Graves Basedow Disease

Diagnosis and Treatment Aspects

By: Vîlceanu Maria Ramona

 Purpose

 Analysis of the particular forms of Graves

Basedow disease

 Incidence of other autoimune

determinations
 STUDY METHODS

 The study was made of a 100 patients group

with Graves Basedow disease, hospitalised
in Endocrinology Clinique of Timişoara,
Romania between 2004-2005
 SEXES REPARTITION
8%

 92% females females

males

 8% males 92%

100

 raport F/M=11,5/1 p
80
r
60
o females
c
40 males
e
n 20
t
e 0
F M
 GROUPS OF AGE REPARTITION
 The bigger incidence of this disease was at 41-60 years
group of age

Group of Age Number of subjects

11-20 years 6
21-30 years 11
31-40 years 10
41-50 years 31
51-60 years 29
61-70 years 8
71-80 years 5
 0
10
20
30
40
50
60
70
80
90
Palpitations
Loseweight
Effort dispneea
Physical asthenia
Excessivesweating
Psychomotoragitation
Psychoemotional lability
Insomniacevents
Thermophopbia
Poorappetite
Excessiveappetite
Ocularsymptoms
Lowintestinal motility
Increasedintestinal motility
Articularpains
Abdominal pains
Compression
Dysphagia

> 60 years
21 - 60 years

0
10
20
30
40
50
60
70
80
90

Polinodular goiter

Diffuse goiter

Absence of goiter

With sinus tachycardia

Whitout sinus tachycardia

Atrial fibrillation

Ventricular extrasystoles

Extremities fine tremor

Exophtalmie

Wet and warm teguments

Paresthesia
CLINICAL MANIFESTATIONS

> 60 years
21 - 60 years
 Symptoms:
 Palpitations
 Lose weight

 Effort dispneea

 Physical asthenia

 Excessive sweating

 Psychomotor agitations

 Psychoemotional lability

 Insomniac events
 Symptoms:
 Thermophobia
 Poor appetite or excessive appetite

 Ocular symptoms

 Low or increased intestinal motility

 Articular pains

 Abdominal pains

 Compressions

 Dysphagia
 Signs:
 Polynodular goiter
 Diffuse goiter

 Absence of goiter

 With or without sinusal tachycardia

 Atrial fibrillation

 Ventricular extrasystoles

 Exophtalmy

 Fine extremities tremor

 Wet and warm teguments

 Paresthesia
Dg. Graves Basedow Disease: diffuse
Dg. Graves Basedow Disease: diffuse
goiter. The thyroid butterfly is seen
goiter.
under the skin.

Dg. Graves Basedow Disease: moderate

diffuse goiter (the thyroid touch the
sternocleidomastoid muscle)
CARDIOTHYREOSE INCIDENCE
1 3
0,9
0,8 2,5 Atrial
0,7 fibrillation
0,6 2
0,5 Atrial 1,5 Ventricular
0,4 fibrillation extrasystoles
0,3 Cardiac 1
0,2
insufficiency 0,5 Cardiac
0,1 insufficiency
0 0
11 - 31 - 51 - 71 - males 11 - 21 - 31 - 41 - 51 - 61 - 71 -
20 40 60 80 20 ani 30 40 50 60 70 80 feamles
years years years years years years years years years years

 The bigger incidence of cardiothyreose was

observed at females and 41-80 years group of age
 INCIDENCE OF SEVERE
EXOPHTALMY FORMS
1 5
0,9 4,5
0,8 4 Infiltrative
0,7 Infiltrative 3,5
0,6 ophtalmopathy ophtalmopathy
subje 0,5
subje 3
0,4 2,5
cts Maligne cts
0,3 2 Maligne
0,2 ophtalmopathy 1,5
0,1 1 ophtalmopathy
0 0,5
11 - 31 - 51 - 71 -
20 40 60 80 males 0
years years years years
11 - 31 - 51 - 71 - females
20 40 60 80
years years years years

 Exophtalmy is bigger in 41-60 years group of age and

females
Bilateral moderate infiltrative exophtalmy. Bilateral severe infiltrative
The superior eyelid elevates over the iris. exophtalmy. The superior eyelid is more
elevated over the iris. Ocular motility
disorders. Convergent strabismus.

Bilateral moderate infiltrative exophtalmy , predominant in right eye. The superior eyelid elevates
over the iris. Incomplete palpebral occlusion at the right eye .
 DISEASES ASSOCIATED WITH GRAVES
BASEDOW DISEASE
 The most frequent disease associated with Graves Basedow
disease is arterial hypertension followed by osteoporosis,
ferriprive anemia, anxious-depressive disorder, decrease in
glucose tolerance and ischemic cardiopathy.

Arterial Hypertension
25%
Ferriprive anemia

27% Anxious-depressive
disorder
Decrease in glucose
tolerance
7%
Ischemic cardiopathy

14% Osteoporosis

8% 10%
POSTTREATMENT EVOLUTION

5% 6%
Compensation after
antithyroid drugs
Remission after
antithyroid drugs
45% Recidivation with
31% antithyroid drugs
Iatrogenic
hypothyroidism
Postsurgery
recidivation
7%
 CONCLUSIONS
 The bigger incidence of the disease in 41-60 years group of age

 Females were more affected than males F/M = 11.5/1

 The clinical manifestations are represented by the triad

exophtalmy, goiter, tachycardia

 Antithyroid treatment was efficient in most of the cases (45%). An

important percent (31%) presented postsurgery recidivations and
needed readministration of the antithyroid drugs or another
surgery.
Thank You!