What is Hyperthyroidism?

Hyperthyroidism is a clinical condition caused by an excessive presence of thyroid hormones in the blood, leading to an increase in metabolic processes.

The most common cause is Graves' disease, a familial autoimmune disease that most often affects women between the ages of 30 and 40.

The mechanisms behind the increased thyroid activity can be numerous, but the symptoms are unfortunately often very similar. However, through various tests, it is possible in most cases to reach a definitive diagnosis, tracing back to inherent blood tests and the hormones present in the blood and the thyroid gland, stimulated by the pituitary gland, itself controlled by the hypothalamus.

What are the causes of hyperthyroidism?

Primary Causes

The damage is primarily located in the thyroid gland. These include:

• Graves' Disease: This is an autoimmune disease. The individual's immune system produces antibodies active against the TSH receptor, located on the thyroid cells. This receptor is therefore constantly activated, stimulating the thyroid to develop and, above all, to release hormones into the bloodstream;
• Toxic Multinodular Goiter: Presence of several nodules in the parenchyma of the thyroid gland. Regions with increased secretory activity are found there;
• Toxic Adenoma: Benign neoplasm, a small group of thyroid cells that begins to proliferate, organize, and secrete hormones. The mechanism is similar to that of toxic multinodular goiter, but it's as if all the work here is done by a single nodule, namely the adenoma;
• Other causes:
  • Genetic mutations capable of persistently activating the TSH receptor;
  • Metastases resulting from a hyperfunctioning thyroid carcinoma or true thyroid tumors;
  • Medications, in most cases, an increased intake of iodine;

Secondary Causes

In this case, the problem is located in the anterior pituitary gland.

• Pituitary adenoma secreting TSH;
• Thyroid hormone resistance syndrome: if T3 and T4 peripherally do not function, the pituitary interprets this as a lack of these hormones in the bloodstream and therefore stimulates the thyroid by increasing TSH production;
• Tumors secreting hCG (chorionic gonadotropin), because it has a similar structure to TSH and is therefore capable of stimulating thyroid cells;
• Pregnancy: sometimes, precisely because of the increase in circulating hCG, it can have the same effect;

Tertiary Causes

The cause of hyperthyroidism is tertiary if the problem lies in the hypothalamus. Found in this category are:

• Forms of thyrotoxicosis without true hyperthyroidism;
• Subacute thyroiditis;
• Silent thyroiditis;
• Early stage of Hashimoto's thyroiditis;
• Other causes:
  • Medications toxic to the thyroid;
  • Radiation;
  • Infarction of thyroid tissue due to lack of blood supply;
  • Thyroid hormones introduced externally;

Diagnosis of Hyperthyroidism

Physical Examination

A physical examination in cases of hyperthyroidism allows the detection of numerous symptoms and signs that can guide the doctor towards a good diagnosis.

Blood Tests

Once the symptoms are identified, the first approach to classify a patient as suffering or not from a thyroid disorder is represented by laboratory tests, which show:

• Increased T3 and T4;
• Reduced TSH;

Complementary Examinations

Several complementary examinations can be performed as part of the diagnosis of hyperthyroidism. We find in this sense:

• Thyroid ultrasound, where, as in a first X-ray, the doctor can study the presence of more or less evident formations, an enlarged gland, seemingly irregular, ...;
• Doppler study: always within the framework of an ultrasound, it allows us to assess how the different regions (and especially the possible formations present, the nodules in fact) are or are not endowed with their own vascularization;
• Thyroid scintigraphy with iodine: it allows us to evaluate how the different areas of the thyroid gland capture iodine (and therefore function, since we remember that iodine is used by thyroid cells for hormone production);
• Needle aspiration and biopsy to directly study, in case of additional suspicion, the nodules and formations present in the context of the gland;
• In the context of laboratory tests, we can then evaluate many other elements, such as the presence of specific antibodies (think of Graves' disease);

Treatment of Hyperthyroidism

Hyperthyroidism is treated by taking medications (such as methimazole) that block the production of hormones by the thyroid.

If, after one year, the treatment has not yielded the expected results, you can prolong it or switch to more radical treatments, such as thyroidectomy (removal of the thyroid gland followed by thyroid hormone replacement therapy).

Without treatment, hyperthyroidism can cause a fever above 39°C (102.2°F), tachycardia, atrial fibrillation, cardiovascular decompensation, psychomotor agitation, mental confusion, convulsions, nausea, vomiting.

The Impact of Hyperthyroidism on Couple's Life

Hyperthyroidism can have a considerable impact on a couple's life. In fact, hyperthyroidism is often associated with sexual dysfunctions such as premature ejaculation and infertility.

Let's examine the causes:

• Premature ejaculation. Hyperthyroidism has a significant impact on the central nervous system and the psyche of the patient who may be affected by anxiety or psychotic episodes. These behavioral alterations have an impact on erection and sexual appetite. Fortunately, these disorders disappear once the condition is treated;
• Fertility problems. In patients suffering from hyperthyroidism, a reduction in seminal volume, sperm count, and motility is often observed. The causes of these problems are found in the reduction of the proportion of bioavailable testosterone and in the increase in transport proteins and female hormones;