diffuse toxic goiter скачать в хорошем качестве

diffuse toxic goiter

(Graves' disease) An autoimmune condition characterized by a diffusely hyperplastic thyroid gland with excessive overproduction of thyroid hormone. The body produces antibodies that are specific to a self-protein, the receptor for thyroid-stimulating hormone (TSHr). Antibodies to thyroglobulin and to the thyroid hormones T3 and T4 may also be produced. They cause hyperthyroidism because they bind to the TSHr and chronically stimulate it, resulting in an abnormally high production of T3 and T4. Therefore, the clinical symptoms of hyperthyroidism and goiter can be seen. (Symptoms) • hyperthyroidism • Graves' ophthalmopathy • goiter • pretibial myxedema • thyroid dermopathy • acropachy (Possible causes) • genetic: E.g. more prone to develop TSHr. • environmental factors: E.g. exposure to severe stressors, high levels of subsequent distress (e.g. PTSD). • viral or bacterial infection: It may trigger antibodies which cross-react with the human TSH receptor (antigenic mimicry). (Diagnosis) Physical exam: • Constitutional symptoms (e.g. weight loss) • Neck swelling, proptosis, lid lag, periorbital edema • Tachycardia, arrhythmia, systolic hypertension. • Tremor of extremities, hyperreflexia, hyperactivity, muscle weakness. • Tachypnea. • Moist, warm skin, pretibial myxedema. Blood tests: • Usually low or normal TSH levels with elevated serum thyroid hormone (T3, T4) levels. • Positive TSHr antibodies (TRAb). Imaging test: • An elevated radioactive iodine uptake diffusely, detected by gamma probe or in scintigraphy. (Treatment) • antithyroid drugs: Reduce the production of thyroid hormone. E.g. carbimazole, methimazole, propylthiouracil. • radioiodine: Radioactive iodine I-131. • thyroidectomy: Surgical excision of the gland. As operating on a hyperthyroid patient is dangerous, therefore, preoperative treatment with antithyroid drugs is given to render the patient euthyroid.