Pathogenesis (development of disease)
The cause of hyperthyroidism is mostly Graves’ disease. As a result, too much T3 and T4 and too little TSH is found in the blood due to the formation of TSH receptor autoantibodies. In addition to Graves’ disease, thyroid autonomy (independent thyroid hormone production) due to iodine deficiency can also lead to hyperthyroidism. Another cause is iodine-induced hyperthyroidism.
Etiology (causes)
Biographic causes
- Genetic burden – gene mutations such as.
- Graves’ disease (immune hyperthyroidism; autoimmune disease of the thyroid gland).
- McCune-Albright syndrome (MAS) – belongs to the neurocutaneous syndromes; clinical triad: fibrous bone dysplasia (FD), café-au-lait spots (CALF) of the skin (light brown, uniform skin patches of varying size), and pubertas praecox (PP; premature onset of puberty); later endocrinopathies with hyperfunction appearing, e.g. For example, hyperthyroidism (hyperthyroidism) and increased secretion of growth hormone, Cushing’s syndrome and renal phosphate loss.
- Hormonal factors – hormone resistance: the body does not respond to thyroid hormones T3 (triiodothyronine) and T4 (thyroxine).
Behavioral causes
- Consumption of stimulants
- Tobacco (smoking)
- Psycho-social situation
- Stress
Disease-related causes
Endocrine, nutritional and metabolic diseases (E00-E90).
- Autoimmune thyroiditis (Hashimoto’s thyroiditis) – autoimmune disease of the thyroid gland; initially with increased secretion of thyroid hormones, later with gradual transition to hypothyroidism (hypothyroidism).
- Hyperthyroidism with decreased or absent uptake in the thyroid scintigram.
- Hyperthyroidism factitia – overdose of thyroid hormones.
- Marine-Lenhart syndrome – simultaneous occurrence of nodular goiter with or without autonomy and immunogenic hyperthyroidism (Graves’ disease) denoted.
- Post-partum thyroiditis – thyroiditis after childbirth.
- Postradiogenic hyperthyroidism (hyperthyroidism after radiation therapy.
- Pregnancy hyperthyroidism / gestational hyperthyroidism.
- Goiter with hyperthyroidism (hyperthyroidism):
- Initial stage of thyroiditis (with transient hyperthyroid phase).
- Autonomous (independent) thyroid adenoma / thyroid autonomy (unifocal, multifocal, disseminated, unifocal with disseminated portions).
- Graves’ disease (immune hyperthyroidism; autoimmune disease of the thyroid gland).
- Thyroiditis de Quervain (subacute granulomatous thyroiditis) – relatively rare form of thyroiditis, which often occurs after a respiratory infection; circa five percent of all thyroiditis.
Cardiovascular system (I00-I99).
- Elephantiasis – massive doughy swellings of body parts (e.g., legs) due to chronic congestion of lymphatic fluid.
Infectious and parasitic diseases (A00-B99).
- Elephantiasis – massive doughy swellings of body parts (e.g., legs) due to chronic congestion of lymphatic fluid.
Neoplasms – tumor diseases (C00-D48).
- Pheochromocytoma – tumor of the adrenal medulla that produces catecholamines (norepinephrine, epinephrine, and metanephrines).
- TSHoma of the pituitary gland (TSH-producing hypophsenadenoma).
- Struma ovarii (= teratoma of the ovary/ovary with thyroid tissue) (detection on iodine scintigram).
Psyche – nervous system (F00-F99; G00-G99)
- Depression
- Mania
- Panic attacks
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).
- Cachexia (emaciation).
- Autoimmune thyroiditis (AIT) – autoimmune disease of the thyroid gland; initially with transient hyperthyroid phases (increased secretion of thyroid hormones: hyperthyroidism), later with gradual transition to hypothyroidism (hypothyroidism).
- Graves’ disease (immune hyperthyroidism) – autoimmune disease of the thyroid gland.
- Brain tumors
- Thyroid cancer
- Struma multinodosa – enlarged thyroid gland with nodular tissue.
- Goiter with focal or diffuse autonomy/thyroid autonomy (independent thyroid hormone production).
- Thyroitides with transient hyperthyroid phases.
- Toxic nodular goiter
- Thyrotoxic crisis (trigger is, for example, a jodexposition in thyroid autonomy).
Medication
- Amiodarone (iodine-containing antiarrhythmic drug; antiarrhythmic agent) – in 40% of cases, therapy-resistant thyroid dysfunction (thyroid dysfunction) occurs during amiodarone therapy; this is caused by the high iodine content or immune-related cytotoxic effects. Two types of amiodarone-induced hyperthyroidism (AIH) are distinguished:
- AIH type I (thyrotoxicosis induced by jodexcess (crisis-like exacerbation of hyperthyroidism) in preexisting thyroid disease).
- AIH type II (amiodarone-triggered inflammatory-destructive effect on the thyroid gland with increased thyroid hormone release).
- Interferon-α
- Interleukin-2, tyrosine kinase inhibitor
- Lithium
- Iodine-containing contrast mediaNote: Contraindicated in manifest hyperthyroidism (absolute avoidance); in latent (subclinical) hyperthyroidism, use of iodine-containing contrast media only under thyrostatic protection (perchlorate and thiamazole shortly before the examination and 2 weeks afterwards, so that iodine uptake by the thyroid gland is no longer possible).
- Iodine excess (50-60% of hyperthyroidism in old age is iodine-induced).
Other causes
- Pregnancy (→ pregnancy hyperthyroidism (HCG-induced hyperthyroidism); DD: immunogenic hyperthyroidism, autonomous adenoma with manifest hyperthyroidism).
