Frequently Asked Questions (FAQs) on primary-thyrotoxicosis-or-graves-disease | HospitalKhoj
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PRIMARY THYROTOXICOSIS (Or Graves’ Disease)

PRIMARY THYROTOXICOSIS (Or Graves’ Disease)

Ques. 1     What is grave’s disease?

Ans.          This is a disease characterised by tachycardia, tremor, exophthalmos and increased basal metabolism due to hyperthyroidism.

It is common in women, usually in early adult life. The exact cause is unknown. The associated factors are-

  1. Psychological trauma, e.g. accident, fright, emotional shock, severe illness, chronic anxiety etc.
  2. The long acting thyroid stimulator.
  3. Genetic predisposition.
  4. Excessive secretion of thyroid stimulating hormone.
  5. Increased sensitivity of the thyroid follicles to thyroid stimulating hormone as in acute infections. e.g. tonsillitis, whooping cough, influenza etc. g. tonsillitis, measles, whooping cough etc.

Pathology :

  • Very vascular.
  • Cut surface-like raw meat.
  • Uniform enlargement of the gland with smooth surface.
  • Soft, elastic and friable-consistency.

Ques.

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2     What are the sign and symptoms of grave’s disease?

Ans.          Clinical Features : Symptoms

  • Unpleasant feeling of warmth-preference of cold, less clothing than average required during day, increased sweating, skin always moist.
  • Loss of weight.
  • Cardiac-palpitation ; Pounding heart action ; dyspnoea and angina on slight exertion : occasionally orthopnoea ; other symptoms of congestive cardiac failure.
  • Fatigability – occasionally specific weakness of certain muscles, e.g. leg muscles.
  • G.I. Symptoms-Polyphagia and polydipsia ; may be diarrhoea.
  • Goitre-Swelling in front of neck ; may be symmetrical and smooth, or uneven and lumpy.
  • Exophthalmos-progressive bulging of eyeballs, usually bilateral ; increased lacrimation common.
  • Diminished menstrual flow, both in quantity and duration.
  • Abdominal pain occasionally simulating acute abdomen.
  • Nervousness-episodes of extreme excitability ; irritability ; emotional instability ; outbursts of temper, alternating with weeping, esp. in females.
  • Tremor – very apparent when holding a glass or cup of liquid ; frequently an internal tremulous sensation.
  • Signs –

  • Thyroid symmetrically enlarged, palpable thrill and audible bruit over gland ; multiple firm or stony hard nodules ; sometimes semicystic.
  • Rapid heart rate, 100-130 p.m,
  • Fine rapid tremor, when arms are outstretched and fingers extended ; general body tremor ; exaggerated deep reflexes ; sometimes planter extensor.
  • Blood pressure-raised.
  • Tendency to low grade fever.
  • Occasional enlargement of spleen and also enlargement of thymus.
  • Patient anxious, nervous, tremulous and tense ; loss of weight often obvious sometimes emaciation ; looks ill; speech may be rapid and stuttering.
  • Skin flushed, warm, moist.
  • Investigations :

  • Full face photograph.
  • Laryngoscopy.
  • Thyroid scanning test-positive.
  • Radio-active iodine uptake test-positive.
  • Serum cholesterol-decreased.
  • E.C.G.
  • T3 resin uptake test-positive.
  • Straight X-ray of the chest and neck.
  • B.M.R. – high.
  • P.B.I.- high.
  • Complications :

  • Heart failure,
  • Thyrotoxic myxoedema,
  • Thyroid crisis or storm,
  • Thyrotoxic bulbar palsy,
  • Secondary infection e.g. pulmonary tuberculosis,
  • Myopathy,
  • Myasthenia,
  • Thyroid achropatchy,
  • Exophthalmic ophthaloplegia,
  • Thyroid diabetes.
  • Pressure effect – Dysphagia, hoarseness of voice,
  • Auricular fibrillation or flutter,
  • Cardinal Signs:

  • Goitre-present.
  • Sleeping pulse rate-high.
  • Tremor-present.
  • Exophthalmos-present.
  • Differential Diagnosis:

  • Anxiety state, where the sleeping pulse rate is not high,
  • Progressive atrophy of muscles,
  • Glycosuria or diabetes mellitus, where the blood sugar is higher,
  • Other conditions causing protrusion of the eyeball. The final diagnosis is possible only with determination of B.M.R. or by a therapeutic test with iodine.
  • Ques. 3     What is the treatment of grave’s disease?

    Ans.          Treatment :

  • Potassium chloride 1 to 3 gin females.
  • Potassium chloride 1 to 3 g. daily,
  • Above 45 year- Radioactive iodine,
  • Failure after adequate surgery- (a) radioactive iodine, (b) anti-thyroid drugs,
  • High caloric diet-4000 to 5000 cals. Daily,
  • Supplements of Calcium, phosphorus and vitamin D,
  • Below 45 years- (a) anti-thyroid drugs, viz. - Propyl thiouracil 200-600 mg. daily, Metimazole, 15-120 mg. daily, Carbimazole 15-60 mg, daily (all these drugs are to be given in three divided doses daily, (b) Surgery,
  • Failure after anti-thyroid drugs or radioactive iodine-surgery,
  • Sedatives,
  • Rest-both physical and mental,
  • Homoeopathic remedies
  • Ques. 4     Which Homoeopathic Remedies are important?

    And.          1) PHYTOLACCA- Nodulated goitre ; glands of right side of neck swollen ; jerking, shooting, lancinating pains, worse in damp weather, at night.

    2) IODUM – Hard goiter with sensation of constriction in tumour and in higher potencies in fresh soft goiter; swelling and induration of cervical glands ; patients with dark hair and eyes: emaciation ; sweating.

