Graves disease - hyperthyroidism. causes. symptoms. diagnosis and treatment , Lectures by Dr Alamzeb

Medical education is the process of training and developing future physicians and other health professionals. Graves disease - hyperthyroidism. Graves disease is the most common cause of hyperthyroidism. It is due to an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone. Graves disease is most common in women over age 20. But the disorder can occur at any age and can affect men as well. Graves' Disease is a type of hyperthyroidism that is due to the production of autoantibodies against the TSH receptor on the follicular epithelial cells. These antibodies mimic the effects of TSH and cause overproduction and release of thyroid hormone. These substances are immunoglobulin antibodies that bind with the same membrane receptors that bind TSH. pathology of Hyperthyroidism In most patients with hyperthyroidism, the thyroid gland is increased 2-3 times normal size, with tremendous hyperplasia and infoldings of the follicular cell lining into the follicles, so that the number of cells is increased greatly. Effects of TSI on Hormone Secretion Increased activity of the iodide pump, which increases the rate of "iodide trapping" in the glandular cells, sometimes increasing the ratio of intracellular to extracellular iodide concentration to as much as eight times of normal. Increased iodination of tyrosine to form the thyroid hormones Increased size and increased secretory activity of the thyroid cells Increased number of thyroid cells plus a change from cuboidal to columnar cells and much infolding of the thyroid epithelium into the follicles The most important effect of TSI is to initiate proteolysis of the thyroglobulin, which causes release of thyroxine and triiodothyronine into the blood. Exophthalmos/ Signs of Graves' Disease. Protrusion of the eyeballs is called exophthalmos. Exophthalmos occurs in about one third of hyperthyroid patients, and the condition sometimes becomes so severe that the eyeball protrusion stretches the optic nerve enough to damage vision. Eyes are damaged because the eyelids do not close completely when the person blinks or is asleep. As a result, the epithelial surfaces of the eyes become dry and irritated and often infected, resulting in ulceration of the cornea. Graves' dermopathy Rarely, people who have Graves' disease develop a reddish thickening of the skin that resembles the texture of an orange peel (Graves' dermopathy). This results from a buildup of protein in the skin. It often occurs on the shins and on the tops of the feet. Symptoms of Hyperthyroidism The Symptoms Of Hyperthyroidism Are A High State Of Excitability, Intolerance To Heat, Increased Sweating, Mild To Extreme Weight Loss (Sometimes As Much As 100 Pounds), Varying Degrees Of Diarrhea, Muscle Weakness, Nervousness Or Other Psychic Disorders, Extreme Fatigue But Inability To Sleep, And Tremor Of The Hands. post Menopause like symptoms Diagnosis of Hyperthyroidism Hyperthyroidism is diagnosed with a medical history, physical exam and blood tests. Blood tests. Blood tests that measure the hormones T-4 and T-3 and thyroid-stimulating hormone (TSH) can confirm a diagnosis of hyperthyroidism. A high level of T-4 and a low level of TSH is common in people with hyperthyroidism. Blood tests are particularly important for older adults because they may not have classic symptoms of hyperthyroidism. Antithyroid drugs methimazole (Tapazole) or propylthiouracil (PTU): These drugs block the ability of thyroid to make hormones. They offer rapid control of thyroid. Methimazole Uses: It is used in the treatment of hyperthyroidism in patients with Graves’ disease or a toxic multinodular goiter (surgery or radioactive iodine therapy is not appropriate) In preparation for thyroidectomy or radioactive iodine therapy, it can be used to ameliorate the hyperthyroid symptoms. Carbimazole (Neomercazole) is not available in the US. However, in most countries including Pakistan, Carbimazole is commonly used (where Methimazole is not available). Methimazole and Carbimazole are not equivalent on a mg: mg basis. 0.6 mg of Methimazole is equivalent to 1.0 mg of Carbimazole Physiology of Treatment in Hyperthyroidism The most direct treatment for hyperthyroidism is surgical removal of most of the thyroid gland. In general, it is desirable to prepare the patient for surgical removal of the gland before the operation. This is done by administering propylthiouracil, usually for several weeks, until the basal metabolic rate of the patient has returned to normal. Then, administration of high concentrations of iodides for 1 to 2 weeks immediately before operation causes the gland itself to recede in size and its blood supply to diminish. #Graves disease - hyperthyroidism. causes. symptoms. diagnosis and treatment#