MARA UNIVERSITY OF TECHNOLOGY FACULTY OF HEALTH SCIENCE PUNCAK ALAM CAMPUS HPY 450: HEALTH PSYCHOLOGY SECOND ASSIGNMENT: HYPERTHYROIDISM (DISEASE OR ILLNESS THAT I KNOW ABOUT) Written by MOHD RUHAIZIE BIN RIYADZI NRIC : 810920-11-5519 Student ID : 2010282848 Program : Bachelor Degree in Environmental Safety & Health (HS223) Group : EHSE4A Lecturer: TUAN HAJI ABDUL HAMID BIN KAMARUDIN
HPY 450 Health Psychology Bachelor Degree Program in Environmental Safety and Health (HS223) Faculty of Health Science, MARA University of Technology (UiTM) Puncak Alam Second Assignment: HYPERTHYROIDISM, also a patient of Hyperthyroidism 1.0 INTRODUCTION Most of the medical references world wide agree to define hyperthyroidism as a term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones which are thyroxine or labeled as T4 and/or triiodothyronine (labeled as T3). Picture 1: Chemical structural of Thyroxine or T4 Before we go further, I would like to stress-out that this written essay might be more dependent not only to the literature references, but also to my own experiences as hyperthyroidism patient since I firstly been diagnosed in year 2001.
Picture 2: Chemical structural of Triiodothyronine or T3 2.0 NORMAL THYROID HORMONES FUNCTION Thyroid hormones, T4 and T3 are originally trigger from thyroid gland. Thyroid gland is a butterfly-like soft tissue place at front of our neck just below the voice box. To be more exactly, a tiny voice cord or vane is placed very near to the gland. In normal condition, thyroid hormones function as a controller of the pace of all of the processes in the body. This pace is called metabolism. It's important at a cellular level, affecting nearly every type of tissue in the body. (Wikipedia.org) According to Endocrine Web, these hormones have direct effects on most organs, including peripheral organ such as heart, which the beats depend on how much adrenaline hormone triggered as a result from the consumption of thyroid hormones to the pituitary.
Picture 3: Thyroid gland located in front of the neck under larynx. Picture 4: Work plan for thyroid system
According to Picture 4, our brain via hypothalamus section which received signal from body producing thyrotropin-releasing hormones (TRH) to pituitary gland. Pituitary gland is a nut-size gland under hypothalamus in our brain. TRH will trigger TSH (thyroidstimulating hormones in pituitary gland, yet it send message to thyroid gland to produce T4 and T3 to organ in our body via blood vessel. T3 and T4 main function are to increase metabolism to our body. This explanation can be more understanding with an example. Let's say one day we go to the motor-sport circuit to see F1 Racing Championship. When we see the team which we support are approaching their target to win the battle, our sensory-elements through-out our body send messages to our brain. Brain will release TRH via hypothalamus to pituitary. Pituitary send signals that trigger thyroid hormones inside thyroid gland. These thyroid hormones flow through-out our blood vessel to every organ. By then, our metabolism will increase, yet also increase our adrenaline hormone level. Our body starts sweating and our heart beats rapidly than normal. In this moment, enthusiasm and spirit to win have been focused and optimized. Negative feedback sent back to brain to trigger more hormones. If our racing team we, applause will blow out. After the moment coming back to normal, our gland also trigger less hormone, then reducing our metabolism and finally we're also be norm. Other than this example, some more examples are when we're scare or angry. In both situation, thyroid hormone release to increase our metabolism, yet conclude stage of our fear or angry. More hormones trigger means more scare or more anger we'll be depend on situation that face us.
Therefore, hyperthyroidism happened when too much thyroid hormones triggered and spread in our body. According to Wikipedia.org, hyperthyroidism usually begins slowly. At first, the symptoms may be mistaken for simple nervousness due to stress. If one has been trying to lose weight by dieting, one may be pleased with weight loss success until the hyperthyroidism, which has quickened the weight loss, causes other problems. Hyperthyroidism may run in families, examinations of the members of family may reveal other individuals with thyroid problems. On the other hand, a lack of functioning thyroid tissue results in symptomatic lack of thyroid hormone, termed hypothyroidism. Hyperthyroidism often eventually leads to hypothyroidism. THE CAUSE According to the Royal Medical Society in Britain and Endocrine Web (USA), several causes can trigger hyperthyroidism, such as below: 1. Heredity which genetic factors play important roles in this problem. Hyperthyroidism can occur from parent as generation above or maybe skipped for some generations than occur again. 2. Getting too much iodine via our daily diet. Iodine is the most active element in thyroid hormones chemical structures. (Refer back to Picture 1 and Picture 2 iodine symbolized by letter I ).
3. The most common cause is from Grave's disease. This is happened when the entire gland is overproducing thyroid hormone. This is also known as toxic diffuse goiter which affecting about 75% of hyperthyroidism cases world wide. Grave's disease also classified as an autoimmune disease, a condition cause by the patient's own immune system turning against the patient's own thyroid gland. 4. Inflammation (thyroiditis) of the thyroid due to viral infections or other causes. 5. Noncancerous growths of the thyroid gland or pituitary gland 6. Tumors in brain and reproductive organ (testes for male and ovaries for female) SIGNS AND SYMPTOMS Most of medical specialist in endocrine field revealed most common clinical signs and symptoms of this problem are as below: 1. Weight loss (often accompanied by an increased appetite). 2. Anxiety. 3. Heat intolerance.
