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

Ans.          Clinical Features : Symptoms

  1. Unpleasant feeling of warmth-preference of cold, less clothing than average required during day, increased sweating, skin always moist.
  2. Loss of weight.
  • Cardiac-palpitation ; Pounding heart action ; dyspnoea and angina on slight exertion : occasionally orthopnoea ; other symptoms of congestive cardiac failure.
  1. Fatigability – occasionally specific weakness of certain muscles, e.g. leg muscles.
  2. G.I. Symptoms-Polyphagia and polydipsia ; may be diarrhoea.
  3. 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.
  1. Abdominal pain occasionally simulating acute abdomen.
  2. Nervousness-episodes of extreme excitability ; irritability ; emotional instability ; outbursts of temper, alternating with weeping, esp. in females.
  3. Tremor – very apparent when holding a glass or cup of liquid ; frequently an internal tremulous sensation.

Signs –

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

Investigations :

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

Complications :

  1. Heart failure,
  2. Thyrotoxic myxoedema,
  3. Thyroid crisis or storm,
  4. Thyrotoxic bulbar palsy,
  5. Secondary infection e.g. pulmonary tuberculosis,
  6. Myopathy,
  7. Myasthenia,
  8. Thyroid achropatchy,
  9. Exophthalmic ophthaloplegia,
  10. Thyroid diabetes.
  11. Pressure effect – Dysphagia, hoarseness of voice,
  12. Auricular fibrillation or flutter,

Cardinal Signs:

  1. Goitre-present.
  2. Sleeping pulse rate-high.
  3. Tremor-present.
  4. Exophthalmos-present.

Differential Diagnosis:

  1. Anxiety state, where the sleeping pulse rate is not high,
  2. Progressive atrophy of muscles,
  3. Glycosuria or diabetes mellitus, where the blood sugar is higher,
  4. 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 :

  1. Potassium chloride 1 to 3 g. daily,
  2. Above 45 year- Radioactive iodine,
  3. Failure after adequate surgery- (a) radioactive iodine, (b) anti-thyroid drugs,
  4. High caloric diet-4000 to 5000 cals. Daily,
  5. Supplements of Calcium, phosphorus and vitamin D,
  6. 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,
  7. Failure after anti-thyroid drugs or radioactive iodine-surgery,
  8. Sedatives,
  9. Rest-both physical and mental,
  10. 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 -

 

Points

Primary Thyrotoxicosis

Secondary Thyrotoxicosis

(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.

Prominent.

(7)

Pressure symptoms ;

Rare.

Common.

(8)

Recurrence after throidectomy ;

Frequent.

Rare,

(9)

Response to anti thyroid drugs;

Good.

Poor.

 

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   

# Tushar 2017-04-20
Hello, plz let me know What is menarche, I want to consult with gynec in Nilgiris, plz suggest ?
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# Dr. Pooja 2017-04-21
the process of starting of the menstrual cycle in females is called menarche, plz find good Gynecologist in Nilgiris.
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# Vaibhav 2017-04-16
Hii, I am from Mainpuri, Please tell that can moisture be responsible for infections ?
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# Dr. Pooja 2017-04-17
Hello, good to see that you are from Mainpuri, yes,that is why u must keep your genital organs clean and dry because moisture can favour infections.
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# Himmat 2017-04-03
Hii, I am from Mandla, I want to know can cigerrete sharing can lead to syphilis ?
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# Dr. Pooja 2017-04-04
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 Mandla
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# Harikiran 2017-03-28
Hii, I am from Ghazipur, Please tell that can moisture be responsible for infections ?
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# Dr. Naresh 2017-03-29
Hello, good to see that you are from Ghazipur, yes,that is why u must keep your genital organs clean and dry because moisture can favour infections.
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# Vivaan 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 Khagaria?
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# 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 Khagaria .
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