“Sarvendriyanam Nayanam pradhaanam’(Of all the sense organs the eyes are the most important)
Definition
A state thyroid hormone excess. Autoimmune Grave’s disease is the cause in the majority of patients, especially in the young: Multinodular goiter is the commonest cause in the older is group.
Prognosis
Unless treated adequately, most cases of Grave’s disease progress with ocular, psychological and cardiac complications causing irreversible changes. Recurrences can occur with any therapy but particularly after drug therapy, with up to 60% relapsing within the first year after stopping drug therapy, but 30-4-% remains euthyroid 10 years after cessation of therapy. Recurrences tend to be more in young patients, those with large goiters, opthalmopathy, or high serum concentrations of TRA. In about 15% of these patients, autoimmune hypothyroidism develops after 10-15 years. Permanent hypo-parathyroidism and vocal cord paralysis can occur after surgery. Opthalmopathy tends to worsen for 12-18 months after therapy, but stabilizes and improves in 60% of cases subsequently.
General Measures
Ensure sufficient calories to prevent weight loss. In patients with cardiac failure, usual procedures are adopted along with administration of full doses of antithyroid drugs, and digitalis, which should be tapered down as euthyrooid state obtains.
Advice to Patient
To understand the importance of drug therapy. To beware of possible side effects of antithyroid drugs and to report unusual symptoms like sore throat, gum bleeding, fever, infection, adenopathy etc. (best to give written instructions in the prescription). To stop therapy and report to physician in such an event
Follow Up
To repeat thyroid tests twice a year.
Therapy with antithyroid rugs may have to continue for up to 2 years. CBC and LFT as appropriate. After radio active iodine therapy, thyroid function studies to be repeated after 6 weeks, 12 weeks, 6 months, and annually thereafter, even if the patient is clinically euthyroid, to detect onset of hypothyroidism
Inadequate Response
Ensure patient compliance. Consider bigger dose of antithyroid drug, or radio active iodine therapy.
