Toxic Goitre
Toxic Goitre has two categories:
1- Diffuse toxic (Graves’ disease):
Graves’ disease is the most common cause of overactive thyroid. It is an autoimmune disease in which the antibodies that produced by the immune system (normally attack bacteria, viruses and other microbes) attack the thyroid gland, causing it to enlarge and produce too much thyroxine. These antibodies bind to TSH receptor sites and produce a disproportionate and prolonged effect. It is more common in younger women and 50% of patients have positive family history. It is mostly associated with eye signs, causing discomfort and double vision.
Triad of Graves’ disease:
1- Hyperthyroidism
2- Exophthalmos (protrusion of the one or both eyeball anteriorly out of the orbit) (Figure 11&12).
3- Pretibial myxedema (waxy, discoloured, swelling, symmetrical and thickness of the skin) (Figure 13).
More obvious eye signs for Graves’ disease called Graves' ophthalmopathy which include (Figure 14):
1- Diffuse toxic (Graves’ disease):
Graves’ disease is the most common cause of overactive thyroid. It is an autoimmune disease in which the antibodies that produced by the immune system (normally attack bacteria, viruses and other microbes) attack the thyroid gland, causing it to enlarge and produce too much thyroxine. These antibodies bind to TSH receptor sites and produce a disproportionate and prolonged effect. It is more common in younger women and 50% of patients have positive family history. It is mostly associated with eye signs, causing discomfort and double vision.
Triad of Graves’ disease:
1- Hyperthyroidism
2- Exophthalmos (protrusion of the one or both eyeball anteriorly out of the orbit) (Figure 11&12).
3- Pretibial myxedema (waxy, discoloured, swelling, symmetrical and thickness of the skin) (Figure 13).
More obvious eye signs for Graves’ disease called Graves' ophthalmopathy which include (Figure 14):
- Swelling around the eyes
- Conjunctival injection: redness of the whites of the eyes
- Proptosis or Exophthalmos: protrusion of the one or both eyeball anteriorly out of the orbit .
- Incomplete lid closure: inability to full close of lid
- Ophthalmoplegia: failure in the external ocular movements due to muscle tethering.
- The acuity of the eye: decrease in the acuity may indicate compression in the optic nerve.
- Lid retraction: visible of the whites of the eyes above the iris.
- Lid lag: delay in the upper eye lid following downward rotation.
2- Toxic Multinodular goitre (plummer’s disease)
It is mostly unassociated with eye signs. It is more common in middle-aged or elderly patients. The patient has symptoms and sing of hyperthyroidism (Figure 15).
It is mostly unassociated with eye signs. It is more common in middle-aged or elderly patients. The patient has symptoms and sing of hyperthyroidism (Figure 15).