Hyperthyroidism - it is a pathological state of an organism that develops with an excess of the body of tiregormones, often accompanied by an increased metabolism of substances in the body. The most common causes of hyperthyroidism are: diffuse or diffuse nodular toxic goiter, thyrotropin-producing pituitary adenoma, toxic adenoma of the thyroid gland, autoimmune thyroiditis (Hashimoto's disease).
Basic clinical manifestations of arthropathy with hyperthyroidism
When thyrotoxicosis in bone tissue is mainly dominated by the processes of resorption (resorption) of bone tissue, reducing its density. The speed of this process directly depends on the level of the content of tiregormones in the blood. Simultaneously with the processes of bone resorption in thyrotoxicosis, there is a decrease in intake of calcium in the intestine and a violation of the metabolism of vitamin D in the body. All this leads to the development of osteoporosis - reducing the density of bone tissue and increasing the bone fragility.
Osteoporosis with hyperthyroidism is diffuse in nature and is accompanied by symptoms of varying degrees of severity. It can also be bone pain, and pathological fractures, which may occur even without obvious traumatic damage, and kyphotic deformity of the spine. Especially high risk of hip fractures in patients with thyrotoxicosis in the elderly - it is increased by almost 2.5 times. If it is timely and adequately to make correction of the hormonal background in such patients, then the phenomena of osteoporosis pass independently, even without treatment.
With hyperthyroidism, arthropathy with thickening of nail phalanges and a periosteal reaction may occur - the so-called tireogene acropathy (Marie-Bamberger syndrome, or hypertrophic osteoarthropathy), in which deformation of nail phalanges in the form of drum sticks, and nails - in the form of clock cliffs. This is usually accompanied by muscle weakness and muscle pain (myalgia). One of the most common manifestations of bone and articular defeat in hyperthyroidism is affliction of the shoulder and penile periarthrosis (adhesive capsule, shoulder and brush syndrome), observed in 17.5% of patients, and carpal tunnel syndrome.
Hyperthyroidism may be accompanied by an increase in the amount of the thyroid gland (struma is formed), abnormalities in the work of the heart (tachycardia, heart rhythm disturbance) and central nervous system (with thyrotoxicosis), increased fatigue, emotional instability, vegetative disorders (hyperhidrosis, tremor of arms, etc.) With pronounced hyperthyroidism, bilateral symmetrical exophthalmos may be observed (fecundity).
Diagnosis of arthropathy with hyperthyroidism
- Determination of serum in high levels of triiodothyronine and thyroxine, thyroid stimulating hormone (with thyrotropin produces pituitary tumors).
- Ultrasound examination of the thyroid gland (or MRI).
- Radioisotope scan.
- Thyroid biopsy under the control of an ultrasound.
- In peripheral blood (with autoimmune thyroiditis) there may be an acceleration of ESR and a positive Boyd reaction.
- X-ray, computed tomography or MRI of the skull and Turkish saddle are objective (for the detection of pituitary adenoma), as well as advanced neuro-ophthalmological examination.
- Ultrasonic or X-ray densitometry (to determine the severity of osteoporosis).
- Ultrasound of the shoulder joint, radial and other joints (for the detection of shoulder-capillary periarthrosis, carpal tunnel syndrome, etc.).
Treatment of arthropathy with hyperthyroidism
Treatment of the underlying disease leads to a decrease in the phenomena of arthropathy and to the reduction of the phenomena of osteoporosis. But at the same time it is necessary strictly differentiated treatment after conducting of the proper examination and detection of the cause of the disease:
- In cerebellum, thyroid medications (tyrosine, Mercazolil and other drugs) or radioactive iodine are prescribed.
- When autoimmune thyroiditis is prescribed corticosteroids or immunosuppressors.
- Thyrotoxicosis and/or diffuse nodular goiter, tumors of the thyroid gland are treated operatively (currentectomy), pituitary tumors - radiation therapy and other specific types of treatment.
- Pain in arthropathy is treated symptomatically, with osteoporosis - treatment of bifosfonates, calcium preparations with vitamin D and other drugs.