I know I'll miss Group J
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Thursday, November 11, 2010
Wednesday, October 6, 2010
Causes of infertility
Other causes of infertility
For some couples attempting pregnancy, something goes wrong in this complex process, resulting in infertility. The cause or causes of infertility can involve one or both partners:
• In about 20 percent of cases, infertility is due to a cause involving only the male partner.
• In about 30 to 40 percent of cases, infertility is due to causes involving both the male and female.
• In the remaining 40 to 50 percent of cases, infertility is due entirely to a cause involving the female.
Combined infertility
In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.
Unexplained infertility
Up to 26% of infertile couples have unexplained infertility. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.
General health and lifestyle. General health and lifestyle may affect fertility. Some common causes of infertility related to health and lifestyle include:
• Emotional stress. Stress may interfere with certain hormones needed to produce sperm. Your sperm count may be affected if you experience excessive or prolonged emotional stress. A problem with fertility itself can sometimes become long term and discouraging, producing more stress.
• Malnutrition. Deficiencies in nutrients such as vitamin C, selenium, zinc and folate may contribute to infertility.
• Alcohol and drugs. Alcohol or drug dependency can be associated with poor health and reduced fertility. The use of certain drugs also can contribute to infertility. Anabolic steroids, for example, which are taken to stimulate muscle strength and growth, can cause the testicles to shrink and sperm production to decrease.
Environmental exposure. Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm count either directly by affecting testicular function or indirectly by altering the male hormonal system. Specific causes include:
• Pesticides and other chemicals. Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer. Lead exposure may also cause infertility.
• Overheating the testicles. Frequent use of saunas or hot tubs can elevate your core body temperature. This may impair your sperm production and lower your sperm count.
• Substance abuse. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm.
• Tobacco smoking. Men who smoke may have a lower sperm count than do those who don't smoke.
Environmental and occupational factors
Certain environmental factors may cause men to produce a less concentrated sperm, according to a government report. Exposure to lead, other heavy metals, and pesticides has also been associated with male infertility. Many other factors, such as excessive heat exposure, microwave radiation, ultrasound, and other health hazards, are more controversial as to whether they induce infertility.
Toxic effects related to tobacco, marijuana, and other drugs
Smoking may cause infertility in both men and women. In experimental animals, nicotine has been shown to block the production of sperm and decrease the size of a man's testicles. In women, tobacco changes the cervical mucus, thus affecting the way sperm reach the egg.
Marijuana may disrupt a woman's ovulation cycle (release of the egg). Marijuana use affects men by decreasing the sperm count and the quality of the sperm.
Heroin, cocaine, and crack cocaine use induces similar effects but places the user at increased risk for PID and HIV infection associated with risky sexual behavior.
In women, the effects of alcohol are related more to severe consequences for the fetus. Nevertheless, chronic alcoholism is related to disorders in ovulation and, therefore, interferes with fertility. Alcohol use by men interferes with the synthesis of testosterone and has an impact on sperm concentration. Alcoholism may delay a man's sexual response and may cause impotence (unable to have an erection).
Exercise
Exercise should be encouraged as part of normal activities. However, too much exercise is dangerous, especially for long-distance runners. For women, it may result in disruption of the ovulation cycle, cause no menstrual periods, or result in miscarriages (loss of pregnancy). In men, overexercise may cause a low sperm count.
Inadequate diet associated with extreme weight loss or gain
Obesity is becoming a major health issue in the United States. Obesity has an impact on infertility only when a woman's weight reaches extremes.
Weight loss with anorexia or bulimia can create problems with menstrual periods (no periods) and thyroid levels, thus disrupting normal ovulation.
• Caffeine intake. Studies are mixed on whether consuming too much caffeine may be associated with decreased fertility. Some studies have shown a decrease in fertility with increased caffeine use while others have not shown adverse effects. If there are effects, it's likely that caffeine has a greater impact on a woman's fertility than on a man's. High caffeine intake does appear to increase the risk of miscarriage.
Age
A woman becomes less fertile as she ages into her fifth decade of life (age 40-49 years). Among men, as they age, levels of testosterone fall, and the volume and concentration of sperm change.
Healthy couples younger than 30 years who have regular sexual intercourse and use no birth control methods have a 25-30% chance of achieving pregnancy each month. A woman's peak fertility is early in the third decade of life. As a woman ages beyond 35 years (and particularly after age 40 years), the likelihood of becoming pregnant is less than 10% per month.
For some couples attempting pregnancy, something goes wrong in this complex process, resulting in infertility. The cause or causes of infertility can involve one or both partners:
• In about 20 percent of cases, infertility is due to a cause involving only the male partner.
• In about 30 to 40 percent of cases, infertility is due to causes involving both the male and female.
• In the remaining 40 to 50 percent of cases, infertility is due entirely to a cause involving the female.
Combined infertility
In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.
Unexplained infertility
Up to 26% of infertile couples have unexplained infertility. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.
General health and lifestyle. General health and lifestyle may affect fertility. Some common causes of infertility related to health and lifestyle include:
• Emotional stress. Stress may interfere with certain hormones needed to produce sperm. Your sperm count may be affected if you experience excessive or prolonged emotional stress. A problem with fertility itself can sometimes become long term and discouraging, producing more stress.
• Malnutrition. Deficiencies in nutrients such as vitamin C, selenium, zinc and folate may contribute to infertility.
• Alcohol and drugs. Alcohol or drug dependency can be associated with poor health and reduced fertility. The use of certain drugs also can contribute to infertility. Anabolic steroids, for example, which are taken to stimulate muscle strength and growth, can cause the testicles to shrink and sperm production to decrease.
Environmental exposure. Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm count either directly by affecting testicular function or indirectly by altering the male hormonal system. Specific causes include:
• Pesticides and other chemicals. Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer. Lead exposure may also cause infertility.
