Long Term Management
Patients who have not had thyroid disease previously must be examined on a regular basis in case they develop thyroid disease. Patients with eye disease who have had their hyperthyroidism treated previously should also be examined at regular intervals to make certain that thyroid function remains normal since recurrence of hyperthyroidism, or development of hypothyroidism, may cause the eye disease to flare up. In some cases, cosmetic surgery for the eye or surgery to correct the double vision is performed. The patient is hyperthyroid at first and may have the same symptoms as patients with Graves’ hyperthyroidism, but then goes through a hypothyroid phase before full recovery. The presence of thyroid antibodies, similar to those seen in Hashimoto’s thyroiditis, is a risk factor for the persistence of hypothyroidism.
In addition to the mentioned side effects several others have been reported. In both males and females acne are frequently reported, as well as hypertrophy of sebaceous glands, increased tallow excretion, hair loss, and alopecia. There is some evidence that anabolic steroid abuse may affect the immune system, leading to a decreased effectiveness of the defense system. Steroid use decreases the glucose tolerance, while there is an increase in insulin resistance. These changes mimic Type II diabetes. These changes seem to be reversible after abstention from the drugs.
Both versions are then enveloped in a relatively large glycoprotein complex called thyroglobulin and stored in the thyroid gland. To be released into the bloodstream for circulation throughout the body, the hormones are separated from thyroglobulin and bound to a much smaller globulin thyroxin-binding globulin or albumin. However, only % of thyroid hormone is "free" to be biologically active. Thyroid's action in the cell is to increase the biosynthesis of enzymes, resulting in heat production, oxygen consumption, and elevated metabolic rate. Thyroid stimulates the oxidation of fatty acids, and reduces cholesterol by oxidizing it into bile acids. Thyroid also stimulates enzymes for protein synthesis and, when present in excessive amounts, can catabolize (destroy) muscle protein. Estrogen causes food calories to be stored as fat. Thyroid hormone causes fat calories to be turned into usable energy. Thyroid hormone and estrogen have opposing actions. Estrogen inhibits thyroid action in the cells, interfering with the binding of thyroid to its receptor. Both hormones have phenol rings at a corner of their molecule. The respiratory enzymes of cells are thyroid-dependent. When thyroid function is low, cellular oxygen is low (cellular hypoxia). Thus, estrogen-induced thyroid interference contributes to less-than-optimal brain function. Excess estrogen may compete with thyroid hormone at the site of its receptor. In so doing, the thyroid hormone may never complete its mission, creating hypothyroid symptoms despite normal serum levels of thyroid hormone. Progesterone, on the other hand, increases the sensitivity of estrogen receptors for estrogen and yet, at the proper level, inhibits many of estrogen's side effects. GABA (gamma-aminobutyric acid) is an amino acid that acts as a neurotransmitter-inhibitor and tends to have a calming effect. When estrogen interferes with thyroid production and slows the metabolism of brain cells, it indirectly decreases GABA production and increases brain cell excitability, a factor in epilepsy.