thyroid-stimulating hormone test
thyroid
[thi´roid]Thyroid crisis is a serious event that can be fatal if not brought under control. All of the body processes are accelerated to dangerously high levels. The pulse may rise to 200 beats per minute, and there is concurrent rise in the respiratory rate. The temperature control center loses control, bringing about a rapid and steady increase in body temperature. Pulmonary edema and congestive heart failure can also occur.
Treatment is aimed at correction of the hyperthyroidism, control of the symptoms, and prevention of further crisis by treating the underlying cause. Medications are employed to block synthesis of thyroid hormones, block their release, and inhibit conversion of triiodothyronine to thyroxine. plasmapheresis. plasma exchange, or hemodialysis may be necessary to remove the hormones from the circulation.
Supportive care includes administration of oxygen and measures to control hyperthermia, such as the use of ice packs or a hyperthermia blanket. Intravenous hydration is important to prevent shock. The use of glucocorticoids is associated with improved survival rates. propranolol, sympatholytics, and guanethidine are often used, as well as other medications that treat symptoms.
Diagnostic tests for thyroid disorders include radioimmunoassay for T3, T4, and thyroid-stimulating hormone (TSH), free thyroxine serum concentration, and free thyroxine index (FTI). These and other thyroid function tests can be distorted by preparations and foods containing iodine, and by oral contraceptives, phenytoin (Dilantin), and several other drugs. The thyroid scan is useful in detecting nodules and active thyroid tissue and, combined with radioactive iodine uptake, measures the ability of the thyroid gland to take in ingested iodine.
Persons who received radiation to the head and neck as children are at higher than normal risk for development of thyroid abnormalities. Of these disorders about one-third are carcinomas of the thyroid. Other problems related to radiation early in life include adenomas and other malignant and benign tumors, hypo- and hyperthyroidism, and thyroiditis. The American Thyroid Association suggests periodic laboratory testing and physical assessment of persons at high risk in order to detect these abnormalities when they are more amenable to treatment.
Secretion of thyroid hormones is regulated by the hypothalamus-pituitary-thyroid control system. Internal environmental conditions, such as low thyroid hormone and norepinephrine serum levels, or external factors, such as cold and stress, activate the hypothalamus, which secretes thyrotropin-releasing hormone (TRH). This hormone acts on the pituitary gland and brings about the release of thyroid-stimulating hormone (TSH). The TSH then stimulates the release of thyroid hormones such as T3 and T4 from the thyroid gland. When sufficient levels of serum thyroxine and other thyroid hormones have been reached, there is negative feedback to the hypothalamus and TRH is no longer secreted. See also hypothyroidism and hyperthyroidism.