DISEASE OF THE ENDOCRINE GLANDS : GRAVES ' DISEASE AND HYPERTHYROIDISM (MORBUS BASEDOWI, HYPERTHYREOSIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Hyperthyroidism or thyroid dysfunction. The most important etiological factor is the irritation of the cerebral cortex that violates a complex system of regulation of its endocrine and autonomic functions conducted through the optic tubercle, the interstitial nucleus of the brain, the anterior portion of the brain appendage, producing in graves ' disease, excessive amounts of thyroid-stimulating hormone, enhancing the function of the thyroid gland. History often have a mental injury, shock, fatigue, prolonged nervous work, and rarely infection. In some cases, the disease develops in connection with pregnancy, childbirth and menopause period. Women suffer from graves ' disease and hyperthyroidism more often than men.
Symptoms. The increase in thyroid cancer, the extent of which does not always correspond to the severity of the disease. Sometimes goiter outside a little noticeable, but during surgery it turns out that much of it is in the chest or the side lobes increase back and compress adjacent organs. The volume of goiter often varies depending on strong, often changing his blood. Sometimes after a few days of rest goiter is significantly reduced. By touching basidomycetes goiter significant ripple, when listening to cardiovascular noises. Craw has a diffuse character, sometimes it felt nodes. Characteristic eye symptoms - ectoplasm (exophthalmia) from a barely perceptible extent to sharp protrusion and the inability to close the eyelids, eye gloss, rare blinking, the appearance of a white strip of sclera above the iris when the eye moves downward, the deviation to the outside of the eyeball when the fixation of view at close range. Significant tachycardia of 140 to 150 beats per minute, in severe cases, and paroxysmal atrial fibrillation, heart expanded, loud colours, often functional murmurs, palpitations, throbbing of vessels, increasing the maximum pressure at a lower minimum. Vascular phenomena (sudden feeling of heat, red dermographism). Subfebrile temperature. Appetite usually good, feeling thirsty, often decreased acidity of gastric juice, sometimes diarrhea. Sharp anxiety, irritability, poor sleep. The unstable psyche, for the most part excited state, less depression. Tendon reflexes increased, tremor of the tongue, eyelids, fingers, shortness of breath, sometimes salivation, rapid breathing. On the part of the autonomic nervous system is dominated by the phenomenon of increased tone of the sympathetic, although there are cases and vagotonia with a slow pulse. Hair fall and early graying. The skin is moist. Nevynosimost to heat. Metabolism is severely disrupted. Patients lose weight, you receive significant muscle atrophy and weakness. Occasionally there are cases of graves ' disease, accompanied by obesity. Gas exchange increases (up to +100 - 120%); the degree of this increase can be judged on the severity of the disease.
From classic forms of graves ' disease is necessary to distinguish the numerous deleted forms (formes frustes), hyperthyreosis in which the above-mentioned symptoms are much less basal metabolic rate increases of no more than +20%, minor weight loss, enlargement of the thyroid gland is very limited. At the forefront are nervous phenomenon, and tachycardia. Mild forms of hyperthyroidism are observed quite often. They usually appear in the form of a more or less pronounced vegetative neurosis or neurosis of the heart. One enlargement of the thyroid gland, even considerable, without other symptoms, does not give grounds for diagnosis and hyperthyroidism, as it can be a simple goiter.
Allocate specific farm hyperthyroidism - toxic th nodular goiter (struma basedowificata), growing on soil knotted Zobov, mostly in the elderly and is often associated with the climacteric period. This form gives a sharp tachycardia, weight loss, increased metabolic rate, but it is rarely accompanied by exophthalmos. The goiter may be a small quantity, nodular, non-pulsating. Toxic goiter improved after surgery and rarely recurs. Malignant neoplasms of the thyroid gland are rare and may be accompanied by symptoms of hyperthyroidism, and goiter different density. Infectious inflammation of the thyroid gland thyroiditis, or strumitis, may be accompanied by hyperthyroidism and is characterized by significant morbidity.
For. There are acute form of graves ' disease: a thriving, with a sharp increase in the severity of all symptoms, with severe intoxication, cardiac decompensation of and exhaustion. This form can quickly lead to cachexia and death. Positive flows subacute form, in which there are periods of remission. The chronic form occurs slowly, without sudden disorders of the compensation body. Deleted forms and hyperthyreosis flow usually favorably.
Recognition based on the above it is easy.
Prediction in severe advanced cases serious. Death may be due to cardiac decompensation of the soil of thyrotoxic myodegeneration the heart muscle. Made timely resection of goiter in most cases leads to almost complete clinical recovery, but in some cases there are relapses.