Here are two closely related disorders of the endocrine system that are more common in women but also can occur in men:
• Hyperthyroidism. This condition occurs when an overactive thyroid gland produces excessive amounts of thyroid hormone, increasing your metabolic rate and your heart rate. Graves' disease (see below) is the most common cause of hyperthyroidism. Early symptoms develop gradually and usually include irritability, anxiety, mood swings, dry skin, weight loss, increased appetite, and increased sweating. In more advanced cases, symptoms can include an enlarged thyroid gland (called a goiter), muscle wasting, tremor, abnormal heart rate and rhythm, and bulging eyeballs. A goiter is visible as a swelling on the neck. A large goiter may press on the esophagus or the trachea, making it difficult or painful to swallow or breathe. Doctors diagnose hyperthyroidism based on the symptoms, a physical examination, and blood levels of thyroid hormone and thyroid-stimulating hormone. Doctors often prescribe beta-blockers (see page 225) to relieve symptoms such as a rapid heart rate. Antithyroid medications (such as methimazole and propylthiouracil) that reduce production of thyroid hormones also are prescribed. If treatment with medication is ineffective, you may be treated with a single dose of radioactive iodine (in liquid or pill form), which collects in the thyroid gland, even-
tually destroying some thyroid tissue and inhibiting production of thyroid hor- 375
mones. Some people may require additional radioactive iodine treatments. (In Endocrine some cases, a doctor may treat a person with radioactive iodine before pre- system scribing medication.) If a goiter is particularly unsightly or if it is causing problems with swallowing or breathing, a doctor may recommend surgery to remove the enlarged portion of the thyroid gland.
• Graves' disease. Also called diffuse toxic goiter, Graves' disease is an autoimmune disease (a disturbance in the body's immune system) in which the body produces antibodies that attack the cells of the thyroid gland. Because these antibodies imitate thyroid-stimulating hormone, they cause the thyroid gland to produce excessive amounts of thyroid hormone, resulting in a condition known as hyperthyroidism (see above). Graves' disease tends to run in families. Symptoms, diagnosis, and treatment are the same as for hyperthyroidism.
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