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hyperthyroidism .pdf



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HYPERTHYROIDISM

INTRODUCTION


Hyperthyroidism, also known as Thyrotoxicosis, is the clinical
syndrome that results from elevated concentrations of free thyroid
hormone in the plasma, associated with clinical evidence of
hypermetabolism.

CAUSES

GRAVE’S DISEASE (GD)


GD is overall the most common cause of Hyperthyroidism. GD is
caused by a generalized over activity of the entire thyroid gland
(Hyperthyroidism).



GD is an autoimmune disorder in which Thyroid Receptor
Antibodies (TRAbs) stimulate the TSH receptor, increasing thyroid
hormone production.

Prevalance







Women are more frequently affected by Grave s Disease than men
by a 5:1 ratio. TRAbs are present in 70-100% of Grave s Disease (85100% for activating antibodies and 75-96% for blocking antibodies).
The prevalence of hyperthyroidism has been studied in several
studies in India.
In an epidemiological study from Cochin, Subclinical and Overt
Hyperthyroidism were present in 1.6% and 1.3% of subjects
participating in a community survey.
In a hospital-based study of women from Pondicherry, Subclinical
and Overt Hyperthyroidism were present in 0.6% and 1.2% of
subjects.

Pathogenesis


The Hyperthyroidism of Grave’s Disease is caused by Thyroid
stimulating immunoglobulin that are synthesised in the thyroid
gland as well as in bone marrow and lymphnodes. A combination of
environmental and genetic factors, including polymorphism in HLADR, CTLA-4, CD25, PTPN22 & TSH-R contribute to Grave s Disease
susceptibility. Cytokines appear to play a major role in thyroidassociated opthalmopathy.

Clinical Manifestations

Laboratory Evaluations


In Grave s Disease, the TSH level is suppressed & total and unbound
thyroid hormone levels are increased. In 2-5 % of patients, only T3
is increased (T3 toxicosis).



Measurement of Thyroid receptor antibodies is the most reliable
diagnostic method if the diagnosis is unclear clinically.

A SCHEME FOR EVALUATING SUSPECTED

HYPERTHYROIDISM


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