“Graves' Disease”

Graves' disease

Introduction

A thyroid disease described by Robert Graves in 1835, now known as Graves' disease is an autoimmune disease characterized by the presence of hyperthyroidism, goiter, ophthalmopathy and occasionally infiltrative dermopathy or pre-tibial myxedema.

Graves Disease is responsible for 60-80% of cases of hyperthyroidism. Regarding the incidence by gender, arises in a relationship female/male 5-10. The annual incidence in women over a period of 20 years is about 0.5 per 1000. Can occur at any age, but the typical age is between 20 and 40 years (Maruyama, et, al. 2004). The prevalence is similar among Caucasians and Asians and is lower in blacks.

Discussion upon Graves' Disease

Clinical manifestations of Graves' disease divided into which are common to any form of hyperthyroidism and in particular for the Graves' disease. The ophthalmopathy and dermopathy are not related to elevated levels of circulating thyroid hormones.

In about 90% of patients less than 50 years was a palpable diffuse goiter of variable size and gland firm, only 75% of the elderly found that expression. Although nodules thyroid antibodies may be present is essential to exclude multinodular goiter toxic (especially in the elderly) and thyroid neoplasia; remains unclear whether the differentiated thyroid cancer is more common and more aggressive in these patients (Maruyama, et, al. 2004).

The most common symptoms are nervousness, fatigue, tachycardia, palpitations, heat intolerance, and weight loss; these symptoms are present in more than half of patients. With advancing age, the weight loss and loss of appetite are common, while irritability and heat intolerance are less common.

Atrial fibrillation (AF) is rare in patients under 50, but occurs in up to 20% of elderly individuals. In 60% of patients with hyperthyroidism and AF, this rate is converted to sinus rhythm when the hyperthyroidism is treated. These patients should be hypo-coagulated in accordance with the guidelines of the American College of Cardiology (Jankovic, et, al. 1997). Systolic hypertension is common among individuals with DG. Hyper-pigmentation can occur in severe cases and appears to be the result of rapid metabolism leading to increased cortisol secretion of ACTH. You can also check out menstrual irregularities, gynecomastia and impotence, increased sex hormone binding globulin of free testosterone levels, worsening of metabolic control of the diabetic patient and decreased levels of parathormone. The concentration of estradiol is enhanced by the extra-gonadal higher conversion of testosterone to oestradiol, which is in fact the genesis of gynecomastia, decreased libido and erectile dysfunction. Can still be observed the following laboratory abnormalities: normocytic normochromic increasing hematocrit is supplanted by increased plasma volume); leukocytes at the lower limit of normal or mild leucopenia with relative lymphocytosis and monocytosis; platelets at the lower limit of normal or below; elevation of serum bilirubin, transaminases and ferritin.

The rate of bone resorption is increased. Hyper-calciuria is common, but hyper-calcemia is rare. Glucose intolerance and, rarely, diabetes mellitus, hyperthyroidism may follow. This functional state increases insulin requirements in diabetic insulinotratados (Jin, et, al. 2012). The lipid profile also changes in hyperthyroidism, with a tendency to decrease total cholesterol and high density lipoproteins ...