Causes of Graves Disease
List of causes of Graves Disease
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Graves Disease)
that could possibly cause Graves Disease includes:
- Graves's disease is autoimmune in etiology. The autoimmune process in Graves disease isinfluenced by a combination of environmental and genetic factors
More causes:
see full list of causes for Graves disease
Causes of Graves Disease (Diseases Database):
The follow list shows some of the possible medical causes of Graves Disease
that are listed by the Diseases Database:
Source: Diseases Database
Graves Disease Causes: Book Excerpts
Graves Disease as a complication of other conditions:
Other conditions that might have
Graves Disease as a complication may,
potentially, be an underlying cause of Graves Disease.
Our database lists the following as having
Graves Disease as a complication of that condition:
Graves Disease as a symptom:
Conditions listing Graves Disease
as a symptom may also be potential underlying causes of Graves Disease.
Our database lists the following as having
Graves Disease as a symptom of that condition:
Medications or substances causing Graves Disease:
The following drugs, medications, substances or toxins are some of the possible
causes of Graves Disease as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Thyroid replacement hormone - treatment for hypothyroidism can lead to hyperthyroidism.
- more drugs...»
Read more about medication causes of Graves Disease
Medical news summaries relating to Graves Disease:
The following medical news items are relevant to causes of Graves Disease:
Related information on causes of Graves Disease:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Graves Disease may be found in:
Causes of Graves Disease: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Graves Disease.
Proptosis/Exophthalmos:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- TAO
–Major cause of unilateral and bilateral proptosis
–Usually bilateral, although often asymmetric
–Course is variable
–Associated with Graves’ disease; more
commonly occurs in women, smokers, and in patients treated with radioactive iodine
-
Orbital cellulitis
–Most cases occur due to contiguous spread from sinusitis
-
Mucormycosis
–Occurs primarily in diabetic and
immunocompromised patients
- Orbital tumors
–Children: Dermoid, capillary hemangioma, rhabdomyosarcoma, lymphangioma, optic nerve glioma, leukemia (chloroma or granulocytic sarcoma), metastatic neuroblastoma, plexiform neurofibroma, teratoma
–Adults: Metastatic breast, lung, or prostate cancer; cavernous hemangioma; mucocele; lymphoid tumors; optic nerve sheath meningioma; neurofibroma; neurilemoma (schwannoma); fibrous histiocytoma; hemangiopericytoma
-
Trauma (e.g., intraorbital foreign body, retrobulbar hemorrhage)
-
Orbital vasculitis (e.g., Wegener's granulomatosis, polyarteritis nodosa)
-
Arteriovenous malformation (e.g., carotid-cavernous fistula, retina or brain)
- Cavernous sinus thrombosis
–Orbital cellulitis signs plus cranial neuropathies (third, fourth, fifth, and/or sixth)
–Mental status changes
–Usually bilateral and rapidly progressive
-
Neurofibromatosis
-
Pseudoproptosis
–Enlarged globe (myopia, buphthalmos)
–Enophthalmos of the fellow eye
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Proptosis/Exophthalmos:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Orbital cellulitis is associated with ethmoid sinusitis, presents with rapid onset of fever, EOM restriction, periorbital edema
- Malignancy
–Rhabdomyosarcoma: Most common primary pediatric orbital malignancy, average age 5–7, proptosis is presenting sign, may develop acutely
–Neuroblastoma: One of most common childhood cancers, most frequent source of orbital metastasis, associated with opsoclonus (rapid multidirectional eye movements), periorbital ecchymoses, 40% bilateral
–Acute leukemia: Most common childhood malignancy, may cause proptosis, ecchymosis, and lid edema
- Benign tumors
–Capillary hemangioma: Most common benign pediatric orbital tumor, females > males, presents in infancy, slowly progressive, increases in size with crying, associated with skin hemangioma, thrombocytopenic purpura
–Lymphangioma: Second most common benign pediatric orbital tumor consists of lymph-filled channels, may hemorrhage after minor trauma or URI (chocolate cyst)
- Neurofibromatosis type 1 (NF1)
–Optic gliomas: Slowly progressive, associated with decreased vision, optic disc atrophy, and swelling
–Orbital and periorbital plexiform neurofibromas; associated with sphenoid bone defects, may be pulsatile
- Hyperthyroidism
–Graves disease is the cause of hyperthyroidism most commonly associated with proptosis/exophthalmos
–Proptosis may be unilateral or bilateral, and lid retraction is common
-
Trauma
–Fracture of orbital bones and hemorrhage into the orbital space may cause proptosis, pain, and EOM impairment
-
Orbital dermoid cyst
–Rupture of cyst causes an inflammatory reaction
-
Craniosynostosis (e.g., Apert, Crouzon)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Exophthalmos:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Cavernous sinus thrombosis
Usually, cavernous sinus thrombosis causes the sudden onset of pulsating, unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, and impaired extraocular movement and visual acuity. Other features include a high fever with chills, papilledema, a headache, nausea, vomiting, somnolence and, rarely, seizures.
