Diseases Treatment

What is this Condition?

Graves’ disease is a metabolic imbalance resulting from overproduction of thyroid hormones. This disorder causes increased production of the hormone thyroxine, enlarges the thyroid gland (goiter), and causes numerous changes in body systems. Graves’ disease occurs most often between ages 30 and 40, especially in people with a family history of thyroid abnormalities; only 5% of people with the disorder are younger than age 15.

With treatment, most people can lead normal lives. However, thyroid storm - an acute exacerbation of Graves’ disease - is a medical emergency that may lead to life-threatening heart, liver, or kidney failure.

What Causes it?

Graves’ disease may result from both genetic and immunologic influences. For example, certain twins have a higher risk for Graves’ disease, suggesting a genetic link. This disease occasionally coexists with abnormal iodine metabolism and other endocrine disorders, such as diabetes, thyroiditis, and hyperparathyroidism.

In latent Graves’ disease, excessive dietary intake of iodine and, possibly, stress can precipitate clinical hyperthyroidism. Unless the disorder is properly treated, stress - including surgery, infection, toxemia of pregnancy, and diabetic ketoacidosis - can precipitate thyroid storm.

What are its Symptoms?

Classic symptoms include goiter (an enlarged thyroid), nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremor, and palpitations.

Abnormally protruding eyeballs are a classic sign but don’t occur in all cases.

How is it Diagnosed?

Diagnosing Graves’ disease is usually uncomplicated. If your doctor suspects that you have it, he or she will carefully review your history, perform a physical exam, and order routine hormone tests. These tests confirm Graves’ disease by showing increased levels of the thyroid hormones thyroxine and triiodothyronine and other characteristic features of the illness. Ultrasound test may confirm eye problems caused by Graves’ disease.

How is it Treated?

Antithyroid drugs, radioactive iodine, and surgery are primary treatments for Graves’ disease. Which one is used depends on the size of the goiter, the causes, the person’s age and whether he or she plans to have children, and how long surgery will be delayed (if the person is a candidate).

Drug therapy

Antithyroid drug therapy is used for children, young adults, pregnant women, and people who refuse surgery or radioactive iodine treatment. These drugs include propylthiouracil (PTU) and Tapazole, which block thyroid hormone synthesis. Although symptoms subside within 4 to 8 weeks after such therapy begins, the person must continue the medication for 6 months to 2 years. Many people must take the drug lnderal at the same time to prevent a rapid heart rate and other side effects of treatment.

Pregnant women should receive the lowest possible dosage of anti­thyroid medication to minimize the risk of thyroid hormone insufficiency in the fetus. Because Graves’ disease sometimes worsens after childbirth, continuous control of the mother’s thyroid function is essential. The mother receiving low-dose antithyroid treatment may breast-feed as long as the infant’s thyroid function is checked periodically.

Radioactive iodine treatment in the form of a single oral dose of iodine 131 is another major therapy for Graves’ disease and is the preferred treatment for people who don’t plan to have children. During treatment, the thyroid gland picks up the radioactive element as it does regular iodine. The radioactivity destroys some of the cells that normally concentrate iodine and produce thyroxine, thus decreasing thyroid hormone production and normalizing thyroid size and function. In most people, hypermetabolic symptoms diminish from 6 to 8 weeks after such treatment; others may require a second dose.

Surgery

Thyroidectomy - surgery to remove part of the thyroid gland­reduces its ability to produce hormone. Surgery is the preferred treatment for people with a large goiter who chronically relapse after drug therapy and for people who refuse or aren’t candidates for iodine 131 treatment.

After surgery or treatment with radioactive iodine, regular lifelong medical supervision is necessary because many people develop thyroid insufficiency, sometimes years after treatment.

Other treatments

Therapy for eye problems caused by Graves’ disease includes local applications of topical medications but may require high doses of corticosteroids. A person with severe eyeball bulging that causes pressure on the optic nerve may require external beam radiation therapy or surgical decompression to lessen pressure,

Treatment of thyroid storm includes administration of an antithy­roid drug, intravenous Inderal, a steroid, and an iodide drug. Supportive measures include administration of nutrients, vitamins, fluids, and sedatives.

What is this Condition?