• Overheating the testicles. Frequent use of saunas or hot tubs can elevate your core body temperature. This may impair your sperm production and lower your sperm count.
• Substance abuse. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm.
• Tobacco smoking. Men who smoke may have a lower sperm count than do those who don't smoke.
Environmental and occupational factors
Certain environmental factors may cause men to produce a less concentrated sperm, according to a government report. Exposure to lead, other heavy metals, and pesticides has also been associated with male infertility. Many other factors, such as excessive heat exposure, microwave radiation, ultrasound, and other health hazards, are more controversial as to whether they induce infertility.
Toxic effects related to tobacco, marijuana, and other drugs
Smoking may cause infertility in both men and women. In experimental animals, nicotine has been shown to block the production of sperm and decrease the size of a man's testicles. In women, tobacco changes the cervical mucus, thus affecting the way sperm reach the egg.
Marijuana may disrupt a woman's ovulation cycle (release of the egg). Marijuana use affects men by decreasing the sperm count and the quality of the sperm.
Heroin, cocaine, and crack cocaine use induces similar effects but places the user at increased risk for PID and HIV infection associated with risky sexual behavior.
In women, the effects of alcohol are related more to severe consequences for the fetus. Nevertheless, chronic alcoholism is related to disorders in ovulation and, therefore, interferes with fertility. Alcohol use by men interferes with the synthesis of testosterone and has an impact on sperm concentration. Alcoholism may delay a man's sexual response and may cause impotence (unable to have an erection).
Exercise
Exercise should be encouraged as part of normal activities. However, too much exercise is dangerous, especially for long-distance runners. For women, it may result in disruption of the ovulation cycle, cause no menstrual periods, or result in miscarriages (loss of pregnancy). In men, overexercise may cause a low sperm count.
Inadequate diet associated with extreme weight loss or gain
Obesity is becoming a major health issue in the United States. Obesity has an impact on infertility only when a woman's weight reaches extremes.
Weight loss with anorexia or bulimia can create problems with menstrual periods (no periods) and thyroid levels, thus disrupting normal ovulation.
• Caffeine intake. Studies are mixed on whether consuming too much caffeine may be associated with decreased fertility. Some studies have shown a decrease in fertility with increased caffeine use while others have not shown adverse effects. If there are effects, it's likely that caffeine has a greater impact on a woman's fertility than on a man's. High caffeine intake does appear to increase the risk of miscarriage.
Age
A woman becomes less fertile as she ages into her fifth decade of life (age 40-49 years). Among men, as they age, levels of testosterone fall, and the volume and concentration of sperm change.
Healthy couples younger than 30 years who have regular sexual intercourse and use no birth control methods have a 25-30% chance of achieving pregnancy each month. A woman's peak fertility is early in the third decade of life. As a woman ages beyond 35 years (and particularly after age 40 years), the likelihood of becoming pregnant is less than 10% per month.
Female Infertility Causes
Causes of Failure to Ovulate
Ovulatory disorders are one of the most common reasons why women are unable to conceive, and account for 30% of women's infertility. Fortunately, approximately 70% of these cases can be successfully treated by the use of drugs such as Clomiphene and Menogan/Repronex. The causes of failed ovulation can be categorized as follows:
(1) Hormonal Problems
• Failure to produce mature eggs
In approximately 50% of the cases of anovulation, the ovaries do not produce normal follicles inwhich the eggs can mature. Ovulation is rare if the eggs are immature and the chance of fertilization becomes almost nonexistent. Polycystic ovary syndrome, the most common disorder responsible for this problem, includes symptoms such as amenorrhoea, hirsutism, anovulation and infertility. This syndrome is characterized by a reduced production of FSH, and normal or increased levels of LH, oestrogen and testosterone. The current hypothesis is that the suppression of FSH associated with this condition causes only partial development of ovarian follicles, and follicular cysts can be detected in an ultrasound scan. The affected ovary often becomes surrounded with a smooth white capsule and is double its normal size. The increased level of oestrogen raises the risk of breast cancer.
• Malfunction of the hypothalamus
The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. If the hypothalamus fails to trigger and control this process, immature eggs will result. This is the cause of ovarian failure in 20% of cases.
• Malfunction of the pituitary gland
The pituitary's responsibility lies in producing and secreting FSH and LH. The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced. This can occur due to physical injury, a tumor or if there is a chemical imbalance in the pituitary.
(2) Scarred Ovaries
Physical damage to the ovaries may result in failed ovulation. Eg. extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur. Infection may also have this impact.
(3) Premature Menopause
This presents a rare and as of yet unexplainable cause of anovulation. It is hypothesized that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise. There is also a genetic possibility for this condition.
(4) Follicle Problems
Although currently unexplained, "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it every month yet the follicle fails to rupture.
Causes of Poorly Functioning Fallopian Tubes
Tubal disease affects approximately 25% of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for tubal disease is most commonly surgery and, owing to the advances in microsurgery and lasers, success rates (defined as the number of women who become pregnant within one year of surgery) are as high as 30% overall, with certain procedures having success rates up to 65%. The main causes of tubal damage include:
(1) Infection
Caused by both bacteria and viruses and usually transmitted sexually, these infections commonly cause inflammation resulting in scarring and damage. A specific example is Hydrosalpnix, a condition in which the fallopian tube is occluded at both ends and fluid collects in the tube.
(2) Abdominal Diseases
The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.
(3) Previous Surgeries
This is an important cause of tubal disease and damage. Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.
(4) Ectopic Pregnancy
This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage.
(5) Congenital Defects
In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.
