1st order laboratory parameters – obligatory laboratory tests. TSH ↓ (thyroid-stimulating hormone). T3 ↑ (triiodothyronine) and T4 ↑ (thyroxine) (in manifest hyperthyroidism). Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification. TRAK (TSH receptor antibody) – thyroid autoantibody, which may be present in the … Graves’ Disease: Test and Diagnosis
Therapeutic target Achieve a euthyroid metabolic state (= thyroid levels in the normal range). Therapy recommendations Thyrostatic drugs (drugs that inhibit thyroid function and are used to treat hyperthyroidism) In manifest hyperthyroidism (hyperthyroidism) → thioamide type (thiamazole and carbimazole) or with propylthiouracil (PTU); duration of therapy: one year (to one and a half years) of … Graves’ Disease: Drug Therapy
Obligatory medical device diagnostics. Thyroid ultrasonography (ultrasound examination of the thyroid gland) – as a basic examination to determine thyroid size and volume and any structural changes such as nodules[M. Graves’ disease: goiter with diffuse echo-poor, signs of infiltration are seen as homogeneous internal structures; in the Duplexsonographe shows increased vascularization / vascular proliferation or … Graves’ Disease: Diagnostic Tests
1st order Subtotal thyroidectomy – removal of the main part of the thyroid gland. Indications: in case of large thyroid gland (large strumen), suspected malignant (malignant) change of thyroid gland or personal refusal of radioiodine therapy. Furthermore, surgery is considered if symptoms do not improve or recurrence occurs after therapy with thyrostatic drugs. Total thyroidectomy … Graves’ Disease: Surgical Therapy
To prevent Graves’ disease, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet High iodine intake Consumption of stimulants Tobacco (smoking) Psycho-social situation Stress
The following symptoms and complaints may indicate Graves’ disease: I. Symptoms of hyperthyroidism (overactive thyroid) Leading symptomsbasic metabolic rate Increase in body temperature → heat intolerance or hypersensitivity to heat (thermophobia). Sweating Warm moist skin Weight loss (despite increased appetite) Cardial (cardiovascular) Tachycardia – heartbeat too fast: > 100 beats per minute [cardiac output volume … Graves’ Disease: Symptoms, Complaints, Signs
Pathogenesis (disease development) Graves’ disease is an autoimmune disorder that is clustered in people with HLA-DR3. The disease is often associated with other autoimmune diseases (type 1 diabetes mellitus, rheumatoid arthritis, Addison’s disease). Graves’ disease is caused by autoantibodies produced against the TSH receptor (TRAK) of TSH (thyroid-stimulating hormone). This permanently stimulates (excites) the receptors, … Graves’ Disease: Causes
General measures In case of orbitopathy (protrusion of the eyeballs) – use artificial tears and tinted glasses with side shields if necessary and, if possible, adopt a relatively upright sleeping position; furthermore, the eyelids can be taped shut during sleep (watch glass bandage). Nicotine restriction (refrain from tobacco use) – smoking cessation is to be … Graves’ Disease: Therapy
Neoplasms – tumor diseases (C00-D48). Pheochromocytoma – tumor of the adrenal medulla that produces catecholamines (norepinephrine, epinephrine, and metanephrines). Tumor diseases of any kind that lead to weight loss. Psyche – Nervous System (F00-F99; G00-G99). Amphetamine abuse Cocaine abuse Mania Panic attacks Psychosis Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99). Cachexia … Graves’ Disease: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be caused by Graves’ disease: Eyes and eye appendages (H00-H59). Corneal damage due to dehydration in the absence/incomplete closure of the eyelids (lagophthalmos). Optic nerve compression (2-5% of patients) – high pressure on the optic nerve that can lead to visual impairment or blindness, … Graves’ Disease: Complications
Staging of endocrine orbitopathy (EO). Stage Description I Foreign body sensation Photophobia (light shyness) Retrobulbar pressure sensation (retrobulbar, i.e., behind the eyeball). II Eyelid retractions (retraction: shrinkage, shortening) and connective tissue involvement with: Chemosis (= edema of the conjunctiva): In the case of more severe conjunctivitis (conjunctivitis) or In inflammatory processes of the neighborhood due … Graves’ Disease: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing) of skin, eyes, and entire body [wg. Alopecia (hair loss, diffuse). Sweating, warm and humid skin Eyes: exophthalmos (synonyms: ophthalmoptosis; ophthalmopathy; protrusio bulbi; popularly known as “googly eyes”) – … Graves’ Disease: Examination