Diabetes mellitus is a chronic disease in which the body produces little or no insulin or resists the insulin that it does produce. Insulin transports glucose into the cells for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage in the fat deposits. When a person lacks sufficient insulin, body tissues have less access to essential nutrients for fuel and storage.

The incidence of diabetes mellitus is equal in men and women and rises with age. The disease increases the risk of heart attack, stroke, kidney failure, and peripheral blood vessel disease. What’s more, it’s a major cause of blindness in adults.

Classifying Diabetes

There are two main forms of diabetes mellitus: Type I or insulin-dependent, and the more prevalent Type II or non-insulin-dependent. Type I usually occurs before age 30, although it may strike at any age . The person with this type is usually thin and needs insulin injections and dietary modifications to control his or her blood sugar level. Type II usually occurs in obese adults over age 40. It’s most often treated with diet and exercise (possibly in combination with drugs that lower the blood sugar level), although treatment sometimes includes insulin therapy.

What Causes it?

The cause of diabetes mellitus remains unknown, but genetic factors may playa part in development of the disease. In Type I diabetes, cells in the pancreas that produce insulin are damaged, possibly because of an immune system problem. Consequently, these cells are able to produce very little or no insulin.

In Type II diabetes, the cells in the pancreas are still able to produce insulin, but not enough to meet the body’s needs. People with this type of diabetes are usually obese.

Other forms of diabetes, called secondary diabetes, may be caused by pregnancy, physical or emotional stress, or the use of certain medications.

What are its Symptoms?

All types of diabetes produce similar symptoms. The most common symptom is fatigue, caused by energy deficiency and abnormal processing of fats, carbohydrates, and proteins. Insulin deficiency causes high blood sugar. High blood sugar, in turn, causes increased and frequent urination, dehydration, excessive thirst, dry mucous membranes, and dry skin. Some people with diabetes may experience weight loss, as fat and muscles are burned up to provide energy and excessive amounts of glucose are excreted in the urine.

Symptoms of Type I diabetes may develop rapidly within weeks or months. Symptoms of Type II diabetes usually develop more gradually and may not appear until many years after the onset of the disease.

If not properly managed, diabetes may also lead to dangerous metabolic crises, such as ketoacidosis and hyperosmolar nonketotic syndrome. These crises result from excessive amounts of glucose in the blood and may lead to fluid loss and shock.

Long-term effects of diabetes may include retinal changes, kidney problems, atherosclerosis (plaque buildup in the arteries), and nervous system problems, such as pain or numbness in hands and feet or paralysis of the stomach resulting in nausea. Other nervous system effects include impotence, nighttime diarrhea, and dizziness when rising to an upright position (due to low blood pressure).

High levels of sugar in the blood encourage bacterial growth and reduce resistance to infection, possibly leading to skin and urinary tract infections and vaginal inflammation.

How is it Diagnosed?

When making a diagnosis of diabetes mellitus, the doctor observes the person for symptoms of uncontrolled diabetes. He or she will order blood tests to measure sugar levels. A blood sugar level equal to or above 200 milligrams per deciliter suggests diabetes mellitus. Another test for diabetes mellitus, called the fasting plasma glucose test, requires fasting for 12 or 14 hours before blood is drawn.

An eye examination may show retinal abnormalities. Other diagnostic and monitoring tests include urinalysis and additional blood tests.

How is it Treated?

The goal of treatment is to normalize the person’s blood sugar level. In Type I, this is achieved with insulin injections, diet, and exercise. The person may receive insulin in a single-dose, mixed-dose, split­mixed dose, or multiple-dose regimen. For a multiple-dose regimen, an insulin pump may be used. Insulin may be rapid-acting (regular), intermediate-acting (NPH), long-acting (ultralente), or a combination of rapid-acting and intermediate-acting (Mixtard); it may be standard or purified, and it may be derived from beef pork, or human sources. Today, purified human insulin is commonly used.

A person with either Type I or Type II diabetes must follow a strict diet to meet nutritional needs, control blood sugar levels, and reach and maintain appropriate weight. The person must follow the diet consistently and eat meals at regular times.

For an obese person with Type II diabetes, dietary measures aim to promote weight reduction. In many cases, diet alone may be sufficient to control Type II diabetes. Alternatively, a person with Type II diabetes may take oral antidiabetic drugs to stimulate the body’s insulin production, increase the cells’ sensitivity to insulin, and stop the formation of carbohydrates from noncarbohydrate sources in the liver.

