Graves′ orbitopathyPPT.pptVIP

*;Case report: Graves’ Disease;P.E. : diaphoresis, cachexia, a resting HR 110 beats/min, and a diffusely enlarged, nontender thyroid gland; lid retraction, mild proptosis,and conjunctival injection. The pt had been aware of a mass growing in the anterior neck for the previous 6 years and recent hair loss, heat intolerance, and a resting tremor. Thyrotropin levels were suppressed, at 0.01 mIU/L (reference range, 0.49 to 4.67). Total levels of triiodothyronine and thyroxine were elevated, at 791 ng/dL (reference range, 79 to 149) and more than 24 μg/dL (reference range, 4.5 to 12), respectively. The results of an immunoassay for levels of unbound triiodothyronine and thyroxine were not available. Dx: Graves’ disease. Tx: propranolol and methimazole resulted in a substantial improvement in fatigue, tremulousness, and tachycardia within 1 week. She was thereafter lost to follow-up.;*;Graves orbitopathy (GO);手術治療 ;A wait-and-see strategy in which pts are monitored until symptoms worsen can be challenged. First, many pts with even mild GO have a substantial decrease in their quality of life, as assessed either by general health–related quality-of-life questionnaires or by a GO–specific quality-of-life questionnaire (GO-QOL). Second, in a natural-history study of mild GO, spontaneous improvement occurred in about 20% of pts, but eye disease remained static in 65% and progressed in 15%. Two agents that may potentially inhibit pathogenic mechanisms believed to be relevant in GO are selenium and pentoxifylline.;Selenium is a trace mineral and an essential nutrient for selenocysteine synthesis. Selenocysteine is incorporated into several selenoproteins, mostly enzymes, in which selenium acts as a reduction–oxidation center and functions as an antioxidant. A number of in vitro studies have suggested that increased generation of oxygen free radicals plays a pathogenic role in GO. Selenium also has an important effect on the immune system and might be beneficial in Hashim