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!