Endometriosis
For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36%. This condition is characterized by excessive growth of the lining of the uterus, called the endometrium. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum. A positive diagnosis can only be made by diagnostic laparoscopy, a test that allows the physician to view the uterus, fallopian tubes, and pelvic cavity directly. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms.
Additional Factors
(1) Other variables that may cause infertility in women:
• At least 10% of all cases of female infertility are caused by an abnormal uterus. Conditions such as fibroid, polyps, and adenomyosis may lead to obstruction of the uterus and Fallopian tubes.
• Congenital abnormalities, such as septate uterus, may lead to recurrent miscarriages or the inability to conceive.
• Approximately 3% of couples face infertility due to problems with the female cervical mucus. The mucus needs to be of a certain consistency and available in adequate amounts for sperm to swim easily within it. The most common reason for abnormal cervical mucus is a hormone imbalance (too little estrogen or too much progesterone)
(2) Behavioral Factors:
Diet and Exercise
Optimal reproductive functioning requires both proper diet and appropriate levels of exercise. Women who are significantly overweight or underweight may have difficulty becoming pregnant.
Smoking
Cigarette smoking has been shown to lower sperm counts in men and increases the risk of miscarriage, premature birth, and low-birth-weight babies for women. Smoking by either partner reduces the chance of conceiving with each cycle, either naturally or by IVF, by one-third.
Alcohol
Alcohol intake greatly increases the risk of birth defects for women and, if in high enough levels in the mother’s blood, may cause Fetal Alcohol Syndrome. Alcohol also affects sperm counts in men.
Drugs
Drugs, such as marijuana and anabolic steroids, may impact sperm counts in men. Cocaine use in pregnant women may cause severe retardations and kidney problems in the baby and is perhaps the worst possible drug to abuse while pregnant.
(3) Environmental and Occupational Factors:
Lead: Lead can produce teratospermias (abnormal sperm) and is thought to be an abortifacient
Medical Treatments and Materials: radiation therapy
Ethylene Oxide: may cause birth defects in early pregnancy and has the potential to provoke early miscarriage.
Dibromochloropropane (DBCP): Handling the chemicals found in pesticides, such as DBCP, can cause ovarian problems, leading to a variety of health conditions, like early menopause, that may directly impact fertility.
Ovulatory disorders are one of the most common reasons why women are unable to conceive, and account for 30% of women's infertility. Fortunately, approximately 70% of these cases can be successfully treated by the use of drugs such as Clomiphene and Menogan/Repronex. The causes of failed ovulation can be categorized as follows:
(1) Hormonal Problems
• Failure to produce mature eggs
In approximately 50% of the cases of anovulation, the ovaries do not produce normal follicles inwhich the eggs can mature. Ovulation is rare if the eggs are immature and the chance of fertilization becomes almost nonexistent. Polycystic ovary syndrome, the most common disorder responsible for this problem, includes symptoms such as amenorrhoea, hirsutism, anovulation and infertility. This syndrome is characterized by a reduced production of FSH, and normal or increased levels of LH, oestrogen and testosterone. The current hypothesis is that the suppression of FSH associated with this condition causes only partial development of ovarian follicles, and follicular cysts can be detected in an ultrasound scan. The affected ovary often becomes surrounded with a smooth white capsule and is double its normal size. The increased level of oestrogen raises the risk of breast cancer.
• Malfunction of the hypothalamus
The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. If the hypothalamus fails to trigger and control this process, immature eggs will result. This is the cause of ovarian failure in 20% of cases.
• Malfunction of the pituitary gland
The pituitary's responsibility lies in producing and secreting FSH and LH. The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced. This can occur due to physical injury, a tumor or if there is a chemical imbalance in the pituitary.
(2) Scarred Ovaries
Physical damage to the ovaries may result in failed ovulation. Eg. extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur. Infection may also have this impact.
(3) Premature Menopause
This presents a rare and as of yet unexplainable cause of anovulation. It is hypothesized that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise. There is also a genetic possibility for this condition.
(4) Follicle Problems
Although currently unexplained, "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it every month yet the follicle fails to rupture.
Causes of Poorly Functioning Fallopian Tubes
Tubal disease affects approximately 25% of infertile couples and varies widely, ranging from mild adhesions to complete tubal blockage. Treatment for tubal disease is most commonly surgery and, owing to the advances in microsurgery and lasers, success rates (defined as the number of women who become pregnant within one year of surgery) are as high as 30% overall, with certain procedures having success rates up to 65%. The main causes of tubal damage include:
(1) Infection
Caused by both bacteria and viruses and usually transmitted sexually, these infections commonly cause inflammation resulting in scarring and damage. A specific example is Hydrosalpnix, a condition in which the fallopian tube is occluded at both ends and fluid collects in the tube.
(2) Abdominal Diseases
The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.
(3) Previous Surgeries
This is an important cause of tubal disease and damage. Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.
(4) Ectopic Pregnancy
This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage.
(5) Congenital Defects
In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.
Endometriosis
For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36%. This condition is characterized by excessive growth of the lining of the uterus, called the endometrium. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum. A positive diagnosis can only be made by diagnostic laparoscopy, a test that allows the physician to view the uterus, fallopian tubes, and pelvic cavity directly. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms.
Additional Factors
(1) Other variables that may cause infertility in women:
• At least 10% of all cases of female infertility are caused by an abnormal uterus. Conditions such as fibroid, polyps, and adenomyosis may lead to obstruction of the uterus and Fallopian tubes.
• Congenital abnormalities, such as septate uterus, may lead to recurrent miscarriages or the inability to conceive.
• Approximately 3% of couples face infertility due to problems with the female cervical mucus. The mucus needs to be of a certain consistency and available in adequate amounts for sperm to swim easily within it. The most common reason for abnormal cervical mucus is a hormone imbalance (too little estrogen or too much progesterone)
(2) Behavioral Factors:
Diet and Exercise
Optimal reproductive functioning requires both proper diet and appropriate levels of exercise. Women who are significantly overweight or underweight may have difficulty becoming pregnant.
