**2.4 Nervous system**

*Goiter - Causes and Treatment*

**2. Clinical manifestations**

anti thyroid drugs are initiated.

**2.1 Cardiovascular system**

**1.1 Prevalence**

are Graves' disease (GD) and toxic nodular goitre.

Treatment of thyrotoxicosis is symptomatic and the treatment of the cause, but treatment of hyperthyroidism is divided in three parts. First antithyroid drugs (ATD), radioactive iodine and thyroid surgery. The prevalence of hyperthyroidism is 1.2–1.6, 0.5–0.6 overt and 0.7–1.0% subclinical [1, 2]. The most frequent causes

Prevalence of thyroid disease varies with iodine sufficiency of the region The National health and nutrition examination survey (NHANES III)[3] and epidemic survey in UK [4] demonstrates female preponderance of thyroid diseases and lower incidence of hyperthyroidism with 1–2% prevalence in women and 1/10th in men.

Hyperthyroidism can mimic other health problems, which can make it difficult to diagnose. It can also cause a wide variety of signs and symptoms like, Unintentional weight loss, palpitations, missed heartbeats, increased appetite, nervousness, anxiety and irritability, tremulousness, excess sweating, menstrual irregularity, heat intolerance, changes in bowel patterns especially more frequent bowel movements, goitre, easy fatigue, muscular weakness, insomnia, thinning of skin, hair loss. Elderly are either asymptomatic or may have palpitations, easy fatigue, etc.

Signs include tremors, warm handshake, fast tachycardia/arrhythmia, flushing over upper body, brisk reflexes, goitre and prominent eyes. Early diagnosis has become possible because of easy availability of blood investigations for thyroid.

Cause of patient's thyrotoxicosis can be guessed from presentation of patient and disease duration. Patients with hyperthyroidism have symptoms since months and dating back is usually difficult, patients of acute thyrotoxicosis due to thyroiditis usually date back their signs and symptoms. Many patients having mild thyrotoxi-

Easy access to blood tests of thyroid has made diagnosis of thyrotoxicosis easy. It is important to differentiate between thyrotoxicosis and hyperthyroidism before

Alterations in cardiovascular function are due to increased circulatory demand that result from the hyper metabolism, first, in heart rate, and with more severe disease, in stroke volume [5]. Widening of the pulse pressure results from the increase in systolic and decrease in diastolic pressure due to reduced peripheral resistance [6, 7].

Both synthesis and degradation rates of proteins are increased indicated by muscle wasting. Uncontrolled diabetes can be due to increased degradation rate of

The improvement in cardiac function with β-blockade in patients with hyperthyroidism has led to the concept that there is increased sympathetic

Clinical manifestations involve multiple systems of the body as follows.

cosis attribute their symptoms to day to day fatigue, stress, etc.

**2.2 Protein, carbohydrate, and lipid metabolism**

insulin. Lipolysis is predominantly observed [8].

**2.3 Sympathetic nervous system and catecholamines**

**48**

Nervousness, emotional lability, and hyperkinesia are major symptoms. Emotional lability mental disturbance may be severe; the patient shifts positions frequently, and movements are quick, jerky, exaggerated, and often purposeless.

In children, inability to focus may lead to deterioration of school performance. A fine tremor of the hands, tongue, or lightly closed eyelids is observed on clinical examination.