Some people with diabetes may be candidates for pancreas transplantation to help them produce insulin. But this procedure is experimental and requires long-term use of drugs that suppress the immune system.

Treating Complications

A diabetic with kidney failure may receive dialysis or a kidney transplant. A person with retinal abnormalities may undergo a procedure called photocoagulation, in which a laser or xenon arc light is used to cause condensation of protein material in the eye. Blood vessel disease may require vascular surgery.

What can a person with diabetes mellitus do?

• Be sure to comply with your prescribed treatment program.

• Make sure you understand - and follow - your doctor’s instructions on managing minor illnesses, such as a cold, flu, or upset stomach. (For instance, you may need to increase your insulin dosage.)

• For more information on this disease, contact the Juvenile Diabetes Foundation or the American Diabetes Association.

What do Doctors call these Conditions?

Hyperpituitarism

What are these Conditions?

Acromegaly and gigantism are chronic, progressive diseases marked by hormonal dysfunction and startling skeletal overgrowth. Acromegaly causes bones to thicken and grow transversely. Gigantism causes proportional overgrowth of all body tissues. These disorders usually reduce life expectancy unless treated in a timely fashion. The earliest signs of acromegaly are swelling and enlargement of the arms, legs, and face. This rare disorder occurs in men and women equally, usually between ages 30 and 50. Gigantism causes remarkable height increases of as much as 6 inches (15 centimeters) a year. Infants and children may grow to three times the normal height for their age; adults may ultimately reach a height of more than 6 feet 8 inches (2 meters).

What Causes them?

Typically, oversecretion of human growth hormone produces changes throughout the body, resulting in acromegaly or, when over­secretion occurs before puberty, gigantism. Tumors of the anterior pituitary gland may cause this oversecretion, but the causes of the tumors themselves remain unclear. Occasionally, levels of human growth hormone are elevated in more than one family member, suggesting the possibility of a genetic cause.

What are their Symptoms?

Acromegaly develops slowly and typically produces profuse sweating, oily skin, hypermetabolism, and excessive hair growth. Severe headache, central nervous system impairment, loss of sharp vision, and blindness may also result. Oversecretion of human growth hormone produces cartilaginous and connective tissue overgrowth, resulting in a characteristic hulking appearance, with an enlarged ridge over the eye and thickened ears and nose. The jaw may project so much that chewing becomes difficult. Enlargement of the larynx and paranasal sinuses and thickening of the tongue cause the voice to sound deep and hollow. Fingertips display an arrowhead appearance on X-rays, and the fingers are thickened. Irritability, hostility, and various psychological disturbances may occur. Prolonged effects of human growth hormone oversecretion include bowlegs, barrel chest, arthritis, osteoporosis, kyphosis, high blood pressure, and hardening of the arteries. Both gigantism and acromegaly may also cause symptoms similar to those of diabetes. Gigantism develops abruptly, producing some of the same skeletal abnormalities seen in acromegaly. As the disease progresses, the pituitary tumor enlarges and invades normal tissue, thereby causing the organ involved to stop functioning.

How are they Diagnosed?

The doctor will observe a person with acromegaly or gigantism for characteristic features. He or she will order blood tests to measure levels of human growth hormone, which are usually elevated. However, results of this test may be misleading. A lab test called the glucose suppression test may be ordered to obtain more reliable information. Glucose normally suppresses the secretion of growth hormone. If an infusion of glucose does not suppress the hormone level, it may indicate acromegaly or gigantism. In addition, skull X-rays, computed tomography scan (commonly called a CAT scan), arteriography, and magnetic resonance imaging (commonly called MRI) determine the presence and extent of the pituitary lesion. Bone X-rays showing a thickening of the cranium and of the long bones, as well as osteoarthritis in the spine, support this diagnosis.

How are they Treated?

Treatment aims to limit human growth hormone secretion by pituitary radiation therapy or by surgery to remove the underlying tumor. In acromegaly, surgery is mandatory when a tumor causes blindness or other severe neurologic disturbances. Postoperative therapy often requires replacement of thyroid hormones, cortisone, and gonadal hormones. Additional treatment may include administration of Parlodel and Sandostatin, which inhibit human growth hormone synthesis.