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Hyperthyroidism
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Graves’ disease accounts for 95% of women with hyperthyroidism. It can be associated with diffuse thyromegaly or infiltrative ophthalmopathy. Non-Graves’ hyperthyroidism accounts for 5% of women with hyperthyroidism, and can be associated with gestational trophoblastic neoplasia [4, 7], toxic nodular and multinodular goiter [5], hyperfunctioning thyroid adenoma, subacute thyroiditis, extra thyroid source of thyroid hormone (e.g., struma ovarii), iodine-induced hyperthyroidism, thyrotropin receptor activation [8], or viral thyroiditis.
Exophthalmos (Proptosis)
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Exophthalmos or proptosis is characterized by a staring expression with prominence of the eyeballs and retraction of the upper eyelids. Hyperthyroidism is a common cause of exophthalmos. Although in most patients with hyperthyroidism the condition is bilateral, in the early stages, exophthalmos may be more marked in one eye. Exophthalmos may also develop in an eye of a patient previously treated for hyperthyroidism. Beside lid retraction, lid lag and wide palpebral fissures are important physical signs that usually result because of excessive sympathetic stimulation. Infiltrative ophthalmopathy occurs due to what is thought to be autoimmune disease. Retro-orbital fat, connective tissue, and the muscles are all involved.
Effect of IL-21 on the Balance of Th17 Cells/Treg Cells in the Pathogenesis of Graves’ Disease
Published in Endocrine Research, 2019
Yan Tan, Wei Chen, Chun Liu, Xiaoya Zheng, Ai Guo, Jian Long
Twenty-eight newly diagnosed patients with GD, 27 patients with eGD and 24 healthy individuals were recruited from the First Affiliated Hospital of Chongqing Medical University from October 2014 to June 2015. The study was approved by the First Affiliated Hospital of Chongqing Medical University Ethical Committee. Informed consent was obtained from all participants. According to the guidelines for the diagnosis and management of thyroid disease provided by the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) in 201126, the inclusion criteria for the GD group were as follows: (1) symptoms of elevated metabolism; (2) an increased thyroid hormone concentration and a decreased serum Thyroid-stimulating hormone (TSH) concentration; (3) diffuse thyroid enlargement (palpation and B-confirmed) with or without goiter; (4) anterior tibial mucinous edema; (5) eye bulging and other infiltrative ophthalmopathy; and (6) positivity for Thyrotrophin receptor antibody (TRAb), Thyroid-stimulating antibody (TSAb), Thyroid peroxidase antibody (TPOAb), and Thyroglobulin antibody (TgAb). The inclusion criteria for the eGD group were as follows: (1) diagnosis of GD; (2) methimazole (MMI) treatment for ≥ 1 year; (3) a normal level of thyroid function; and (4) a maintenance dose of 2.5–10 mg/d. The GD group included 21 females and 7 males. The eGD group included 21 females and 6 males. Twenty-four healthy volunteers, including 16 females and 8 males, were selected as normal controls. All the subjects were negative for acute and chronic infections, other autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus, and psoriasis), pregnancy, tumors, allergic diseases, glucocorticosteroid treatment and the consumption of iodine-containing foods or drugs within the last 3 days.