Smoking
Cigarette smoking has been shown to lower sperm counts in men and increases the risk of miscarriage, premature birth, and low-birth-weight babies for women. Smoking by either partner reduces the chance of conceiving with each cycle, either naturally or by IVF, by one-third.
Alcohol
Alcohol intake greatly increases the risk of birth defects for women and, if in high enough levels in the mother’s blood, may cause Fetal Alcohol Syndrome. Alcohol also affects sperm counts in men.
Drugs
Drugs, such as marijuana and anabolic steroids, may impact sperm counts in men. Cocaine use in pregnant women may cause severe retardations and kidney problems in the baby and is perhaps the worst possible drug to abuse while pregnant.
(3) Environmental and Occupational Factors:
Lead: Lead can produce teratospermias (abnormal sperm) and is thought to be an abortifacient
Medical Treatments and Materials: radiation therapy
Ethylene Oxide: may cause birth defects in early pregnancy and has the potential to provoke early miscarriage.
Dibromochloropropane (DBCP): Handling the chemicals found in pesticides, such as DBCP, can cause ovarian problems, leading to a variety of health conditions, like early menopause, that may directly impact fertility.
Wednesday, September 29, 2010
Kline and turn
Turner syndrome
Turner syndrome or Ullrich-Turner syndrome (also known as "Gonadal dysgenesis”) encompasses several conditions, of which monosomy X (absence of an entire sex chromosome, the Barr body) is most common. It is a chromosomal abnormality in which all or part of one of the sex chromosomes is absent (unaffected humans have 46 chromosomes, of which two are sex chromosomes). Typical females have two X chromosomes, but in Turner syndrome, one of those sex chromosomes is missing or has other abnormalities. In some cases, the chromosome is missing in some cells but not others, a condition referred to as mosaicism[2] or 'Turner mosaicism'.
Occurring in 1 out of every 2500 girls,
There are characteristic physical abnormalities, such as short stature, swelling, broad chest, low hairline, low-set ears, and webbed necks
Girls with Turner syndrome typically experience gonadal dysfunction (non-working ovaries), which results in amenorrhea (absence of menstrual cycle) and sterility. Concurrent health concerns are also frequently present, including congenital heart disease, hypothyroidism (reduced hormone secretion by the thyroid), diabetes, vision problems, hearing concerns, and many autoimmune diseases.[4] Finally, a specific pattern of cognitive deficits is often observed, with particular difficulties in visuospatial, mathematical, and memory areas
Common symptoms of Turner syndrome include:
• Short stature
• Lymphedema (swelling) of the hands and feet
• Broad chest (shield chest) and widely spaced nipples
• Low hairline
• Low-set ears
• Reproductive sterility
• Rudimentary ovaries gonadal streak (underdeveloped gonadal structures)
• Amenorrhoea, or the absence of a menstrual period
• Increased weight, obesity
• Shield shaped thorax of heart
• Shortened metacarpal IV
• Small fingernails
• Characteristic facial features
• Webbed neck from cystic hygroma in infancy
• Coarctation of the aorta
• Bicuspid aortic valve
• Poor breast development
• Horseshoe kidney
• Visual impairments sclera, cornea, glaucoma, etc.
• Ear infections and hearing loss
• High waist-to-hip ratio (the hips are not much bigger than the waist)
• Attention Deficit/Hyperactivity Disorder (problems with concentration, memory and attention)
• Nonverbal Learning Disability (problems with math, social skills and spatial relations)
Women with Turner syndrome are almost universally infertile. While some women with Turner syndrome have successfully become pregnant and carried their pregnancies to term, this is very rare and is generally limited to those women whose karyotypes are not 45,X.[18][19] Even when such pregnancies do occur, there is a higher than average risk of miscarriage or birth defects, including Turner Syndrome or Down Syndrome.[20] Some women with Turner syndrome who are unable to conceive without medical intervention may be able to use IVF or other fertility treatments.[21]
Klinefelter's syndrome
Klinefelter's syndrome, 47, XXY, or XXY syndrome is a condition in which human males have an extra X chromosome. While females have an XX chromosomal makeup, and males an XY, affected individuals have at least two X chromosomes and at least one Y chromosome.[1] Because of the extra chromosome, individuals with the condition are usually referred to as "XXY Males", or "47, XXY Males".[2]
In humans, Klinefelter's syndrome is the most common sex chromosome disorder[3
The condition exists in roughly 1 out of every 1,000 males. One in every 500 males has an extra X chromosome but does not have the syndrome.[4] Other mammals also have the XXY syndrome, including mice
The principal effects are development of small testicles and reduced fertility. A variety of other physical and behavioral differences and problems are common, though severity varies and many boys and men with the condition have few detectable symptoms.
Affected males are almost always effectively infertile, although advanced reproductive assistance is sometimes possible.
The term hypogonadism in XXY symptoms is often misinterpreted to mean "small testicles" or "small penis".
Males with Klinefelter syndrome may have a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. Thus far, only about 10 cases have been described in literature.[20]
Turner syndrome or Ullrich-Turner syndrome (also known as "Gonadal dysgenesis”) encompasses several conditions, of which monosomy X (absence of an entire sex chromosome, the Barr body) is most common. It is a chromosomal abnormality in which all or part of one of the sex chromosomes is absent (unaffected humans have 46 chromosomes, of which two are sex chromosomes). Typical females have two X chromosomes, but in Turner syndrome, one of those sex chromosomes is missing or has other abnormalities. In some cases, the chromosome is missing in some cells but not others, a condition referred to as mosaicism[2] or 'Turner mosaicism'.