    3) SPONGIA- Large and hard strauma with stinging and shooting pressure, thyroid gland swollen even with chin, at night suffocating spells, with stinging in throat and soreness in abdomen ; swelling and induration of glands. Eyes protruding.

    4) CAL. CARB – Cystic swelling; painless swelling of glands; granular vegetations, polypi; nutrition faulty with a tendency to glandular enlargements.

    Ques. 5     Which Biochemic Remedies are important?

    Ans.          NATRUM MUR – Vision not clear, protrusion of eyeballs ; eyes seem misty all day, enlargement of thyroid glands, difficulty of breathing, even when keeping quiet, on standing, walking, with trembling of hands and feet, intermitting pulse, short-breathed from least exertion.

    Differential Diagnosis -

    (1)

    Onset of thyroid :

    Simultaneous with symptoms

    May appear several years.

    (2)

    Age ;

    Younger.

    Older.

    (3)

    Surface of swelling :

    Smooth and diffuse.

    Nodular

    (4)

    Exophthalmos :

    Often severe

    Absent of slight.

    (5)

    Nervous & emotional symptoms ;

    Prominent.

    Slight.

    (6)

    Cardiac symptoms :

    Mild.

    (7)

    Pressure symptoms ;

    Rare.

    Common.

    (8)

    Recurrence after throidectomy ;

    Frequent.

    Rare,

    (9)

    Response to anti thyroid drugs;

    Good.

    Poor.

    Points

    Primary Thyrotoxicosis

    Secondary Thyrotoxicosis

     

    Ques. 6     What is secondary thyrotoxicosis?

    Ans.          A disease marked by presence of one or more adenomata in the thyroid gland after followed by thyrotoxic symptoms.

    1. Thyroid crises is absent,
    2. Cardiac complications are more,
    3. Recurrence after surgery is rare,
    4. Exophthalmos is less and other eye signs are less,
    5. Tremor or other neurologicial signs are usually not prominent,
    .
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    Comments

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    Hi, plz let me know What is the incubation period of Syphilis, also give me the list of good female's specialist in Kancheepuram ?
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    0 # Dr. Pooja Older than three months
    Hii, The incubation period can be 10 to 90 days, plz find list of Gynecologist in Kancheepuram
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    0 # Vaibhav Older than three months
    Hii, plz tell me,Which tests can confirm syphilis in primary stage, also suggest name of good maternity hospitals in Karur ?
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    0 # Dr. Naresh Older than three months
    During the primary stage,DG illumination tests are very helpful, find good maternity hospitals-Amaravathi Hospital.
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    0 # Himmat Older than three months
    Hii, I am from Erode, I want to know can cigerrete sharing can lead to syphilis ?
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    0 # Dr. Naresh Older than three months
    yes,sharing cigerette,drinking cups,common spoons etc can also lead to syphilis, Generally whenever the fluid of a person who has syphilis is shared,the infection can occur, you should also consult with good Gynecologist in Erode
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    0 # Aarav Older than three months
    Hii, can you plz tell me,What changes can occur in skin in syphilis patient, also suggest good obstertrician in Chandrapur ?
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    0 # Dr. Pooja Older than three months
    Rashes can occur on the skin in the near areas,rashes can be discrete and also symmetrical in nature, Rashes can also be pustular, you can consult with Obstetrician in Chandrapur.
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    0 # Jayesh Older than three months
    Hii can you plz tell me, Which fluids can cause or spread syphilis infection, alos give me the list of good gynec in Sivasagar?
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    0 # Dr. Naresh Older than three months
    Infection from semen, blood or lactation milk can occur and cause syphilis, Infection from blood syringes is very common, Infected mothers can transmit it through their milk also, consult with good Gynecologist in Sivasagar .
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    0 # Vivaan Older than three months
    Hii, I am from Dewas, can you plz tell me What is the mode of infection in syphilis ?
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    0 # Dr. Naresh Older than three months
    90 percent cases in syphilis are transmitted through unsafe sexual contacts, Mothers can also pass infection through breast milk, you can also consult with good Gynecologist in Dewas .
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    0 # Rohan Older than three months
    Hello, I am from Nalanda, PLz suggest some biochemic remedies for gonorrhoea .
    Reply | Reply with quote | Quote
    0 # Dr. Pooja Older than three months
    Kali Mur, Natrum Mur, Natrum Sulph, and silicea are few important biochemic emedies in homoeopathy which can be used safely in this case, you can also take advise from gynecologist given here-Gynecologist in Nalanda.
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    0 # Priyansh Older than three months
    Hii, I am from Changlang, plz let me know What is gonorrhoea ?
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    0 # Dr. Naresh Older than three months
    Hello, Gonorrhoea is a sexually transmitted disease caused by the Neisseria gonorrhoea,This disease is caused in the genitourinary tracts, for more details plz visit good gynec in Changlang, find list of Gynecologist in Changlang
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    0 # Nishith Older than three months
    Hello, I am from Banmore, PLz suggest some biochemic remedies for gonorrhoea .
    Reply | Reply with quote | Quote
    0 # Dr. Pooja Older than three months
    Kali Mur, Natrum Mur, Natrum Sulph, and silicea are few important biochemic emedies in homoeopathy which can be used safely in this case, you can also take advise from gynecologist given here-Gynecologist in Banmore.
    Reply | Reply with quote | Quote
    0 # Aayush Older than three months
    Hii, can you plz tell me,What changes can occur in skin in syphilis patient, also suggest good obstertrician in Karimganj ?
    Reply | Reply with quote | Quote
    0 # Dr. Pooja Older than three months
    Rashes can occur on the skin in the near areas,rashes can be discrete and also symmetrical in nature, Rashes can also be pustular, you can consult with Obstetrician in Karimganj.
    Reply | Reply with quote | Quote
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