4. Hair loss. 5. Muscle aches or weakness. (this sign often happened to me when I ignore my medication for too long. Obviously, this sign happened when I really have bad palpitation my heart beats more than 120/minute and I can't tolerate with temperatures around me. When it is happened, I usually can't get up so I need to use only my hand to grab something or to drag myself when moving). 6. Fatigue. 7. Irritability (this sign appears only recently on me, not from the first I have been diagnose). 8. Tremors in several parts of body such as arms tremors (since my first diagnose of hyperthyroidism, my arms had never stop shivering, just sometimes slow and sometimes vibrate like an earthquakes so I can't event holds a cup of water without spill it out). 9. Sweating (don't be surprise if I'm sweating in cold condition such as in a room with air conditioning system turns on).
10. Palpitation (in several times after neglecting my medication, tremor will appear as a result for my rapidly increasing heart beats. From my medical records, my highest heart beats was once more than 140 beats/minute. As an advise, my doctor tells me that I can only last not more than 3 months if non-immediate action taken). DIAGNOSIS METHODOLOGIES According to Endocrine Web, several methodologies can be run to diagnose and test the present of hyperthyroidism. Most common is from blood test in measuring level of thyroid hormones and TSH (thyroid-stimulating hormones) in blood vessel. 1. TSH produced by the pituitary will be decreased in hyperthyroidism. Thus, the diagnose of hyperthyroidism is nearly always associated with a low (suppressed) TSH level. If TSH level are not low, then other test must be run. (As always when hyperthyroidism trigger in me, my TSH level aren't more than 0.01 mmol). 2. Thyroid hormones themselves (T3 and T4) will be increased. For patients like me who have hyperthyroidism problem, the level should be higher, while for normal person it should be less (about between 12 20 mmol).
3. Iodine thyroid scan will show if the cause is a single nodule or the whole gland. Picture 5: Iodine profile shows the problem of hyperthyroidism involve the whole gland 4. X-ray examination also can be conducted. 5. If goiter is the main cause of the hyperthyroidism, then ultrasound technique can be executed. Picture 6: Ultrasound probe attach on neck to see the gland inside.
Picture 7: Picture from the result of the ultrasound. Picture 8: Patient can also do physical examination on themselves.
THE TREATMENT There are two types of treatment which can be done, either short term medication or permanent (long term) solution. A. SHORT TERM MEDICATION Several pills can be prescribe by medical doctor to reduce and treat this problem in short term. This pills can suppress thyroid hormones production if taken for long time, but it can cause over consumption so that will result hyperthyroidism really suppress and turn down as hypothyroidism. More than that, if the medication pills aren't taken for long time, the problem might occur again but with greater effect (it's like resistant to the hormones). Therefore, pills need to be taken every time as prescribe and review must be made not more once in three month. Until now, I still consume 40 mg of Carbimazole 5mg daily (taken twice which 20mg each). Carbimazole 5mg comes in a tablet of 5 mg each. Therefore, once taken, I need to consume 4 tablet each time. Other than that, I also consume Propanolol 40 mg Tablet daily to reduce my tremor, Slow K (Potassium Chloride) 600 mg and Calcium Lactate 300 mg daily to maintain electrolyte of Calcium and Potassium in my body so the event of muscle pain and weakness never occur again.
B. PERMANENT TREATMENT There are two methodologies in permanent or long term treatment. One is surgery and secondly by radioactive iodine isotop dose consumption. Surgery Method In surgery method, whole gland or part of it will be cut and remove. Therefore, number of gland that can produce hormones will be reduce. But not many patients can be treat using this method. This method only suit patient with growth of the gland (goiter) or cancerous hyperthyroid type. The risk of this method is greater in losing voice and difficult to swallow food. Voice can be lost if surgeon without intention cut the tiny voice cord in front of the gland. Radio-Iodine Method In most cases including me, an advise to try radio-iodine method has been made several time by my doctors. In this method, patient need to orally taking an radioactive isotope of iodine-131 either in liquid or pill-formed. This isotope will destroy most of the gland tissue and it takes several days to weeks to be succeed. Although no research done result that this isotope bring side effect to the patient, but I still thinking either to go on with this treatment or not. The risks might be there.
Picture 9: Surgery operation in order to cut down the gland. CONCLUSION Hyperthyroidism is an endocrine health problem that trigger most processes in our body to speed up. It can cause by various reason but most common it can be inherit in generation and as a result from too iodine consumption in daily diet. The signs and symptoms might not be aware or maybe false understand thus result it has been ignored at early stages. Patient only know they're in trouble as the problem comes to the severe stage. But, no matter how severe it is, after diagnosed, it can be controlled either using short term treatment or long term treatment. Patient just need to get right information from discussion with their medical consultant what treatment will be the best and low-risk for them.
REFERENCES Dr. James Abulant (1998). Gangguan Tiroid. Terjemahan oleh Nafisah Noor. Kuala Lumpur: Penerbitan Fajar Medical Book Series. Wikipedia.org on related topic of Hyperthyroidism. http://www.wikipedia.org Endocrine Web on related topic of Hyperthyroidism http://www.endocrineweb.com World Health Organization http://www.who.int USA TODAY HEALTH SCOUT http://www.healthscout.com ABOUT.COM on related topic of Hyperthyroidism. http://www.about.com