EXOPTHALMIC GOITRE

EXOPTHALMIC GOITRE:

Introduction:

·         It is also known as Grave’s disease or toxic diffuse goitre or endocrine disorder i.e. the most common cause of hyperthyroidism and thyrotoxicosis (effects of excess thyroid hormone action in tissues).

·         Grave’s disease results in an abnormal over activity of the thyroid gland. The thyroid gland is stimulated to produce too much thyroid hormone. Increased too much thyroid hormone production leads to stimulation or quickening of the body’s metabolism.

·         It is a form of hyperthyroidism characterized by enlargement of the thyroid gland, protrusion of the eyeballs, increased basal metabolic rate (BMR) and weight loss.

·         Graves disease may also lead to serious, potentially life threatening complications.

·         Over-activity of the thyroid gland associated with protrusion of the eyes, retraction of the upper lids and weakness of the eye movements. The hyperthyroidism causes excitability, a fast pulse rate, sweating and loss of weight.

·         Exopthalmic may be severe as to threaten sight and the pressure in the eye sockets may have to be relieved surgically.

·         They are found in aortic insufficiency, in chronic nephritis, in diffuse type of arteriosclerosis and in some cases of exopthalmic goitre.

·         A disease of unknown cause characterized by enlargement of the thyroid gland. The thyroid gland may be slighty enlarged its normal size several times. The increased thyroid hormone production results in the symptoms and signs of hyperthyroidism. Some patients also experience exopthalmus (protrusion of the eyes) with eyelid retraction, edema of tissues surrounding the eyes, double vision and occasionally loss of vision, all of which are symptoms known as Graves’s opthalmopathy.

·         Grave’s disease is an autoimmune disease, when the body reacts to its own tissues as though they were foreign substance. Patients with Grave’s disease produce antibodies that act on the thyroid to increase thyroid hormone production and thyroid size. These closely related antibodies may cause Grave’s opthalmopathy.

·         Grave’s disease occurs in women 4-6 times as often as in men, it most often affects young to middle aged adults but can occur at all ages. The underlying case of Grave’s disease is not known, but there is genetic susceptibility to the disease and smoking is a risk factor, especially for the Grave’s opthalmopathy.

·         Another characteristic of the disease is spontaneous remission of hyperthyroidism which occurs in 30-40% of the patients.

·         Hyperthyroidism is treated with antithyroid drug, radioactive iodine or rarely surgical removal of the thyroid.

·         Grave’s opthalmopathy occurs in approximately 25% of patients with Grave’s disease. It usually occurs as the patients are developing hyperthyroidism, but it can occur after hyperthyroidism.

·         There is no simple, effective treatment for eye disease and it may persist for years. Patients with severe inflammation of the tissues that surround the eye or with impairment of vision. It may be treated with a glucocorticoid or surgical decompression of the orbits.

·         Approximately 2% of the patients with Grave’s disease have localized myxedema. This is characterized by painless lumps composed of edematous subcutaneous tissue and thickening of the overlying skin in the lower legs or rarely the arms or trunk. Nearly all patients with localized myxedema had hyperthyroidism in the past and have severe opthalmopathy. The only effective treatment is application of glucocorticoid to the affected areas of skin.

·         It is quite generally agreed; although with some dissatisfaction that thyroid gland is responsible, when abnormally active for the symptoms that characterize exopthalmic goitre.

           

Causes:

Exopthalmic goitre is caused due to excessive secretion of thyroxine. Hyperthyroidism means the thyroid gland is overactive. A common cause is Grave’s disease in which the immune system produces antibody that act like TSH and stimulate the thyroid gland uncontrollably. The gland responds by producing an excessive amount of hormones. Grave’s disease can occur when the thyroid gland is attached by the body’s own immune system and causes it to become overactive and produce too much thyroid hormone.

Symptoms:

Disease is characterized by following symptoms:

·         Anxiety and irritability

·         Insomnia or difficulty in breathing

·         Goitre

·         Nervousness

·         Tremor

·         Diarrhoea

·         Vomiting

·         Protrusion of the eyes or bulging of eyes

·         Retraction of the upper lids and weakness of the eye movements

·         Fast pulse rate

·         Sweating

·         Loss of weight

·         Enlargement of the thyroid gland

·         Increased BMR (Basal Metabolic Rate).

·         Excessive perspiration or shortness of breath and difficulty in breathing

·         Irregular menstrual periods in women

·         Increased stool frequency (with or without diarrhoea)

·         Heat tolerance

          

Diagnosis:

·         Diagnosis of exopthalmic goitre begins with taking through medical history including symptoms and completing a physical examination.

·         A physician or health care provider observe a longer than normal thyroid gland in the neck.

·         Blood tests are performed to determine levels of thyroid stimulating hormone (TSH) and the thyroid hormone thyroxine; it indicates that a thyroid gland is overactive.

·         A nuclear scan of the thyroid gland may also be done to visualize the thyroid gland and determine how it is affected by Grave’s disease.

·          Other tests may be performed to check the potential complications of Grave’s disease, such as heart disease.

·         A chest X-rays may be done to evaluate the size of the heart and to check for fluid accumulation in the lungs that can occur with heart failure.

·         An EKG may be done to diagnose abnormal heart rhythms.

·         It is possible that a diagnosis of Grave’s disease can be misused or delayed because the symptoms can be associated with other conditions such as excessive caffeine use, enigma, aging or stress.

 

Treatment:

Prompt diagnosis and treatment of Grave’s disease can results in good prognosis and even a cure in some cases. With regular medical care and monitoring of Grave’s disease many people live active and normal life spans. Some of the treatments of Grave’s disease are discussed as follows:

·         Bed rest

·         Medications

·         Surgery

·         Radium and X- rays helped bad cases, improving them clinically reducing the BMR.

·         Ligation is of immense value in putting a patient into a condition where a thyroidectomy may be safely done.

          

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