4 Tests: – The T4 remain in the blood circulation in two forms : a) T4 bound to proteins that prevent the T4 from entering the various tissues which are need thyroid hormone. b) Thee free T4, which entered the various target tissues to exert its effects. To determine how the thyroid is functioning the free T4 fraction is very important, and test to measure this are called the Free T4 or FT4 and the Free T4 index or FTI. Persons who have hyperthyroidism will have an elevated FT4 or FTI, whereas patients with hypothyroidism will have a low FT4 or FTI.
Thyroid antibody tests :- the body immunity system normally protects from foreign invaders such as bacteria and viruses by destroying these invaders with substances called antibodies produced by blood cells. In many patients with hypothyroidism or hyperthyroidism, lymphocytes make antibodies against their thyroid which either stimulate or damage the gland.
Symptomatic homeopathic treatment may be very useful for such diseases but the treatment should be done under careful medical supervision. Iodium, natrum mur, thyroidnum, calcarea carb, Lachesis, pulsetilla etc. are the some important homeo remedies.
With the administration of homeopathic medicine magnet therapy may be done very effectively. Both palms on two strong magnets in the morning, ceramic magnet on throat should be given. Magnetised water(see, Process of Magnet therapy) also effect well and should be taken at regular interval. If goitre formed North pole of a medium power magnet should be applied on the goitre.