scholarly journals HIPERTIROIDISMEE GRAVES DISEASE:CASE REPORT

2020 ◽  
Vol 6 (1) ◽  
pp. 30-35
Author(s):  
Putri Rahayu Srikandi
Keyword(s):  
Case Report ◽  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Physical Examination ◽  
Clinical Condition ◽  
Laboratory Tests ◽  
Clinical Manifestations ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Hormone Levels

AbstractAbstrak:Hipertiroid adalah kondisi klinis yang disebabkan peningkatan sintesis dan sekresi hormone oleh kelenjar tiroid, sedangkan tirotoksikosis mengacu pada manifestasi klinis.  Penyakit graves merupakan penyebab hipertiroid yang paling sering ditemukan sekitar 60-80% dari semua kasus tirotoksikosis di seluruh dunia. Pada laporan kasus ini akan dibahas pasien Ny. NMS berusia 56 tahun datang dengan keluhan dada berdebar-debar yang dirasakan sejak 3 minggu yang lalu dan pada pemeriksaan fisik didapatkan adanya pembesaran kelenjar tiroid dan indeks Wayne pada kasus ini didapatkan  21. Pada pemeriksaan laboratorium didapatkan kadar Tyroid Stimulating Hormone (TSH) 0,005 uIU/ml, , dan free Tiroksin (fT4) 7,77mg/dl. Penatalaksanaan pada kasus ini yaitu pasien diberikan tyrozol  3x10 mg sehari dan propanolol 3x10mg. Kata kunci: graves, hipertiroidism, tirotoksikosis AbstractHipertiroidisme is a clinical condition caused by increased synthesis and secretion of hormones by the thyroid gland. Thyrotoxicosis is defined as clinical manifestations related to increased thyroid hormone levels. Graves' disease (GD) persists as the most frequently encountered etiology of hipertiroidisme causing approximately 60-80% of all cases of thyrotoxicosis worldwide. In this case report we will discuss woman patient Mrs.NMS aged 56 years with complaints of palpitations felt since three weeks ago and physical examination found enlargement of the thyroid gland and Wayne index in this case obtained 21. In laboratory tests found levels of TSH 0.005 uIU/ml and T4 7.77 mg/dl. Principle in the treatment of hipertiroidisme is suppressing the production of thyroid hormone by using antithyroid drugs. Management in this case that the patient is given 3x10 mg Thyrozol and propranolol 3x10 mg. Keywords: graves, hipertiroidisme, thyrotoxicosis

scholarly journals Deep Vein Thrombosis Secondary To Graves' Disease-A Case Report

2016 ◽  
Vol 5 (1) ◽  
pp. 33-41
Author(s):  
Md Aminul Islam ◽  
Ayesha Beg ◽  
Md Sultan Ahmed ◽  
Sayed Chowdhury ◽  
Mirza Manjurul Haque
Keyword(s):  
Deep Vein Thrombosis ◽  
Case Report ◽  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Lower Limb ◽  
Graves Disease ◽  
Pathophysiological Mechanism ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Overt Hyperthyroidism

Deep Vein thrombosis (DVT) is the formation of a blood clot within a deep vein, most commonly the legs. The incidence of a first venous thrombosis is 1-3 per 1000 persons per year, around two-thirds manifest as DVT of the leg, and one-third as pulmonary embolism (PE). Graves' disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid which frequently results in and is the most common cause of hyperthyroidism, often results in an enlarged thyroid. The disorder results from an antibody, called thyroid stimulating immunoglobulin (TSI), that has a similar effect to thyroid stimulating hormone (TSH) which cause the thyroid gland to produce excess thyroid hormone. Graves' disease will develop in about 0.5% of males and 3% of females, approximately 7.5 times more often in women than men. Various changes in the coagulation- fibrinolytic system have been described in patients with an excess thyroid hormones particularly procoagulant and antifibrinolytic effects. Review analysis confirmed that clinically overt hyperthyroidism modify the coagulation-fibrinolytic balance, indicating that thyroid hormone excess is the probable main pathophysiological mechanism. Patients with overt hyperthyroidism appear to have an increased risk of thrombosis. Here we present a case of right sided leg swelling due to deep vein thrombosis with Grave's disease A 30 year old lady admitted in tertiary care hospital with right sided leg swelling for 25 days and protrusion of both eyes for 3 months. Swelling was sudden in onset, painful, red in colour, which involved almost whole right lower limb and it was associated with venous engorgement. Physical examination revealed patient was ill looking, mildly anaemic, tachycardic, normotensive, severe pitting edema on right leg but left was normal. Thyroid gland was diffusely enlarged. She had bilateral exopthalmos with presence of lid retraction and lid lag. Examination of Lower limbs revealed swollen whole right lower limb with engorged veins in the upper part of thigh with raised local temperature, calf muscle tenderness and positive Homan's sign on right side. The purpose of this case report is to establish that Graves' disease is the cause of DVT in this patient. CBMJ 2016 January: Vol. 05 No. 01 P: 33-41

