ETIOLOGY
Grave's disease
Multinodular goitre
Solitary thyroid nodule
Excess pituitary secretion ofTSH
Drugs (iodine.Amidarone)
Hydatifm mole
Choriocarcinoma
Struma ovarri
carcinoma f thyroid
Subacute thyroidits.
PATHOGENESIS
GRAVE
Thyroid stimulating Ig or TSH receptor antibodies are against TSH receptors which stimulate thyroid harmone production n goitre formation
Fibroblasts produce skin n eye changes.
HLA DR3 risk factor.
E coli.. Y enterocolitica possess cell memb. TSH receptors so cross reaction..
RX InDUCD
Iodide induced.exposure to radiograpic contrast.
Jod basedow pheno endmic goitre who treated c- iodine.
CLINICAL FEATURES
SYMPTOMS SIGNS
GENERAL
Weight loss wt loss
incrd appetite goitre bruit
Heat intolerance
Fatigue .apathy
GASTRO INTESTINAL
Diarrhmea.
Steatorrhoea
Hyperdefecation
Anorexia
vomitng
CARDIORESPIRATORY
palpitations sinus tachycd
Ankle swellng atril fibrilation
Angina sys htn
Dyspnoea cardiac failure
Excrbn f asthma
HAEMATOLOGICAL
NEUROMUSCULAR
Anxiety.irritability tremor
emotional lability. hyperreflexia
musc weaknes bulbar myopty
DERMATOLOGICAL
Sweating palmer erxthema
pruritus pretibial myxdma
alopecia clubbng
0 vitiligo
spider naevi
OCULAR
Grittiness.red lid retraction
eyes lid lag
exc lacrymn chemosis
exopthalmos
periorbital oedema
corneal ulcrn
opthalmoplegia.papplodm
INVESTIGATIONS
1)TSH levels r very low
2)serum T3 T4 elevated
T3 thyrotoxicosis T3 icrd.
3)I 131 uptk incrd
4)elvtd antibds thy peroxidse
5)measure TRAb in Grave
MANAGEMENT
a)Antithyroid drugs
Metiimizole , carbimazole , thiouracil prvnt org bindng f iod
to tyrosine.
Prophylthyo als inhbt cönv T4 to T3
Carbimazole 15mg thrice daily for 3weeks . 10mg thrice daily for 4 8 wks.maint dos 5to 20mg
daily. Total duration 18to 24 months
Propranolol 40to 80mg 6hrly.
b)SURGICAL RX
SUBTOTAL THYROIDECTOMY
choice if
too young
drugs failed
sensitivity to drug
c)RADIOACTIVE I
in patints over 40
young strlisd
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