Occurring in 1 out of every 2500 girls,
There are characteristic physical abnormalities, such as short stature, swelling, broad chest, low hairline, low-set ears, and webbed necks
Girls with Turner syndrome typically experience gonadal dysfunction (non-working ovaries), which results in amenorrhea (absence of menstrual cycle) and sterility. Concurrent health concerns are also frequently present, including congenital heart disease, hypothyroidism (reduced hormone secretion by the thyroid), diabetes, vision problems, hearing concerns, and many autoimmune diseases.[4] Finally, a specific pattern of cognitive deficits is often observed, with particular difficulties in visuospatial, mathematical, and memory areas
Common symptoms of Turner syndrome include:
• Short stature
• Lymphedema (swelling) of the hands and feet
• Broad chest (shield chest) and widely spaced nipples
• Low hairline
• Low-set ears
• Reproductive sterility
• Rudimentary ovaries gonadal streak (underdeveloped gonadal structures)
• Amenorrhoea, or the absence of a menstrual period
• Increased weight, obesity
• Shield shaped thorax of heart
• Shortened metacarpal IV
• Small fingernails
• Characteristic facial features
• Webbed neck from cystic hygroma in infancy
• Coarctation of the aorta
• Bicuspid aortic valve
• Poor breast development
• Horseshoe kidney
• Visual impairments sclera, cornea, glaucoma, etc.
• Ear infections and hearing loss
• High waist-to-hip ratio (the hips are not much bigger than the waist)
• Attention Deficit/Hyperactivity Disorder (problems with concentration, memory and attention)
• Nonverbal Learning Disability (problems with math, social skills and spatial relations)
Women with Turner syndrome are almost universally infertile. While some women with Turner syndrome have successfully become pregnant and carried their pregnancies to term, this is very rare and is generally limited to those women whose karyotypes are not 45,X.[18][19] Even when such pregnancies do occur, there is a higher than average risk of miscarriage or birth defects, including Turner Syndrome or Down Syndrome.[20] Some women with Turner syndrome who are unable to conceive without medical intervention may be able to use IVF or other fertility treatments.[21]
Klinefelter's syndrome
Klinefelter's syndrome, 47, XXY, or XXY syndrome is a condition in which human males have an extra X chromosome. While females have an XX chromosomal makeup, and males an XY, affected individuals have at least two X chromosomes and at least one Y chromosome.[1] Because of the extra chromosome, individuals with the condition are usually referred to as "XXY Males", or "47, XXY Males".[2]
In humans, Klinefelter's syndrome is the most common sex chromosome disorder[3
The condition exists in roughly 1 out of every 1,000 males. One in every 500 males has an extra X chromosome but does not have the syndrome.[4] Other mammals also have the XXY syndrome, including mice
The principal effects are development of small testicles and reduced fertility. A variety of other physical and behavioral differences and problems are common, though severity varies and many boys and men with the condition have few detectable symptoms.
Affected males are almost always effectively infertile, although advanced reproductive assistance is sometimes possible.
The term hypogonadism in XXY symptoms is often misinterpreted to mean "small testicles" or "small penis".
Males with Klinefelter syndrome may have a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. Thus far, only about 10 cases have been described in literature.[20]
Wednesday, September 22, 2010
Treatment of hyperthyroidism
The options for treating hyperthyroidism include:
Temporary treatments
• Treating the symptoms
• Antithyroid drugs (Thyrostatics)
Permanent Treatments
• Radioactive iodine
• Surgery treating symptoms
Temporary Treatments
Treating the symptoms
Many of the neurologic and cardiovascular symptoms of thyrotoxicosis are relieved by beta-blocker therapy [propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor)]. These medications counteract the effect of thyroid hormone to increase metabolism, but they do not alter the levels of thyroid hormones in the blood. A doctor determines which patients to treat based on a number of variables including the underlying cause of hyperthyroidism, the age of the patient, the size of the thyroid gland, and the presence of coexisting medical illnesses.
Thyrostatics (Antithyroid drugs)
There are two main antithyroid drugs available for use in the US, methimazole (Tapazole) and propylthiouracil (PTU). These drugs accumulate in the thyroid tissue and block production of thyroid hormones. PTU also blocks the conversion of T4(thyroxine) hormone to the more metabolically active T3(triiodothyoinine) hormone. The major risk of these medications is occasional suppression of production of white blood cells by the bone marrow (agranulocytosis).
It is important for patients to know that if they develop a fever, a sore throat, or any signs of infection while taking methimazole or propylthiouracil, they should see a doctor immediately. While a concern, the actual risk of developing agranulocytosis is less than 1%. In general, patients should be seen by the doctor at monthly intervals while taking antithyroid medication. The dose is adjusted to maintain the patient in as close to a normal thyroid state as possible (euthyroid). Once the dosing is stable, patients can be seen at three month intervals if long-term therapy is planned.
Usually, long-term antithyroid therapy is only used for patients with Graves' disease, since this disease may actually go into remission under treatment without requiring treatment with thyroid radiation or surgery. If treated from one to two years, the data shows remission rates of 40%-70%. When the disease is in remission, the gland is no longer overactive, and antithyroid medication is not needed.
Recent studies also have shown that adding a pill of thyroid hormone to the antithyroid medication actually results in higher remission rates. The rationale for this may be that by providing an external source for thyroid hormone, higher doses of antithyroid medications can be given, which may suppress the overactive immune system in persons with Graves' disease. This type of therapy remains controversial, however. When long-term therapy is withdrawn, patients should continue to be seen by the doctor every three months for the first year, since a relapse of Graves' disease is most likely in this time period. If a patient does relapse, antithyroid drug therapy can be restarted, or radioactive iodine or surgery may be considered.