Clinical assessment and systemic manifestations of thyrotoxicosis

2011 ◽  
pp. 441-452
Author(s):  
Claudio Marcocci ◽  
Filomena Cetani ◽  
Aldo Pinchera
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Clinical Manifestations ◽  
Clinical Syndrome ◽  
Graves Disease ◽  
Free Triiodothyronine ◽  
Excessive Secretion ◽  
Almost All ◽  
Symptoms And Signs

The term thyrotoxicosis refers to the clinical syndrome that results when the serum concentrations of free thyroxine, free triiodothyronine, or both, are high. The term hyperthyroidism is used to mean sustained increases in thyroid hormone biosynthesis and secretion by the thyroid gland; Graves’ disease is the most common example of this. Occasionally, thyrotoxicosis may be due to other causes such as destructive thyroiditis, excessive ingestion of thyroid hormones, or excessive secretion of thyroid hormones from ectopic sites; in these cases there is no overproduction of hormone by thyrocytes and, strictly speaking, no hyperthyroidism. The various causes of thyrotoxicosis are listed in Chapter 3.3.5. The clinical features depend on the severity and the duration of the disease, the age of the patient, the presence or absence of extrathyroidal manifestations, and the specific disorder producing the thyrotoxicosis. Older patients have fewer symptoms and signs of sympathetic activation, such as tremor, hyperactivity, and anxiety, and more symptoms and signs of cardiovascular dysfunction, such as atrial fibrillation and dyspnoea. Rarely a patient with ‘apathetic’ hyperthyroidism will lack almost all of the usual clinical manifestations of thyrotoxicosis (1). Almost all organ systems in the body are affected by thyroid hormone excess, and the high levels of circulating thyroid hormones are responsible for most of the systemic effects observed in these patients (Table 3.3.1.1). However, some of the signs and symptoms prominent in Graves’ disease reflect extrathyroidal immunological processes rather than the excessive levels of thyroid hormones produced by the thyroid gland (Table 3.3.1.2).

scholarly journals Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

2017 ◽  
Vol 6 (4) ◽  
pp. 200-205 ◽  
Author(s):  
Jan Calissendorff ◽  
Henrik Falhammar
Keyword(s):  
Heart Rate ◽  
Thyroid Hormone ◽  
Side Effects ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Adherence To Medication ◽  
Thyroid Hormone Levels

Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

scholarly journals Mediastinal Thyroid Carcinoma and Graves’ Disease: A Rare Presentation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sara Lomelino Pinheiro ◽  
Inês Damásio ◽  
Ana Figueiredo ◽  
Tiago Nunes da Silva ◽  
Valeriano Leite
Keyword(s):  
Thyroid Gland ◽  
Thyroid Carcinoma ◽  
Mediastinal Mass ◽  
Kinase Inhibitor ◽  
Palliative Radiotherapy ◽  
Endobronchial Ultrasound ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Rare Presentation ◽  
The Right