Dacryoadenitis
Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movements (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia
Foreign body in the eye
When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.
Hemangioma
Most common in young adults, this orbital tumor produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.
Lacrimal gland tumor
Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.
Leiomyosarcoma
Most common in people ages 45 and older, leiomyosarcoma is characterized by slowlydeveloping, unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.
Orbital cellulitis
Commonly the result of sinusitis, this ocular emergency causes the sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce a fever, eye pain, a headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.
Orbital choristoma
A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.
Orbital emphysema
Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.
Parasite infestation
Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.
Scleritis (posterior)
The gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.
Thyrotoxicosis
Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It's usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Thyroid enlargement:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Hypothyroidism
Hypothyroidism is most prevalent in women and usually results from a dysfunction of the thyroid gland, which may be due to surgery, irradiation therapy, chronic autoimmune thyroiditis (Hashimoto’s disease), or inflammatory conditions, such as amyloidosis and sarcoidosis. Besides an enlarged thyroid, signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.
Iodine deficiency
A goiter may result from a lack of iodine in the diet. If the goiter arises from a deficiency of iodine in the food or water of a particular area, it’s called an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.
Thyroiditis
Thyroiditis, an inflammation of the thyroid gland, may be classified as acute or subacute. It may be due to bacterial or viral infections, in which case associated features include fever and thyroid tenderness. The most prevalent cause of spontaneous hypothyroidism, however, is an autoimmune reaction, as occurs in Hashimoto’s thyroiditis. Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.
Thyrotoxicosis
Overproduction of thyroid hormone causes thyrotoxicosis. The most common form is Graves’disease, which may result from genetic or immunologic factors. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.
Tumors
An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.
Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.
Other causes
Goitrogens
Goitrogens are drugs — such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid — and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Exophthalmos:
Causes
(Professional Guide to Diseases (Eighth Edition))
Exophthalmos commonly results from hyperthyroidism, particularly ophthalmic Graves’disease in which the eyeballs are displaced forward and the lids retract. Unilateral exophthalmos may also result from trauma (such as fracture of the ethmoid bone, which allows air from the sinus to enter the orbital tissue, displacing soft tissue and the eyeball). Exophthalmos may also stem from hemorrhage, varicosities, thrombosis, and edema, all of which similarly displace one or both eyeballs.
Other systemic and ocular causes include:
❑ infection — orbital cellulitis, panophthalmitis, and infection of the lacrimal gland or orbital tissues
❑ parasitic cysts — in surrounding tissue
❑ pseudoexophthalmos paralysis of extraocular muscles — relaxation of eyeball retractors, congenital macrophthalmia, and high myopia
❑ tumors and neoplastic diseases — in children, rhabdomyosarcomas, leukemia, gliomas of the optic nerve, dermoid cysts, teratomas, metastatic neuroblastomas, and lymphoma; in adults, lacrimal gland tumors, mucoceles, cavernous hemangioma, meningiomas, metastatic carcinomas, and lymphoma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Simple goiter:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Simple goiter occurs when the thyroid gland can’t secrete enough thyroid hormone to meet metabolic requirements. As a result, the thyroid gland enlarges to compensate for inadequate hormone synthesis, a compensation that usually overcomes mild to moderate hormonal impairment. Because thyroid-stimulating hormone (TSH) levels are generally within normal limits in patients with simple goiter, goitrogenicity probably results from impaired intrathyroidal hormone synthesis and depletion of glandular iodine, which increases the thyroid gland’s sensitivity to TSH. However, increased levels of TSH may be transient and therefore missed.
Endemic goiter usually results from inadequate dietary intake of iodine, which leads to inadequate secretion of thyroid hormone. Since the introduction of iodized salt in the United States, cases of endemic goiter have virtually disappeared.