Permanent treatments
Surgery as an option predates the use of the less invasive radioisotope therapy (radioiodine 131 thyroid ablation), but is still required in cases where the thyroid gland is enlarged and causing compression to the neck structures, or the underlying cause of the hyperthyroidism may be cancerous in origin. Some patients suffering from the related condition of thyroid eye disease leading to diplopia because this condition can be worsened by radiotherapy treatment.
Radioactive Iodine
Radioactive iodine is given orally (either by pill or liquid) on a one-time basis to ablate a hyperactive gland. The iodine given for ablative treatment is different from the iodine used in a scan. (For treatment, the isotope iodine 131 is used, while for a routine scan, iodine 123 is used.) Radioactive iodine is given after a routine iodine scan, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local, and there are no widespread side effects with this therapy.
Radioactive iodine ablation has been safely used for over 50 years, and the only major reasons for not using it are pregnancy and breast-feeding. This form of therapy is the treatment of choice for recurring Graves' disease, patients with severe cardiac involvement, those with multinodular goiter or toxic adenomas, and patients who cannot tolerate antithyroid drugs. Radioactive iodine must be used with caution in patients with Graves' related eye disease since recent studies have shown that the eye disease may worsen after therapy. If a woman chooses to become pregnant after ablation, it is recommended she wait 8-12 months after treatment before conceiving.
In general, more than 80% of patients are cured with a single dose of radioactive iodine. It takes between 8 to 12 weeks for the thyroid to become normal after therapy. Permanent hypothyroidism is the major complication of this form of treatment. While a temporary hypothyroid state may be seen up to six months after treatment with radioactive iodine, if it persists longer than six months, thyroid replacement therapy (with T4 or T3) usually is begun.
Surgery
Surgery to partially remove the thyroid gland (partial thyroidectomy) was once a common form of treatment for hyperthyroidism. The goal is to remove the thyroid tissue that was producing the excessive thyroid hormone. However, if too much tissue is removed, an inadequate production of thyroid hormone (hypothyroidism) may result. In this case, thyroid replacement therapy is begun. The major complication of surgery is disruption of the surrounding tissue, including the nerves supplying the vocal cords and the four tiny glands in the neck that regulate calcium levels in the body (the parathyroid glands). Accidental removal of these glands may result in low calcium levels and require calcium replacement therapy.
With the introduction of radioactive iodine therapy and antithyroid drugs, surgery for hyperthyroidism is not as common as it used to be. Surgery is appropriate for:
• pregnant patients and children who have major adverse reactions to antithyroid medications.
• patients with very large thyroid glands and in those who have symptoms stemming from compression of tissues adjacent to the thyroid, such as difficulty swallowing, hoarseness, and shortness of breath.
Subtotal thyroidectomy is the oldest form of treatment for hyperthyroidism. Total thyroidectomy and combinations of hemithyroidectomies and contralateral subtotal thyroidectomies also have been used.
• Because of excellent effectiveness in regulating thyroid function with antithyroid medications and radioactive iodine, thyroidectomy is reserved for special circumstances, including the following:
o Severe hyperthyroidism in children
o Pregnant women who are noncompliant or intolerant of antithyroid medication
o Patients with very large goiters or severe ophthalmopathy
o Patients who refuse radioactive iodine therapy
o Refractory amiodarone-induced hyperthyroidism
o Patients who require normalization of thyroid functions quickly, such as pregnant women, women who desire pregnancy in the next 6 months, or patients with unstable cardiac conditions
• With current operative techniques, bilateral subtotal thyroidectomy should have a mortality rate approaching zero in patients who are properly prepared. Historically, the most common cause of thyroid storm, a physiologic decompensation in patients who are severely thyrotoxic, with a mortality rate of 50-100%, is operative stress.
• Preoperative preparation includes antithyroid medication, stable (cold) iodine treatment (to decrease gland vascularity), and beta-blocker therapy.5
o Generally, antithyroid drug therapy should be administered until thyroid functions normalize (4-8 wk).
o Titrate propranolol until the resting pulse rate is less than 80 bpm.
o Finally, administer iodide as SSKI (1-2 drops bid for 10-14 d) before surgery.
o An additional benefit from stable iodide therapy, besides the reduction in thyroid hormone excretion, is a demonstrated decrease in thyroid blood flow and possible reduction in blood loss during surgery.
• Adverse effects of therapy include recurrent laryngeal nerve damage and hypoparathyroidism due to damage of local structures during surgery. (A Swiss study indicated that a single dose of steroid administered prior to thyroidectomy can reduce nausea, pain, and vomiting associated with the procedure, as well as improve voice function.
*Ablation means removal of material from the surface of an object by vaporization, chipping, or other erosive processes.
Temporary treatments
• Treating the symptoms
• Antithyroid drugs (Thyrostatics)
Permanent Treatments
• Radioactive iodine
• Surgery treating symptoms
Temporary Treatments
Treating the symptoms
Many of the neurologic and cardiovascular symptoms of thyrotoxicosis are relieved by beta-blocker therapy [propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor)]. These medications counteract the effect of thyroid hormone to increase metabolism, but they do not alter the levels of thyroid hormones in the blood. A doctor determines which patients to treat based on a number of variables including the underlying cause of hyperthyroidism, the age of the patient, the size of the thyroid gland, and the presence of coexisting medical illnesses.
Thyrostatics (Antithyroid drugs)
There are two main antithyroid drugs available for use in the US, methimazole (Tapazole) and propylthiouracil (PTU). These drugs accumulate in the thyroid tissue and block production of thyroid hormones. PTU also blocks the conversion of T4(thyroxine) hormone to the more metabolically active T3(triiodothyoinine) hormone. The major risk of these medications is occasional suppression of production of white blood cells by the bone marrow (agranulocytosis).