Background. Mediastinal thyroid carcinoma is extremely rare, with few cases reported in the literature. Case Report. A 73-year-old man presented with weight loss for 6 months. Imaging by computed tomography (CT) documented a large mediastinal mass below the thyroid gland and pulmonary metastases. Neck ultrasound found two spongiform nodules in the right thyroid lobe, and fine-needle aspiration citology (FNAC) of these nodules revealed they are benign. Endobronchial ultrasound-guided needle biopsy of the mediastinal mass was compatible with papillary thyroid cancer. A few weeks later, the patient developed overt hyperthyroidism due to Graves’ disease, which was treated with antithyroid drugs. 99mPertechnetate scintigraphy showed increased diffuse uptake in the thyroid parenchyma but the absence of uptake in the paratracheal mass and in the lung nodules. The patient was not considered eligible for surgical intervention or therapy with tyrosine kinase inhibitor due to tracheal and mediastinal vessel invasion and was treated with palliative radiotherapy. Two months later, restaging PET-FDG showed an intense uptake in the right lobe of the thyroid gland, lymph nodes, lungs, bone, muscle, myocardial, kidney, and adrenal gland. Conclusion. In this case, thyroid carcinoma presented as a mediastinal mass with concurrent hyperthyroidism due to Graves’ disease. Although uncommon, the clinicians should be aware of these situations. Obtaining a prompt histological examination of an intrathoracic mass is crucial to ensure an early diagnosis and treatment.

scholarly journals Graves Disease in Childhood

2021 ◽  
Author(s):  
Madhukar Mittal ◽  
Vanishri Ganakumar
Keyword(s):  
Thyroid Hormone ◽  
Side Effects ◽  
Age Of Onset ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Older Children ◽  
Prepubertal Children ◽  
Pediatric Age Group

Graves’ disease (GD) is an autoimmune disease caused by autoantibodies against thyroid stimulating hormone receptor (TSH-R), resulting in stimulation of thyroid gland and overproduction of thyroid hormones resulting in clinical manifestations. It is uncommon in children and is 6 times more prevalent in females. The symptomatology, clinical and biochemical severity are a function of age of onset of disease. Prepubertal children tend to present with weight loss and bowel frequency, associated with accelerated growth and bone maturation. Older children are more likely to present with the classical symptoms of thyrotoxicosis like palpitations, tremors and heat intolerance. Prepubertal children tend to have a more severe disease, longer duration of complaints and higher thyroid hormone levels at presentation than the pubertal and postpubertal children. The non-specificity of some of the symptoms in pediatric age group can lead to children being initially seen by other specialities before being referred to endocrinology. Management issues are decided based on patient’s priorities and shared decision making between patient and treating physician. Radioactive Iodine Ablation is preferred when there is relatively higher value placed on Definitive control of hyperthyroidism, Avoidance of surgery, and potential side effects of ATDs. Similarly Antithyroid drugs are chosen when a relatively higher value is placed on possibility of remission and avoidance of lifelong thyroid hormone treatment, Avoidance of surgery, Avoidance of exposure to radioactivity. Surgery is preferred when access to a high-volume thyroid surgeon is available and a relatively higher value is on prompt and definitive control of hyperthyroidism, avoidance of exposure to radioactivity and avoidance of potential side effects of ATDs. Continental differences with regards to management do exist; radio-iodine ablation being preferred in North America while Anti-thyroid drug treatment remains the initial standard care in Europe.

Graves' disease: An analysis of thyroid hormone levels and hyperthyroid signs and symptoms

1989 ◽  
Vol 87 (5) ◽  
pp. 558-561 ◽  
Author(s):  
Paula T. Trzepacz ◽  
Irwin Klein ◽  
Michelle Roberts ◽  
Joel Greenhouse ◽  
Gerald S. Levey
Keyword(s):  
Thyroid Hormone ◽  
Signs And Symptoms ◽  
Graves Disease ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

LINGUAL AND SUBLINGUAL THYROID GLANDS IN EUTHYROID CHILDREN

PEDIATRICS ◽  
1966 ◽  
Vol 38 (4) ◽  
pp. 647-651
Author(s):  
Wellington Hung ◽  
Judson G. Randolph ◽  
Domenic Sabatini ◽  
Theodore Winship
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Physical Examination ◽  
Thyroid Hormones ◽  
Hormone Therapy ◽  
Surgical Intervention ◽  
Ectopic Thyroid ◽  
Lingual Thyroid ◽  
Thyroid Glands ◽  
Careful Physical Examination