Sporadic goiter commonly results from the ingestion of large amounts of goitrogenic foods or the use of goitrogenic drugs. Goitrogenic foods, such as rutabagas, cabbage, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes, contain agents that decrease thyroxine (T4) production. Goitrogenic drugs include propylthiouracil, iodides, phenylbutazone, para-aminosalicylic acid, cobalt, and lithium. In a pregnant woman, these substances may cross the placenta and affect the fetus.
Inherited defects may be responsible for insufficient T4 synthesis or impaired iodine metabolism. Because families tend to congregate in a single geographic area, this familial factor may contribute to the incidence of both endemic and sporadic goiters.
Females are more commonly affected than males. Incidence increases after age 40.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hyperthyroidism:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Hyperthyroidism may result from both genetic and immunologic factors. An increased incidence of this disorder in monozygotic twins, for example, points to an inherited factor, probably an autosomal recessive gene. This disease occasionally coexists with abnormal iodine metabolism and other endocrine abnormalities, such as diabetes mellitus, hyperparathyroidism, and thyroiditis. Hyperthyroidism is also associated with autoantibody production (thyroid-stimulating immunoglobulin and thyroid-stimulating hormone [TSH]-binding inhibitory immunoglobulin), possibly due to a defect in suppressor–T-lymphocyte function that allows the formation of autoantibodies.
In latent hyperthyroidism, excessive dietary intake of iodine and, possibly, stress can precipitate clinical hyperthyroidism. In a person with inadequately treated hyperthyroidism, stress — including surgery, infection, toxemia of pregnancy, and diabetic ketoacidosis — can precipitate thyroid storm. (See Other forms of hyperthyroidism.)
Incidence of Graves’ disease is highest between ages 30 and 40, especially in people with family histories of thyroid abnormalities; only 5% of hyperthyroid patients are younger than age 15.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Thyroid enlargement:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Hypothyroidism
This disorder, which is most prevalent in women, usually results from a dysfunction of the thyroid gland caused by surgery, irradiation therapy, chronic autoimmune thyroiditis (Hashimoto’s disease), or inflammatory conditions, such as amyloidosis and sarcoidosis. Besides an enlarged thyroid, signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.
Iodine deficiency
A goiter may result from a lack of iodine in the diet. A goiter that arises from a deficiency of iodine in the food or water of a particular area is called an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.
Thyroiditis
Thyroiditis, an inflammation of the thyroid gland, may be classified as acute or subacute. It may be due to bacterial or viral infections, in which case associated features include fever and thyroid tenderness. The most prevalent cause of spontaneous hypothyroidism, however, is an autoimmune reaction, as occurs in Hashimoto’s thyroiditis. Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.
Thyrotoxicosis
Overproduction of thyroid hormone causes thyrotoxicosis. The most common form is Graves’disease, which may result from genetic or immunologic factors. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; diaphoresis; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.
Tumors
An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.
Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.
Other causes
Goitrogens
Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs containing goitrogens include lithium, sulfonamides, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Exophthalmos [Proptosis]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Cavernous sinus thrombosis
This disorder usually causes sudden onset of pulsating unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, limited extraocular movement, and impaired visual acuity. Other features include high fever with chills, papilledema, headache, nausea, vomiting, somnolence and, rarely, seizures.
Dacryoadenitis
Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movement (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia.
Foreign body in the eye
When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.
Hemangioma
Most common in young adults, this orbital tumor produces progressive exophthalmos, which may be mild or severe and unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movement, and blurred vision.
Hodgkin’s disease
In this disorder, unilateral exophthalmos may develop gradually along with eyelid edema, diplopia, and a palpable eyelid mass. More characteristic findings include painless swelling of one or more lymph nodes, intermittent fever, weight loss, fatigue, malaise, night sweats, hepatosplenomegaly, and pruritus.
Lacrimal gland tumor
Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.
Leiomyosarcoma
Most common in people ages 45 and older, this tumor is characterized by slowly developing unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.
Leukemia
When leukemia causes intraorbital hemorrhage, mild to moderate bilateral exophthalmos and lacrimal gland enlargement also result. Associated signs and symptoms include bleeding tendency, fever, arthralgia, pallor, weakness, hepatosplenomegaly and, possibly, lymphadenopathy.
Lymphangioma
Hemorrhage of this congenital tumor causes unilateral or bilateral exophthalmos, among other signs.
Neuroblastoma
This highly malignant tumor, the most common extracranial solid tumor of childhood, may produce exophthalmos.
