HYPERTHYROIDISM (GRAVE’S DISEASE)

 

INTRODUCTION: Hyperthyroidism is the second most common endocrine disorder, and Graves’ disease is the most common type. It results from an excessive output of thyroid hormones due to abnormal stimulation of the thyroid gland by circulating immunoglobulins. The disorder affects women eight times more frequently than men and peaks between the second and fourth decades of life. It may appear after an emotional shock, stress, or infection, but the exact significance of these relationships is not understood. Other common causes include thyroiditis and excessive ingestion of thyroid hormone such as from the treatment of hypothyroidism.

CLINICAL MANIFESTATIONS: Hyperthyroidism presents a characteristic group of signs and symptoms collectively known as thyrotoxicosis. 

1) Nervousness characterised by emotionally being hyperexcitable, irritability, apprehensiveness; inability to sit quietly; palpitations; rapid pulse on rest and exertion. 

 2) Poor tolerance of heat; excessive perspiration; skin that is flushed, with a characteristic salmon color, and likely to be warm, soft, and moist. 

 3) Dry skin and diffuse pruritus. 

 4) Fine tremor of the hands. 

 5) Increased appetite and dietary intake, progressive loss of weight, abnormal muscle fatigability, weakness, amenorrhea, and changes in bowel function (constipation or diarrhea). 

6) Pulse ranges between 90 and 160 beats per minute; systolic (but not diastolic) blood pressure elevation (increased pulse pressure). 

7) Atrial fibrillation; cardiac decompensation in the form of congestive HF, especially in the elderly. 

 8) Osteoporosis and fracture. 

 9) Cardiac effects may include sinus tachycardia or dysrhythmias, increased pulse pressure, and palpitations; myocardial hypertrophy and HF may occur if the hyperthyroidism is severe and untreated.

Assessment and Diagnostic Findings: Thyroid gland is enlarged; it is soft and may pulsate; a thrill may be felt and a bruit heard over thyroid arteries. Laboratory tests show a decrease in serum TSH, increased free T4, and an increase in radioactive iodine uptake.

Medical Management: Treatment is directed toward reducing thyroid hyperactivity to relieve symptoms and preventing complications. Three forms of treatment are available: 1) Radioactive iodine therapy for destructive effects on the thyroid gland. 2) Antithyroid medications. 3) Surgery with the removal of most of the thyroid gland.

RELATED;

1.  Metabolism and metabolic disorders  

2.  Addison's disease

3.  Pruritus

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