Five clinically euthyroid children with lingual or sublingual thyroid glands were seen during a 12-month period. Certain recommendations have been formulated based upon our experience with these patients. A careful physical examination should be performed to demonstrate the presence of a normally located thyroid gland in all children presenting with midline masses in the lingual or sublingual areas. When the thyroid gland cannot be palpated with certainty in these children, a scintiscan with I-131 should be carried out to determine if the mass is an ectopic thyroid gland and if a normally located thyroid gland is present. All children with lingual on sublingual thyroid glands should have a trial of full replacement thyroid hormone therapy before excision is contemplated. Thyroid therapy will prevent further hypertrophy and hyperplasia. Surgical intervention should be reserved for those children in whom there is dysphagia, dysphonia, ulceration, or hemorrhage due to a lingual thyroid gland or if the ectopic thyroid gland fails to decrease in size following a course of treatment with thyroid hormones.

scholarly journals Study of Thyroid Hormone Status in Normal Newborn and Preterm, Low Birth Weight Baby

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 787-790
Author(s):  
Tanvir Iqbal ◽  
M Obaidulla Ibne Ali ◽  
Nur E Atia ◽  
Tahorul Islam
Keyword(s):  
Birth Weight ◽  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Low Birth Weight ◽  
Newborn Baby ◽  
Preterm Neonates ◽  
Hormone Levels ◽  
Low Birth Weight Babies ◽  
The Mean ◽  
Thyroid Hormone Levels

Background: Screening for thyroid hormones in the newborn baby is extremely important to detect the newborns who are borned with hypofunctional state of thyroid gland. This screening program in first few weeks of life is essential to prevent serious complications of hypothyroidism in future such as mental retardation.Objective: To assess the thyroid hormone levels in normal newborn and preterm, low birth weight babies and comparison of thyroid dysfunction between these two groups.Method: This cross - sectional analytical type of study was conducted in the department of physiology and paediatrics of Rajshahi Medical College & Hospital (RMCH) from July 2015 to June 2016. A total of 70 newborn baby were enrolled by systematic sampling of which 40 were normal healthy newborn and 30 were preterm, low birth weight babies. Data was collected from the parents and they were filled out standard questionnaire. Then venous blood was collected from each and every neonate and blood was sent to laboratory for estimation of thyroid hormone levels. FT4 and TSH values were estimated as these two are the most important parameters for determination of thyroid function.Result: In this study, the mean (±SD) serum FT4 level in term and preterm neonates were 14.17±2.14 and 12.25±3.16 (pg/ml) respectively. This FT4 value is significantly higher in term neonates than preterm neonates (P<0.05). The mean (±SD) serum TSH level in term and preterm neonates were 3.37±2.12 and 4.23±3.23 (?IU/ml) respectively. Statistically there was no significant difference in TSH values between these two groups (P 0.05).Conclusion: From this study it was evident that preterm, low birth weight babies are more likely to develop hypofunctional state of thyroid gland than normal term babies. The newborns who were found hypothyroid, were informed to their parents for consultation with the concerned physicians. The physicians then took necessary steps to correct the hypofunctional state of thyroid gland.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 787-790

The Thyroid Gland: Physiology and Pathophysiology

2000 ◽  
Vol 19 (8) ◽  
pp. 11-26 ◽  
Author(s):  
Denise Kirsten
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Laboratory Tests ◽  
Clinical Manifestations ◽  
Thyroid Stimulating Hormone ◽  
The Body ◽  
Premature Delivery ◽  
Follicular Cells ◽  
Metabolic Hormones ◽  
Radiologic Findings

The thyroid gland contains many follicular cells that store the thyroid hormones within the thyroglobulin molecule until they are needed by the body. The thyroid hormones, often referred to as the major metabolic hormones, affect virtually every cell in the body. Synthesis and secretion of the thyroid hormones depend on the presence of iodine and tyrosine as well as maturation of the hypothalamic-pituitary-thyroid system. Interruption of this development, as occurs with premature delivery, results in inadequate production of thyroid-stimulating hormone and thyroxine, leading to a variety of physiologic conditions. Pathologic conditions occur in the presence of insufficient thyroid production or a defect in the thyroid gland. Laboratory tests are important in diagnosing conditions of the thyroid gland. A thorough history in combination with clinical manifestations and radiologic findings are also useful in diagnosing specific thyroid conditions. Nurses play an important role in identifying and managing thyroid disorders and in providing supportive care to infants and their families.

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