Ocular tuberculosis
Occasionally, this rare disease causes progressive exophthalmos accompanied by ptosis, painless eyelid edema and erythema, and enlarged lacrimal glands. Examination may reveal yellow or white fat deposits on the cornea and small white nodules in the iris.
Optic nerve meningioma
This tumor usually produces unilateral exophthalmos and a swollen temple. Impaired visual acuity, visual field deficits, and headache may occur.
Orbital cellulitis
Commonly the result of sinusitis, this ocular emergency causes sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce eye pain, conjunctival injection, tearing, eyelid edema and erythema, a purulent discharge, and limited extraocular movement as well as fever, headache, and malaise.
Orbital choristoma
A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.
Orbital emphysema
Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.
Orbital pseudotumor
Progressive unilateral exophthalmos characterizes this uncommon disorder. Limited extraocular movement, eyelid edema, eye pain, and diplopia may also occur.
Parasite infestation
Usually, this disorder causes painless progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.
Scleritis (posterior)
Gradual onset of mild to severe unilateral exophthalmos is common in scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.
Thyrotoxicosis
Although a classic sign of this disorder, exophthalmos is absent in many patients. It’s usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Neck Mass/Thyroid Enlargement:
Differential Overview
(Field Guide to Bedside Diagnosis)
Neck Mass
❑ Inflammatory lymphadenopathy
❑ Parotid swelling/tumor
❑ Laryngeal cancer
❑ Intramuscular hematoma
❑ Lymphoma
❑ Nasopharyngeal carcinoma
❑ Branchial cleft cyst
❑ Thyroglossal duct cyst
❑ Supraclavicular adenopathy
❑ Aortic aneurysm
❑ Carotid aneurysm
❑ Ludwig angina
❑ Pharyngeal pouch
❑ Carotid body tumor
Thyroid Enlargement
❑ Simple goiter
❑ Hashimoto thyroiditis
❑ Grave disease
❑ Drugs
❑ Subacute thyroiditis
❑ Thyroid cancer
❑ Infiltrative disease
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Exophthalmos:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Grave disease
❑ Familial
❑ Orbital asymmetry
❑ Orbital cellulitis
❑ Cavernous sinus thrombosis
❑ Orbital hemorrhage/emphysema
❑ Intracavernous carotid artery aneurysm
❑ Arteriovenous fistula
❑ Carotid-cavernous sinus fistula
❑ Orbital tumor
❑ Pituitary apoplexy
❑ Meningioma
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Thyrotoxicosis:
Causes
(Handbook of Diseases)
Thyrotoxicosis may result from genetic and immunologic factors.
❑ An increased incidence of this disorder in monozygotic twins points to an inherited factor, probably an autosomal recessive gene.
❑ This disease occasionally coexists with other endocrine abnormalities, such as diabetes mellitus, thyroiditis, and hyperparathyroidism.
❑ Thyrotoxicosis may also be caused by the production of autoantibodies (thyroid-stimulating immunoglobulin and thyroid-stimulating hormone [TSH]-binding inhibitory immuno-globulin), possibly because of a defect in suppressor-T-lymphocyte function that allows the formation of autoantibodies.
❑ In latent thyrotoxicosis, excessive dietary intake of iodine and, possibly, stress can precipitate clinical thyrotoxicosis.
❑ In a person with inadequately treated thyrotoxicosis, stress — including surgery, infection, toxemia of pregnancy, and diabetic ketoacidosis — can precipitate thyroid storm.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Goiter:
Causes
(Handbook of Diseases)
Simple goiter occurs when the thyroid gland can’t produce and secrete enough thyroid hormone to meet metabolic requirements. As a result, the thyroid gland enlarges to compensate for inadequate hormone synthesis. Such compensation usually overcomes mild to moderate hormonal impairment.
Because thyroid-stimulating hormone (TSH) levels are generally within normal limits in patients with simple goiter, the disease probably results from impaired intrathyroidal hormone synthesis or depletion of glandular iodine, which increases the thyroid gland’s sensitivity to TSH. Thyroid growth-stimulating immunoglobulins can also cause gland enlargement. However, increased levels of TSH may be transient and therefore missed.
Endemic goiter
Endemic goiter usually results from inadequate dietary intake of iodine, which leads to inadequate production and secretion of thyroid hormone. The use of iodized salt prevents this deficiency.
Sporadic goiter
Sporadic goiter commonly results from the ingestion of large amounts of goitrogenic foods or the use of goitrogenic drugs.
Goitrogenic foods contain agents that decrease thyroxine (T4) production. Such foods include rutabagas, cabbage, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes.
