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Thyrotoxicosis is the clinical syndromes, physiologic and biochemists who are when the fine weaves are exposed to, and respond to the high levels of the thyroid hormone. In most of the cases, the thyrotoxicosis is due to the hyperactivity of the gland of thyroid, or to hyperthyroidism (hypermetabolism). Once in a while, the thyrotoxicosis can be due to other causes such as excessive ingestion of the hormone of thyroid or the ectópicos sites of the form of the secretion. There are several forms of thyrotoxicosis and commonest it is tombs. Disease.
The disease of the tombs, also well-known like disease of Parry.s or Basedow.s or diffuse toxic goiter, is a disorder with three important manifestations: hyperthyroidism with the diffuse goiter, ophthalmopathy, and dermopathy. They do not appear together. In fact, one or two never needs to appear, and on the other hand, the three can work the courses that are to a large extent independent of one another one.
It is the thyrotoxicosis form commonest. It affects so much as 1,9 percents of the feminine population. The quotient of women to the men is as high as 7:1. It reaches his Maxima incidence between the third and ahead decades and the reason of the feminine predominance in this as in all the diseases of thyroid it is not known. The genetic factors play a role important, since there is haplotypes increasing HLA-B8 of a frequency and - DRw3 in caucasian, HLA-Bw36 in Japanese, and HLA-Bw46 in Chinese patients with the disease.
The disease of the tombs at the moment sees like disease autoinmune of the unknown cause. Hyperthyroidism is its main manifestation, TSH is suppressed yet and it has not identified any intrinsic abnormalitys in the gland.
In disease of the tombs, the lymphocytes of T sensitize themselves to the antigens within the thyroid gland and stimulate lymphocytes of B synthesize the antibodies to these antigens. A such antibody goes against the site of the receiver of TSH in the membrane of the cell of the thyroid and has the capacity to stimulate the cell of the thyroid to the increasing growth and the function.
The presence of these antibodies is correlated positively with active disease and the relapse of the disease. There is predisposition genetic underlying, but it is nor it clears what triggers. the acute episodes. Some factors that can urge the inmunorespuesta: pregnancy, particularly the period of the postpartum; excess of iodine, particularly in areas of the deficiency of iodine; therapy of lithium; virales or bacterial infections; glucocorticoid retírese.
The etiología and patogenesia of the tombs ophthalmopathy is not known. It can imply cytotoxic lymphocytes and orbital the sensitized cytotoxic antibodies to an antigen common in fibroblasts, orbital muscle, and the fine weave of the thyroid, that would cause the inflammation, giving by result the protuberance of the ocular globe of globes. Patogenesia of dermopathy can also imply this mechanism. The patients with exoftalmía and particularly those with dermopathy have high titles of circulating the antibodies of the TSH receiver almost always, suggesting these two clinical manifestations represent the most severe form of this disease.
Many symptoms of the thyrotoxicosis suggest a state of the excess of catecholamine, but the levels that circulate of epinephrine are normal; thus, in disease of the tombs, the body appears to be hyperactive to catecholamines and this can partly have to a hormone-half-full increase thyroid in receivers cardiac of catecholamine.
The identification of the thyroid gland spread enlarged, to hypercellular, vascular smoothness and. There is one hipertrofia and one hiperplasia parenchymatous. There is little generally or nothing of colloid present with the linfocítica infiltration and in some cases is impossible to distinguish the microscopic picture of tiroiditis of Hashimoto.s. The generalized linfoides disease is associated once in a while to hiperplasia and the infiltration and to the extension of bazo and the thymus. There it can be the degeneration of fibers of the skeletal muscle, extension of the heart, greasy infiltration or spread the fibrosis of the liver, the decalcification or the skeleton, and the loss of fine weave of the body.
Ophthalmopathy is characterized close and inflammatory it infiltrates of the orbital content. Dermopathy is characterized thickening of the dermis, that infiltrates with the lymphocytes and hidrofílico, metachromatically staining mucopolysaccarides.
The common clinical manifestations of hyperthyroidism are: palpitaciones, easy nervousness, fatigability, hiperquinesia, tremors, diarrea, excessive sweating, intolerancia to the heat, preference by cold. There is often marked loss of the weight without the loss of appetite. The weakness of the next muscle and the loss of mass of the muscle can be so severe that the patient cannot rise of a chair without aid. The patients often speak very quickly. The thyroid gland spreads enlarged, and can be asymmetric or lobulada. It can have bruit on the thyroid that means that the patient is thyrotoxic. From the patient the note often doesn.t the swelling of the neck and comes to the doctor due to the other samples and symptoms.
The samples of the eye of the disease of the tombs can be divided in two components: the espástico and the mechanic. The previous one includes the fixed glance, the delay of the cover, and the contraction of the cover and considers the facies of frightened.. The mechanical component consists of the protuberance of the ocular globe of the degree that varies with ophthalmoplegia and oculopathy congestivo characterized by chemosis, conjuntivitis, the periorbital swelling, and the potential complications of the corneous ulceración, the optical neuritis, and atrophy optician.Popup of hun it can early be unilateral but it progresses generally to the bilateral implication.
Dermopathy consists of the espesamiento of skin(photo), particularly on lukewarm the more loss. It is relatively rare and it is associated generally to ophthalmopathy. The skin cannot be chosen between the fingers. The implication of the body, with the formation of the bone and the subperiosteal swelling is particularly evident in the bones metacarpal, but this one is also rare. Finding of the common field of Amore is separation of the nails of its beds, or onycholysis(photo).
Part 2 will consist of the clinical management of the patient with disease of the tombs, including diagnosis of the laboratory, differentiated diagnosis, the treatment and the prognosis.
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