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Much for tuning touch on today this afternoon i want to talk a few minutes about clears disease and i have been talking about hyperthyroidism and graves disease is the most common cause of hyperthyroidism so let us see the most important things so we have thyroid gland producing the thyroid hormone excessive amounts in businesses basically it affects woman between
Twenty years under 40 years and it’s like eight times more common human women and men basically it is a christian hypersecretion of thyroid hormone because of the stimulation of tsh receptor by immunoglobulin j so here is the tsh receptor and it is stimulated by thyroid hormone like the you see normal thyroid we help psh stimulating the production of thyroid hormone
But here an antibody tsh or antibody an antibody that is directed against the tsh receptor site he is acting on the thyroid follicular immaterial membrane and causing the excess approach na for thyroid hormone so basically we see thyrotoxicosis in veils thesis and there are three things you need to grease this is they are ophthalmopathy thermopylae osteopathy so
Remember those three things works half talam uppity dharma potty osteopathy these are the three things an aftermarket is the most frequently seen physical finding in a grails thesis and then comes dharma potty and osteopathic what happens basically is glycosaminoglycans they actually accumulate under the skin especially in the anterior tibialis where we see the
Pre tbl vex edema in these patients and allison osteopathy there is this accumulation and the ostium of our nation as it is an ophthalmic at a karma party last year patty happens in these patients now have thumb aparte we need to talk about it especially the later interaction ophthalmic li jia and they are very very common did you see the little caption the i-10
Spelled attractively it could be unilateral or bilateral and the most commonly involve the power and anterior is upper and lower less we will also see exam promise basically that the protrusion of the eyeballs many times it is is metric onda usually bilateral and what happens is there is that accumulation of the contents in the orbital cavity and as a result the
Ocular muscles become bulky and the fat accumulation takes place and as a result trojan of the eyeballs happens and then we have the hostel malaysia and even sometimes compression of the globe by the arbitral contents may actually produce the invasion of the intraocular pressure and they can be even a retinal damage and choroidal damage even optic neuropathy optic
Neuropathy happens in severe forms of graves disease so you see folks that are tall mom pattie we see in these patients can have wide-ranging effects right from simple lib retraction to the given optic now and even corneal ulcers many times has these patients hi protrusion happens the cornea is exposed on the cornea eventually develop muscles and the in severe
Exam thomas as what you say the corneal ulceration now let me talk a few minutes about laboratory tests the diagnosis of four graves disease he can actually get it from the physical examination after all mop affair but there is also the increase in free t4 and t3 and decreased in psh and when you don’t see it you need to evaluate 40s i but your thyroid stimulating
Immunoglobulin and it is specific for graves disease thyroid stimulating emma globulin you measure it and if it is elevated it is you are seeing businesses and even that does not help you the gold standard is a radionuclide scan you see you see graves this is basic reason if he is quite say it takes up these things now let us talk about the treatments there are
Three things in the treatments number one the control of hyper and allergic symptoms number two the stop the short-term restoration of your thyroid states and number three the long-term management’s so you need to control the ideological access how do you do that you do that with beta blockers propala underwritten along and you need to cue them even before you start
That your treatment of hyperthyroidism and proper long has the advantage of me beating peripheral conversion of t4 to t3 and it helps you to bring back to the normal state the second thing is restoration of euthyroid states and you use methimazole and car bombers all for this purpose okay the first thing is controller for hybrid genetic states would be poppin la
La atenolol second stage is restoration of euthyroid stage that is insured by methimazole carbimazole are probably fire raza now methimazole you can do them as once daily dose papaya paris you can do them in pregnancy and breastfeeding but it can cause hepatitis in some patients even though it is very very red and purple if they arrest and it blocks the conversion
Of t4 to t3 and attention early it is used for pharaoh toxicosis so propylthiouracil is a good medication in pregnancy and breastfeeding that’s a very very important folks and both propel terrorism and metamucil can cause agranulocytosis so when a patient comes with a sore throat favor and he’s a profile thyristor methimazole they are asking you to think about
Agranulocytosis the patient comes in favor sore throat and he’s a myth missoula popularising you should check the wbc whether they have developed that 2-cd set affects the propellers which is heavy annular cytisus and methimazole can also cause charges and generate a colima habit of stella’s or toxins in a vasculitis now the third step is long-term therapy is
Based on the age of the patients every generation of my brother addison size of the gland and potential for future pregnancy our methimazole is chosen for long kamagra particularly in our allison’s and egg patients with the small glance and less severe disease the other thing is radioactive iodine appalachian radioactive iodine ablation is the treatment of choice
For 21 years old and wall and it’s a very very effective treatment but you cannot do that in pregnancy radioactive hided treatment is contraindicated in pregnancy and is not advised in woman who are planning to become pregnant in next six months that’s a very very very important foreign force so remember that radioactive hide his contrary can fragments now what
Should we you do in such patients go for suppliers of the sub tara’s thyroidectomy sub total thyroidectomy that helps you’re cutting out the excess thyroid tissue now what are the complications of her grace this is the most important thing is ty rider strong is basically thyrotoxicosis and you will see all the symptoms of thyrotoxicosis cardiac problems like
Atrial fibrillation and taking claudia and if she had medical emergency fox when you see a large storm it should immediately treat them with optimal arm propylthiouracil and hydro cantus those are the three medications in the treatment of thyroid storm properly propel tiresome and hydrocortisone so remember those things was so let me summarize and i will finish
Waves disease not even disorder where the antibodies directed against esht scepter resulting in the axises secretion of hair and hormone resulting in feral hogs casas there are three things unique beside all the symptoms caused by thyrotoxicosis there are three things you need to create a sense of calm apathy dharma potty osteopathy those meetings are your neck
And when you diagnose it you’re diagnosing based on ophthalmic athena physical exam and decrease the tsh increase rate t3 and t4 and if this is not enough you go for thyroid stimulating immunoglobulin tsi elevation if what is not enough you go for radionuclide a scam that’s the rig or standard for the lag nurses in the treatment there are three things controller
For hyper it allergic status you do that with the pope mala or et la la then the short-term treatment to bring the patient back to you third estate you do that using methimazole are couple tourism and then finally long-term treatment you do that with the medications are radioactive hide in our subtotal direct to me so those are the important things when you talk
About complications need to think about there are strong and thyroid storm is a medical emergency and you treat it with a couple of purple paris and hydrocortisone those are the most important things so that’s the first things help you thank you very much have a nice day thanks for listening for more medical videos please visit us at www we regularly post on our
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Transcribed from video
Graves' Disease: Essential Points By Paul Kattupalli
