False statement regarding Grave&;s disease
Graves disease (Diffuse Toxic Goiter) MC cause of hypehyroidism, caused by stimulatory autoantibodies to TSH-R Auto immune disease with strong familial predisposition More common in females with peak incidence between 40-60 years Characterized by thyrotoxicosis, diffuse goiter & extrathyroidal conditions (ophthalmopathy, dermopathy, thyroid acropachy and gynecomastia) Clinical features Hypehyroid symptoms (heat intolerance, increased sweating and thirst, weight loss despite adequate caloric intake). Symptoms of adrenergic stimulation (palpitations, nervousness, fatigue, emotional liability, hyperkinesis and tremors) MC GI symptom is increased frequency of bowel movements and diarrhoea Female patients often develop amenorrhoea, decreased feility and increased incidence of miscarriage Children experience rapid growth with early bone maturation. Older patients present with CVS complications (AD & CHF) Ove Cardiac failure presents in only 6-19% Weight loss, facial flushing, warm and moist skin, tachycardia, cutaneous vasodilation, collapsing pulse is seen on examination A fine tremor, muscle wasting and proximal muscle group weakness with hyperactive tendon reflexes often are present Overlying bruit or thrill at upper pole due to increased vascularity Loud venous gun in supraclavicular space Ophthalmopathy (Orbital proptosis) occurs in 50% dermopathy in 1-2% Dermopathy is characterized by deposition of glycosaminoglycans leading to thickened skin in pretibial region and dorsum of foot (pretibial myxedema) Gynecomastia is common in young men. Rare bony involvement leads to subperiosteal bone formation and swelling in metacarpals (thyroid acropachy) Ref : schwaz's principle of surgery 10th edition Pgno :1531
Goiter is diffuse and vascular
Cardiac failure is common
Remissions and exacerbation are not infrequent
Hyperophy/hyperplasia is due to TSH-RA bs
Endocrinology and breast