Goitrogenic drugs include propylthiouracil, methimazole, iodides, and lithium. In a pregnant woman, such substances may cross the placenta and affect the fetus.
Both types
Inherited defects may be responsible for insufficient T4 synthesis or impaired iodine metabolism. Because families tend to congregate in a single geographic area, this familial factor may contribute to the incidence of both endemic and sporadic goiter.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Exophthalmos:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Foreign body in the eye
When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing. Loss of vision or blurred vision may occur in the affected eye.
Hemangioma
Most common in young adults, hemangioma is an orbital tumor that produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.
Lacrimal gland tumor
In patients with a lacrimal gland tumor, exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis, eye deviation, and pain.
Optic nerve meningioma
An optic nerve meningioma usually produces unilateral exophthalmos and a swollen temple. Impaired visual acuity, visual field deficits, and headache may occur.
Orbital cellulitis
Commonly the result of sinusitis, orbital cellulitis is an ocular emergency that causes sudden onset of unilateral exophthalmos, which may be mild or severe. It may also produce fever, eye pain, headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.
Orbital choristoma
A common sign of orbital choristoma (a benign tumor), progressive exophthalmos may be associated with diplopia and blurred vision. A mass may be visible in the orbital area.
Orbital emphysema
With orbital emphysema, air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation. The patient may report orbital pressure.
Parasite infestation
Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.
Scleritis (posterior)
Gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.
Thyrotoxicosis
Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It’s usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Thyroid enlargement:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Hypothyroidism
Besides an enlarged thyroid, signs and symptoms of hypothyroidism include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.
CULTURAL CUE:Goiters are common in areas of the world that are deficient in iodine, such as Asia, Latin America, Africa, and parts of Europe.
Thyroiditis
Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement. In subacute granulomatous thyroiditis, moderate thyroid enlargement may follow an upper respiratory infection or a sore throat. The thyroid may be painful and tender. Dysphagia may also occur.
Thyrotoxicosis
One of the classic features of thyrotoxicosis is an enlarged thyroid gland. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.
Tumors
An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.
Other causes
Goitrogens
Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs include lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Thyroid enlargement:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Hypothyroidism.Hypothyroidism causes an enlarged thyroid. Additional signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.
Iodine deficiency.A deficiency of iodine in the food or water of a particular area may cause an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.
Thyroiditis.Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.
Thyrotoxicosis.Signs and symptoms of thyrotoxicosis include an enlarged thyroid, nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.
Tumors.An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.
Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.
Other causes
Goitrogens.Goitrogens are drugs—such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid—and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Exophthalmos [Proptosis]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Cavernous sinus thrombosis.Usually, cavernous sinus thrombosis causes the sudden onset of pulsating, unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, and impaired extraocular movement and visual acuity. Other features include a high fever with chills, papilledema, a headache, nausea, vomiting, somnolence and, rarely, seizures.
Dacryoadenitis.Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movements (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia.
Foreign body in the eye.When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.
Hemangioma.This orbital tumor produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.
Lacrimal gland tumor.Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.
Leiomyosarcoma.Leiomyosarcoma is characterized by slowlydeveloping, unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.
Orbital cellulitis.Commonly the result of sinusitis, this ocular emergency causes the sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce a fever, eye pain, a headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.
Orbital choristoma.A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.
Orbital emphysema.Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.
Parasite infestation.Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.
Scleritis (posterior).The gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.
Thyrotoxicosis.Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It's usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Goiter:
Goiter - etiology
(The 5-Minute Pediatric Consult)
- The multinodular goiter 1 (MNG1) locus has been identified on chromosome 14q and on chromosome Xp22.
- Other genes implicated in simple goiter formation include thyroglobulin, thyroid-stimulating hormone (TSH) receptor, and Na+/I- symporter.
- Thyroid peroxidase mutations lead to iodide organification defects and goitrous congenital hypothyroidism.
- Twin and family studies show a modest to major contribution of environmental factors, especially iodine deficiency and cigarette smoking.
- Autoimmune goiters, such as chronic lymphocytic thyroiditis, occur in children with a genetic predisposition.
- Thyroid cancers are usually sporadic. Medullary carcinoma can be familial (autosomal dominant), as part of multiple endocrine neoplasia (MEN)-2A and -2B, or as isolated malignancy.
- Pendred syndrome (autosomal recessive) causes congenital sensorineural deafness and iodine organification defect that leads to goiter.
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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