Graves Basedow Disease
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Transcript of Graves Basedow Disease
Graves Basedow Disease Graves Basedow Disease Diagnosis and Treatment AspectsDiagnosis and Treatment Aspects
By:By: Vîlceanu Maria Vîlceanu Maria RamonaRamona
PurposePurpose
AnalAnalysis of the particular forms ysis of the particular forms ofof Graves Graves Basedow Basedow diseasedisease
IncidenIncidence of other ce of other autoimuneautoimune determinationsdeterminations
STUDY METHODSSTUDY METHODS
The study was made of a 100 The study was made of a 100 patients group with Graves patients group with Graves BasedowBasedow disease, hospitalised in disease, hospitalised in Endocrinology Clinique ofEndocrinology Clinique of TimişoaraTimişoara, Romania, Romania between between 2004-20052004-2005
SEXES REPARTITIONSEXES REPARTITION
9292%% femalesfemales
88%% malesmales
raport raport F/M=11,5/1F/M=11,5/1
females
males
8%
92%
0
20
40
60
80
100
F M
females
males
procente
GROUPS OF AGE REPARTITIONGROUPS OF AGE REPARTITION
The bigger incidence of this disease was The bigger incidence of this disease was at at 41-60 41-60 years group of ageyears group of age
Group of AgeGroup of Age Number of subjectsNumber of subjects
11-20 11-20 yearsyears 66
21-30 21-30 yearsyears 111131-40 31-40 yearsyears 101041-50 41-50 yearsyears 3131
51-60 51-60 yearsyears 2929
61-70 61-70 yearsyears 88
71-80 71-80 yearsyears 55
CLINICAL CLINICAL MANIFESTATIONSMANIFESTATIONS
0
10
20
30
40
50
60
70
80
90
Palpi
tation
sLo
se w
eight
Effo
rt dis
pnee
aPh
ysica
l asth
enia
Exce
ssive
swea
ting
Psyc
homo
tor a
gitati
onPs
ycho
emot
ional
labilit
yIns
omnia
c eve
nts
Therm
opho
pbia
Poor
appe
tite
Exce
ssive
appe
tite
Ocula
r sym
ptom
sLo
w int
estin
al mo
tility
Increa
sed i
ntes
tinal
motili
tyAr
ticula
r pain
sAb
domi
nal p
ains
Comp
ressio
nDy
spha
gia
21 - 60 years
> 60 years
0
10
20
30
40
50
60
70
80
90
Po
lino
du
lar
go
iter
Dif
fuse
go
iter
Ab
sen
ce o
f g
oit
er
Wit
h s
inu
s ta
chyc
ard
ia
Wh
ito
ut
sin
us
tach
ycar
dia
Atr
ial f
ibri
llati
on
Ven
tric
ula
r ex
tras
ysto
les
Ext
rem
itie
s fi
ne
trem
or
Exo
ph
talm
ie
Wet
an
d w
arm
teg
um
ents
Par
esth
esia
21 - 60 years
> 60 years
Symptoms:Symptoms: PalpitationsPalpitations Lose weightLose weight Effort dispneeaEffort dispneea Physical asthenia Physical asthenia Excessive sweatingExcessive sweating Psychomotor agitationsPsychomotor agitations Psychoemotional labilityPsychoemotional lability Insomniac eventsInsomniac events
Symptoms:Symptoms: ThermophobiaThermophobia Poor appetite or excessive appetitePoor appetite or excessive appetite Ocular symptomsOcular symptoms Low or increased intestinal motility Low or increased intestinal motility Articular painsArticular pains Abdominal painsAbdominal pains CompressionsCompressions DysphagiaDysphagia
Signs:Signs: Polynodular goiterPolynodular goiter Diffuse goiterDiffuse goiter Absence of goiterAbsence of goiter With or without sinusal tachycardiaWith or without sinusal tachycardia Atrial fibrillationAtrial fibrillation Ventricular extrasystolesVentricular extrasystoles ExophtalmyExophtalmy Fine extremities tremorFine extremities tremor Wet and warm tegumentsWet and warm teguments ParesthesiaParesthesia
Dg. Graves Basedow Disease: Dg. Graves Basedow Disease: diffuse goiter. diffuse goiter. The thyroid The thyroid butterfly is seen under the butterfly is seen under the
skin. skin.
