(EXOPTHALAMIC GOITER / THYROTOXICOSIS) #HYPERTHYROIDISM
- Hyperthyroidism is hyper-reactivity of the thyroid gland which sustained increase in synthesis and release of thyroid hormones.
- Hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormone (T3 & T4) which lead the hyper-metabolic condition of thyrotoxicosis.
- Thyrotoxicosis – physiological effects or clinical syndrome of hyper-metabolism that results from excess circulating level of T3 & T4 or both.
Female>Male . most common in 20 to 40 years old.
- Hyperthyroidism can be caused by a number of conditions, including Graves’ disease, Plummer’s disease and thyroiditis.
- Graves’ disease : Graves’ disease is an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much T4. It’s the most common cause of hyperthyroidism.
- Hyper-functioning thyroid nodules (toxic adenoma, toxic multinodular goiter or Plummer’s disease) :This form of hyperthyroidism occurs when one or more adenomas of your thyroid produce too much T4. An adenoma is a part of the gland that has walled itself off from the rest of the gland, forming noncancerous (benign) lumps that may cause an enlargement of the thyroid.
- Thyroiditis : Sometimes your thyroid gland can become inflamed after pregnancy, due to an autoimmune condition or for unknown reasons. The inflammation can cause excess thyroid hormone stored in the gland to leak into your bloodstream. Some types of thyroiditis may cause pain, while others are painless.
SIGN AND SYMPTOMS
- weight loss, even when your appetite and food intake stay the same or increase
- Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute
- Irregular heartbeat (arrhythmia)
- Pounding of your heart (palpitations)
- Increased appetite
- Nervousness, anxiety and irritability
- Tremor — usually a fine trembling in your hands and fingers
- Changes in menstrual patterns
- Increased sensitivity to heat
- Changes in bowel patterns, especially more frequent bowel movements
- An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
- Fatigue, muscle weakness
- Difficulty sleeping
- Skin thinning
- A family history, particularly of Graves’ disease
- Female sex
- A personal history of certain chronic illnesses, such as type 1 diabetes, pernicious anemia and primary adrenal insufficiency
- Heart problems : Some of the most serious complications of hyperthyroidism involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation that increases your risk of stroke, and congestive heart failure — a condition in which your heart can’t circulate enough blood to meet your body’s needs.
- Brittle bones : Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body’s ability to incorporate calcium into your bones.
- Eye problems : People with Graves’ ophthalmopathy develop eye problems, including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Untreated, severe eye problems can lead to vision loss.
- Red, swollen skin : In rare cases, people with Graves’ disease develop Graves’ dermopathy. This affects the skin, causing redness and swelling, often on the shins and feet.
- Thyrotoxic crisis : Hyperthyroidism also places you at risk of thyrotoxic crisis — a sudden intensification of your symptoms, leading to a fever, a rapid pulse and even delirium. If this occurs, seek immediate medical care.
DIAGNOSIS AND INVESTIGATION
BLOOD TEST :
- Blood tests that measure thyroxine and thyroid-stimulating hormone (TSH) can confirm the diagnosis.
- High levels of thyroxine and low or nonexistent amounts of TSH indicate an overactive thyroid.
- The amount of TSH is important because it’s the hormone that signals your thyroid gland to produce more thyroxine.
- Thyroid blood tests may give false results if you’re taking biotin — a B vitamin supplement that may also be found in multivitamins. To ensure an accurate test, stop taking biotin at least 12 hours before blood is taken.
RADIO IODINE UPTAKE SCAN –
- For this test, you take a small, oral dose of radioactive iodine (radioiodine) to see how much will collect in your thyroid gland. You’ll be checked after four, six or 24 hours — and sometimes after all three time periods — to see how much iodine your thyroid has absorbed.
- A high uptake of radioiodine indicates your thyroid gland is producing too much thyroxine.
- This test uses high-frequency sound waves to produce images of the thyroid. Ultrasound may be better at detecting thyroid nodules than other tests, and there’s no exposure to any radiation.
Cystic swelling ; painless swelling of glands ; granular vegetation ; polypi ; nutrition faulty with tendency to glandular enlargements.
painful glandular swelling and induration of scrofulous subjects ;
dwarfish children ; encysted tumor on scalp.
Goiter, the size of hen’s egg; blonde , lively temperament, blue eyes and fair skin ; swelling and induration of glands, chiefly without suppuration.
Hard goiter sensation of constriction in tumor, and in highest potencies in fresh soft goiter; swelling and induration of cervical glands ; plastic exudation ; patient with dark and hair and eyes , emaciation , sweating even while talking from weakness .
Nodulated goiter ; glands of right side of neck swollen ; jerking ; shooting and lancinating pain ,< damp weather at night.
Large and hard struma stinging and shooting pressure , thyroid gland swollen even with the chin , at night suffocating spells , with stringing in throat and soreness in abdomen swelling and induration of glands.