It is important for patients to know that if they develop a fever, a sore throat, or any signs of infection while taking methimazole or propylthiouracil, they should see a doctor immediately. While a concern, the actual risk of developing agranulocytosis is less than 1%. In general, patients should be seen by the doctor at monthly intervals while taking antithyroid medication. The dose is adjusted to maintain the patient in as close to a normal thyroid state as possible (euthyroid). Once the dosing is stable, patients can be seen at three month intervals if long-term therapy is planned.
Usually, long-term antithyroid therapy is only used for patients with Graves' disease, since this disease may actually go into remission under treatment without requiring treatment with thyroid radiation or surgery. If treated from one to two years, the data shows remission rates of 40%-70%. When the disease is in remission, the gland is no longer overactive, and antithyroid medication is not needed.
Recent studies also have shown that adding a pill of thyroid hormone to the antithyroid medication actually results in higher remission rates. The rationale for this may be that by providing an external source for thyroid hormone, higher doses of antithyroid medications can be given, which may suppress the overactive immune system in persons with Graves' disease. This type of therapy remains controversial, however. When long-term therapy is withdrawn, patients should continue to be seen by the doctor every three months for the first year, since a relapse of Graves' disease is most likely in this time period. If a patient does relapse, antithyroid drug therapy can be restarted, or radioactive iodine or surgery may be considered.
Permanent treatments
Surgery as an option predates the use of the less invasive radioisotope therapy (radioiodine 131 thyroid ablation), but is still required in cases where the thyroid gland is enlarged and causing compression to the neck structures, or the underlying cause of the hyperthyroidism may be cancerous in origin. Some patients suffering from the related condition of thyroid eye disease leading to diplopia because this condition can be worsened by radiotherapy treatment.
Radioactive Iodine
Radioactive iodine is given orally (either by pill or liquid) on a one-time basis to ablate a hyperactive gland. The iodine given for ablative treatment is different from the iodine used in a scan. (For treatment, the isotope iodine 131 is used, while for a routine scan, iodine 123 is used.) Radioactive iodine is given after a routine iodine scan, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local, and there are no widespread side effects with this therapy.
Radioactive iodine ablation has been safely used for over 50 years, and the only major reasons for not using it are pregnancy and breast-feeding. This form of therapy is the treatment of choice for recurring Graves' disease, patients with severe cardiac involvement, those with multinodular goiter or toxic adenomas, and patients who cannot tolerate antithyroid drugs. Radioactive iodine must be used with caution in patients with Graves' related eye disease since recent studies have shown that the eye disease may worsen after therapy. If a woman chooses to become pregnant after ablation, it is recommended she wait 8-12 months after treatment before conceiving.
In general, more than 80% of patients are cured with a single dose of radioactive iodine. It takes between 8 to 12 weeks for the thyroid to become normal after therapy. Permanent hypothyroidism is the major complication of this form of treatment. While a temporary hypothyroid state may be seen up to six months after treatment with radioactive iodine, if it persists longer than six months, thyroid replacement therapy (with T4 or T3) usually is begun.
Surgery
Surgery to partially remove the thyroid gland (partial thyroidectomy) was once a common form of treatment for hyperthyroidism. The goal is to remove the thyroid tissue that was producing the excessive thyroid hormone. However, if too much tissue is removed, an inadequate production of thyroid hormone (hypothyroidism) may result. In this case, thyroid replacement therapy is begun. The major complication of surgery is disruption of the surrounding tissue, including the nerves supplying the vocal cords and the four tiny glands in the neck that regulate calcium levels in the body (the parathyroid glands). Accidental removal of these glands may result in low calcium levels and require calcium replacement therapy.
With the introduction of radioactive iodine therapy and antithyroid drugs, surgery for hyperthyroidism is not as common as it used to be. Surgery is appropriate for:
• pregnant patients and children who have major adverse reactions to antithyroid medications.
• patients with very large thyroid glands and in those who have symptoms stemming from compression of tissues adjacent to the thyroid, such as difficulty swallowing, hoarseness, and shortness of breath.
Subtotal thyroidectomy is the oldest form of treatment for hyperthyroidism. Total thyroidectomy and combinations of hemithyroidectomies and contralateral subtotal thyroidectomies also have been used.
• Because of excellent effectiveness in regulating thyroid function with antithyroid medications and radioactive iodine, thyroidectomy is reserved for special circumstances, including the following:
o Severe hyperthyroidism in children
o Pregnant women who are noncompliant or intolerant of antithyroid medication
o Patients with very large goiters or severe ophthalmopathy
o Patients who refuse radioactive iodine therapy
o Refractory amiodarone-induced hyperthyroidism
o Patients who require normalization of thyroid functions quickly, such as pregnant women, women who desire pregnancy in the next 6 months, or patients with unstable cardiac conditions
• With current operative techniques, bilateral subtotal thyroidectomy should have a mortality rate approaching zero in patients who are properly prepared. Historically, the most common cause of thyroid storm, a physiologic decompensation in patients who are severely thyrotoxic, with a mortality rate of 50-100%, is operative stress.
• Preoperative preparation includes antithyroid medication, stable (cold) iodine treatment (to decrease gland vascularity), and beta-blocker therapy.5
o Generally, antithyroid drug therapy should be administered until thyroid functions normalize (4-8 wk).
o Titrate propranolol until the resting pulse rate is less than 80 bpm.
o Finally, administer iodide as SSKI (1-2 drops bid for 10-14 d) before surgery.
o An additional benefit from stable iodide therapy, besides the reduction in thyroid hormone excretion, is a demonstrated decrease in thyroid blood flow and possible reduction in blood loss during surgery.