Dg. Graves Basedow Dg. Graves Basedow Disease: diffuse goiter.Disease: diffuse goiter.
Dg. Graves Basedow Disease: Dg. Graves Basedow Disease: moderate diffuse goiter moderate diffuse goiter (the (the thyroid touch the thyroid touch the sternocleidomastoid musclesternocleidomastoid muscle))
CARDIOTCARDIOTHYHYREOREOSE INCIDENCESE INCIDENCE
0
0,5
1
1,5
2
2,5
3
11 -20 ani
21 -30
years
31 -40
years
41 -50
years
51 -60
years
61 -70
years
71 -80
years
Atrialfibrillation
Ventricularextrasystoles
Cardiacinsufficiency
feamles
The bigger incidence of cardiothyreose was The bigger incidence of cardiothyreose was observed at females and observed at females and 41-80 41-80 years group of ageyears group of age
00,10,20,30,40,50,60,70,80,9
1
11 -20
years
31 -40
years
51 -60
years
71 -80
years
AtrialfibrillationCardiacinsufficiency
males
INCIDENCE OF SEVERE INCIDENCE OF SEVERE EXOPHTALMY FORMSEXOPHTALMY FORMS
00,10,20,30,40,50,60,70,80,9
1
11 -20
years
31 -40
years
51 -60
years
71 -80
years
Infiltrativeophtalmopathy
Maligneophtalmopathy
subjects
males 00,5
11,5
22,5
33,5
44,5
5
11 -20
years
31 -40
years
51 -60
years
71 -80
years
Infiltrativeophtalmopathy
Maligneophtalmopathy
subjects
females
Exophtalmy is bigger in Exophtalmy is bigger in 41-60 41-60 years group of age and years group of age and femalesfemales
Bilateral moderate infiltrative Bilateral moderate infiltrative exophtalmy. The superior eyelid exophtalmy. The superior eyelid elevates over the iris.elevates over the iris.
Bilateral severe infiltrative Bilateral severe infiltrative exophtalmy.exophtalmy. The superior eyelid The superior eyelid is more elevated over the irisis more elevated over the iris. . Ocular motility disorders. Ocular motility disorders. Convergent strabismus.Convergent strabismus.
Bilateral moderate infiltrative exophtalmyBilateral moderate infiltrative exophtalmy, predominant , predominant in right eyein right eye.. The The superior eyelid elevates over the iris. superior eyelid elevates over the iris. Incomplete palpebral occlusion at Incomplete palpebral occlusion at the right eyethe right eye..
DISEASES ASSOCIATED WITH DISEASES ASSOCIATED WITH GRAVES GRAVES BASEDOWBASEDOW DISEASE DISEASE
The most frequent disease associated with Graves The most frequent disease associated with Graves Basedow disease is arterial hypertension followed by Basedow disease is arterial hypertension followed by osteoporosis, ferriprive anemia, anxious-depressive osteoporosis, ferriprive anemia, anxious-depressive disorder, decrease in glucose tolerance and ischemic disorder, decrease in glucose tolerance and ischemic cardiopathy.cardiopathy.
Arterial Hypertension
Ferriprive anemia
Anxious-depressivedisorder
Decrease in glucosetolerance
Ischemic cardiopathy
Osteoporosis
27%
14%
10%8%
7%
25%
POSTTREATMENT POSTTREATMENT EVOLUTIONEVOLUTION
Compensation afterantithyroid drugs
Remission afterantithyroid drugs
Recidivation withantithyroid drugs
Iatrogenichypothyroidism
Postsurgeryrecidivation
45%
7%
31%
5% 6%
CONCLUCONCLUSIONSSIONS The bigger incidence of the disease in The bigger incidence of the disease in 41-60 41-60 years years
group of agegroup of age
Females were more affected than malesFemales were more affected than males F/M = 11.5/1 F/M = 11.5/1
The clinical manifestations are represented by the The clinical manifestations are represented by the triadtriad exo exophphtalmtalmyy, g, goiteroiter,, tatachycardiachycardia
Antithyroid treatment was efficient in most of the Antithyroid treatment was efficient in most of the cases (45%). An important percent (31%) presented cases (45%). An important percent (31%) presented postsurgery recidivations and needed postsurgery recidivations and needed readministration of the antithyroid drugs or another readministration of the antithyroid drugs or another surgery.surgery.
Thank You!Thank You!