Symptoms pathognomonic for Graves disease: pretibial myxedema (thyroid dermopathy) and thyroid acropachy (clubbing of fingers and toes accompanied by soft-tissue swelling of the hands and feet) Onycholysis (Plummer nails), patchy or generalized hyperpigmentation (especially of the face and neck) Tachycardia, irregular pulse (in atrial fibrillation), dyspnea, orthopnea and peripheral edema (in heart failure) Palpitations, tachycardia, anxiety, tremor, jitteriness, diaphoresis, heat intolerance, stare, lid lag, hyperdefecation (not diarrhea) Tumor secreting large quantities of TSH, and not responding to thyroxine and triiodothyronine feedback Tumor produces β-hCG, which stimulates thyroid TSH receptors Metastasis of functional follicular thyroid cancerĮctopic thyroid tissue in ovarian dermoid tumor produces thyroid hormones Surreptitious ingestion of thyroid hormones Painful inflammation of the thyroid gland caused by viral infection, often with fever, triggering a release of preformed thyroid hormones Subacute granulomatous (de Quervain) thyroiditis Variant of painless thyroiditis with the same mechanism, occurring after delivery High level of β-hCG stimulates TSH receptors Overproduction of thyroid hormones (amiodarone-induced thyrotoxicosis type 1) or release of preformed thyroid hormones (amiodarone-induced thyrotoxicosis type 2, interferon alfa, interleukin-2, or lithium) Somatic mutation in TSH receptor or Gs alpha gene in a thyroid noduleĮxpansion of clonogenic cells with an activating TSH receptor mutation Painless or transient (silent) thyroiditisĪutoimmune destruction of thyroid tissue leading to a release of preformed thyroid hormones The choice of treatment depends on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference.Īutoimmune process in which antibodies stimulate the TSH receptor leading to overproduction of thyroid hormones Radioactive iodine ablation is the most widely used treatment in the United States. Hyperthyroidism caused by overproduction of thyroid hormones can be treated with antithyroid medications (methimazole and propylthiouracil), radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy. The most common cause of an excessive passive release of thyroid hormones is painless (silent) thyroiditis, although its clinical presentation is the same as with other causes. The most common causes of an excessive production of thyroid hormones are Graves disease, toxic multinodular goiter, and toxic adenoma. He’s used to this and can tell a ‘purposeful’ response a mile off - if you know what I mean.Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source. There is a range where the response may be ‘more brisk’ but not significant – ie normal – he or she knows when the response is due to the person being stressed or anxious. The response should always be ‘brisk’ and decent neuro knows just how much normal ‘kick’ he should expect with the ankle and knee taps. Similarly but not so significant is hyperreflexia – for a neuro to tag it ‘abnormal’ depends on the degree of the response. It basically shows that something is interfering with the body’s normal response to an external stimulus and of all the abnormal responses the abnormal Babinki response is the one that rings alarm bells with the neuros With MS it’s usually a lesion/inflammation/scarring somewhere in these areas Neuros see it in people who have had a stroke, or have a brain or spinal cord tumour – it can also be present when someone has metabolic abnormalities like hypoglycaemia. They know a Positive Babinski response for example is caused by some structural abnormality somewhere along the upper spinal tract - or the cerebral cortex/brain stem area of the brain that controls it. With reflexes it’s the same - basically we should be more or less equal both sides! Generally - and I mean generally as MS doesn’t always follow the rules - symptoms and clinical signs tend to be on one side with MSers.
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