• Adverse effects of therapy include recurrent laryngeal nerve damage and hypoparathyroidism due to damage of local structures during surgery. (A Swiss study indicated that a single dose of steroid administered prior to thyroidectomy can reduce nausea, pain, and vomiting associated with the procedure, as well as improve voice function.
*Ablation means removal of material from the surface of an object by vaporization, chipping, or other erosive processes.
Investigation of Grave’s Disease
Laboratory Tests
BLOOD TESTS Thyroid Function Test
1. Ultrasensitive TSH test
a. Detects even tiny amounts of TSH in the blood
b. High TSH indicates thyroid gland is failing because ofproblem that is directly affecting throud (Primary hypothyroidism)
c. Low TSH indicares overactive thyroid that producing too much thyroid (Hyperthyroidism)
d. Low TSH: abnormal pituitary gland that prevents it from making enough TSH to stimulate thyroid (secondary hypothyroidism)
2. T4/throxine test [Free T4 (Ft4) or Free T4 Index (FT4I or FTI)]
a. Circulates in the blood in 2 forms: bound to proteins that prevent the T4 from entering tissues/ free T4 that enter tissues freely
b. Free T4 fraction determine how the thyroid is functioning
c. High FT4/FTI hyperthyroidism; low hypothyroidism
d. elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to disease in the thyroid gland.
e. A low TSH and low FT4 or FTI indicates hypothyroidism due to a problem involving the pituitary gland.
f. A low TSH with an elevated FT4 or FTI is found in individuals who have hyperthyroidism.
3. T3/triiodothyronine test
a. to diagnosis hyperthyroidism or to determine the severity of the hyperthyroidism.
b. High T3 = hyperthyroid
4. Thyroid-stimulating immunoglobulin test (TSH antibody test)
a. Isn’t necessary to diagnose Grave’s
b. Most people with Grave’s have this antibody, but people with other hyperthyroidism do not.
c. 2 antibodies: throid peroxidase and thyroglobulin
d. Anti_thyroid peroxidase (anti-TPO): Autoantibody that found in most people with Grave’s disease, as well as in Hashimptp’s thyroiditis.
Imaging Tests
1. The radioactive iodine uptake test (RAIU)
o Thyroid gland uses iodine to make thyroid hormone (T4)
o Measures the amount of iodine the thyroid collects from the bloodstream. High levels of iodine uptake can indicate hyperthyroidism, eg. Graves’ disease.
o A thyroid scan shows how and where iodine is distributed in the thyroid. In Graves’ disease, the entire thyroid gland is involved so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as nodules—small lumps in the gland—will show a different pattern of iodine distribution.
2. Ultrasond with color-Doppler evaluation
o Cost effective
o 1st step in all hyperthyroid patients
References:
http://www.endocrine.niddk.nih.gov/pubs/graves/
http://www.thyroid.org/patients/brochures/Graves_brochure.pdf
http://www.labtestsonline.org/understanding/conditions/graves-2.html
http://emedicine.medscape.com/article/120619-diagnosis
http://www.thyroid.org/patients/brochures/FunctionTests_brochure.pdf
BLOOD TESTS Thyroid Function Test
1. Ultrasensitive TSH test
a. Detects even tiny amounts of TSH in the blood
b. High TSH indicates thyroid gland is failing because ofproblem that is directly affecting throud (Primary hypothyroidism)
c. Low TSH indicares overactive thyroid that producing too much thyroid (Hyperthyroidism)
d. Low TSH: abnormal pituitary gland that prevents it from making enough TSH to stimulate thyroid (secondary hypothyroidism)
2. T4/throxine test [Free T4 (Ft4) or Free T4 Index (FT4I or FTI)]
a. Circulates in the blood in 2 forms: bound to proteins that prevent the T4 from entering tissues/ free T4 that enter tissues freely
b. Free T4 fraction determine how the thyroid is functioning
c. High FT4/FTI hyperthyroidism; low hypothyroidism
d. elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to disease in the thyroid gland.
e. A low TSH and low FT4 or FTI indicates hypothyroidism due to a problem involving the pituitary gland.
f. A low TSH with an elevated FT4 or FTI is found in individuals who have hyperthyroidism.
3. T3/triiodothyronine test
a. to diagnosis hyperthyroidism or to determine the severity of the hyperthyroidism.
b. High T3 = hyperthyroid
4. Thyroid-stimulating immunoglobulin test (TSH antibody test)
a. Isn’t necessary to diagnose Grave’s
b. Most people with Grave’s have this antibody, but people with other hyperthyroidism do not.
c. 2 antibodies: throid peroxidase and thyroglobulin
d. Anti_thyroid peroxidase (anti-TPO): Autoantibody that found in most people with Grave’s disease, as well as in Hashimptp’s thyroiditis.
Imaging Tests
1. The radioactive iodine uptake test (RAIU)
o Thyroid gland uses iodine to make thyroid hormone (T4)
o Measures the amount of iodine the thyroid collects from the bloodstream. High levels of iodine uptake can indicate hyperthyroidism, eg. Graves’ disease.
o A thyroid scan shows how and where iodine is distributed in the thyroid. In Graves’ disease, the entire thyroid gland is involved so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as nodules—small lumps in the gland—will show a different pattern of iodine distribution.
2. Ultrasond with color-Doppler evaluation
o Cost effective
o 1st step in all hyperthyroid patients
References:
http://www.endocrine.niddk.nih.gov/pubs/graves/
http://www.thyroid.org/patients/brochures/Graves_brochure.pdf
http://www.labtestsonline.org/understanding/conditions/graves-2.html
http://emedicine.medscape.com/article/120619-diagnosis
http://www.thyroid.org/patients/brochures/FunctionTests_brochure.pdf
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