symptoms of toxic goitre or throtoxicosis or hyperthyroidism

 Symptoms of toxic goitre or throtoxicosis or hyperthyroidism

the term thyrotoxicosis is retained because hyperthyroidism as symptoms due to a raised level of circulating thyroid hormones is not responsible for all manifestations of the disease
 
Causes

the incidence of the disease is more common in female than male main causes is due to autoimmune disease so
Antigen:thyroid stimulating hormone(TSH) receptor on the thyroid cell membrane .Antibody :Abnormal thyroid antibodies (tsAb)=IgG=LATS(long acting thyroid stimulator and LASTP(protector)what are the evidence that thyrotoxicosis is an autoimmune disease 1- tsAb are present in 80%of thyrotoxic patients 2- lymphocytic infiltration of the thyroid gland 3- enlargement of other members of R.E.S(reticuloendothelial system )as thymus gland lymph node spleen tonsils

Clinical types

divided into 1- diffuse toxic goitre (primary toxic goitre=Grave,s disease)this is due to tsAb and there is no relation between the size of the gland and the degree of hyperthyroidism 2-  toxic nodular goitre secondary thyrotoxicosis=plummer,s disease) in toxic nodular goitre the nodules are inavtive and it is the internodular thyroid tissue that is overactive here the hyperthyroidism is due to TsAb in some toxic nodular goitre one or more nodules are overactive and and here the hyperthyroidism is due to autonomous (non hormone dependent)thyroid tissue as in toxic nodule 3- toxic nodule this is a solitary overactive nodule Hot nodule on scanning it is autonomous and its hypertrophy and hyperplasia are not due to  TsAb 

WHAT ARE THE CLINICAL PICTURE

Symptoms as  METABOLIC 1- there are severe asthenia 2- rapid loss of weight in spite of increased appetite 3- intolerance to heat and the patient likes winter time 4- slight pyrexia 5- excessive sweating
  
nervous symptoms  as 1- irritability and anxiety 2- insomnia 3- tremors of the hand and tongue  4- weakness and wasting of the proximal muscles

Cardiovascular symptoms as1-exertional dyspnea 2- palpitation 
  gastrointestinal symptoms as 1- increase appetite and polyphagia and in spite the patient continue to loss weight 2- loose stools
 urinary symptoms as 1- excess of metabolic H2O and increased renal blood flow glucosuria
  
gonadal symptoms as increase sex libido at least in the early stages 
 menstrual disturbances starting by polymenorrhea and menorrhgia and ending by amenorrhoea 

skeletal manifestations as generalized bone aches due to osteoporosis 

local  manifestations 1- swelling in the thyroid region 2-  diplopia due to unequal eye bulge and weakness of extra occular muscles and blurring of vision 

pressure symptoms as on trachea postural dyspnea on esophagus  dysphagia on carotid artery fainting attack on internal jugular vein frontal headache
on the nerves as 1- recurrent laryngeal nerve causing hoarseness of voice 2- external laryngeal nerve causing loss of high pitch of voice 3- arnoled nerve causing pain in the ear 4- internal laryngeal nerve causing choking on drinking

tags:goitre,toxic,thyrotoxicosis,hyperthyroidism,symptoms