Thyroid Graves 2

________

Blood Vascular          Enlarge lymphnodes-Thymus

System                  Enlarged-Increased serum IgG

                        Lymphocytic infiltrations of

                        thyroid

Eye                     Infiltration ophthalmopathy

Skin                    Pretibial Myxoedema-Vitiligo

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Fig 31.9a & b

Diagnosis is based on a good clinical examination and establishing the existence of high levels of thyroid hormone by measuring T4 and T3. Non-suppressible high uptake of I131 by the thyroid is also of use.

      Some of the manifestations are also due to the disturbance in the immune mechanism and are classified in Table 31.2

Table 31.2

Signs and Symptoms

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*  Cardiovascular                   *  Reproductive System

   - Dyspnea on Exertion              - Scanty menses

   - Palpitation

   - Rapid pulse > 90

   - Ventricular fibrillation      * Skin

                                    * Loss of curl of hair

                                    * Increased perspiration

                                    * Increased pigmentation

                                    * Warm skin

*  CNS

   - Nervousness                   * Thyroid

   - Irritability                  * Smooth generalized firm

   - Insomnia                         enlargement

                                    * Vascular thrill

                                    * Bruit

* GIT

   - Increased appetite

   - Increased frequency stool

* Neuromuscular

   - Tremors(Hands)

   - Musle wasting

   - Hyperactive reflex

   - Eye(lid lag-increased Palpebral fissure)

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12.3 Treatment

      Surgery is the method recommended for moderate and severe toxicity in those above forty years of age, especially those patients with large goitres producing pressure distortion of trachea (Dysphagia).

      Before thyroidectomy, the patient is rendered euthyroid by the use of Neomercazole (30-40 mg OD) for 4-8 weeks.

      Propranolol 10-40 mg QID can also be used to control symptoms quickly.

      Lugol’s iodine is also required to reduce the vascularity of the the thyroid gland.

      Radio iodine can be used to ablate the gland in all other cases

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