tag:blogger.com,1999:blog-36377684344274266032024-03-06T12:03:04.451-08:00THYROID DISEASESAnonymoushttp://www.blogger.com/profile/06267357132580929345noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-3637768434427426603.post-70673864861370487502013-11-03T22:23:00.003-08:002013-11-03T22:23:54.916-08:00THYROID DISEASES<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="font-size: 20.0pt; mso-ansi-language: EN-US;">Thyroid gland diseases<o:p></o:p></span></b></div>
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<b><span style="font-size: 20.0pt; mso-ansi-language: EN-US;">Thyroid gland diseases. The
diagnosis, the differential diagnosis, preventive maintenance and treatment of
goiter</span></b><b><span lang="UK" style="font-size: 20.0pt; mso-ansi-language: UK;"><o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Iodine deficiency diseases (IDD)</span></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> are pathological states
caused by <span style="color: #4f81bd;">reduced iodine contains in organism.</span>
About 740 million of the world population are ill with IDD. <o:p></o:p></span></div>
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<br /></div>
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<span style="background: white; mso-ansi-language: EN-US;"> </span><span style="color: red; mso-ansi-language: EN-US;"> <b>kinds of IDD:</b><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #0070c0; font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Hypothyroidism,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #0070c0; font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #0070c0;">Diffuse euthyroid goiter or nontoxic,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #0070c0; font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Nodular and multinodular
euthyroid goiter,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #0070c0; font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Functial autonomy of the thyroid
gland.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
main phatology is Goiter – diffuse. Now we use modern classification of
increasing of the thyroid gland. <o:p></o:p></span></div>
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<span style="color: red;">Degrees of Thyroid Gland Size
Abnormalities<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">0 degree</span></b><span style="font-size: 14pt;"> - goiter is hidden and not palpable;</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">I degree</span></b><span style="font-size: 14pt;"> - goiter is palpable, but hidden; or one or more nodules are palpable
in the thyroid gland;</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">II degree</span></b><span style="font-size: 14pt;"> - goiter is palpable and visible.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span lang="RU" style="color: #0070c0; font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">Factors of
Etiology</span></b><b><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">.<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Main factor is iodine insufficiency, f.e. in <span style="color: #0070c0;">water, in food<o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Goitrogenes factors</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">,
which inhibit transportation of iodides to the thyroid gland<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Low level of microelements,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">
such as Zn, Co, Se, Mg, Cu and high level of Ca<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="UK" style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Ionize radiation</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> and
environment pollution with radionuclides</span><span lang="UK" style="font-size: 14pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="UK" style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: UK; mso-bidi-font-size: 10.5pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.5pt;">Infectious diseases</span><span lang="UK" style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: UK; mso-bidi-font-size: 10.5pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="UK" style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: UK; mso-bidi-font-size: 10.5pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.5pt;">Helmintic invasion</span><span lang="UK" style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: UK; mso-bidi-font-size: 10.5pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="UK" style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: UK; mso-bidi-font-size: 10.5pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.5pt;">Lack of Vitamin A - reduction</span><span lang="UK" style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: UK; mso-bidi-font-size: 10.5pt;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="UK" style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.5pt;">Hereditary factors </span><span style="font-size: 14pt;">connected with disorders of syntheses thyroid hormones</span><span lang="UK" style="font-size: 14pt;"><o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-size: 14pt;">Differenceeted </span><span style="font-size: 14pt;">natural
stumogenes of food products contained in </span><span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.5pt;">tapioca, soy,
peanut, turnip. Some flavonoids provoked disorders of metabolism iodine,</span><span style="font-size: 14pt;"> f.e. african millet, sorghum, bobs.</span><span style="font-size: 14pt;"><o:p></o:p></span></div>
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<span style="font-size: 14pt;">What do
analysis of presence of iodine deficiency? </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Analyses of <span style="color: #0070c0;">iodine deficiency can be made according to concentration
of iodine in urine. </span>There are some degrees of iodine deficiency:<o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Endemic goiter severity criteria </span></b><span style="font-size: 14pt;">(WHO, 1994)</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b>Indices,
at children and adults</b><b><o:p></o:p></b></div>
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<b>Standard<span lang="RU"><o:p></o:p></span></b></div>
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<b>Severity
degree<span lang="RU"><o:p></o:p></span></b></div>
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<b>Mild<span lang="RU"><o:p></o:p></span></b></div>
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<b>Middle<span lang="RU"><o:p></o:p></span></b></div>
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<b>Severe<span lang="RU"><o:p></o:p></span></b></div>
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goiter
rate during palpation(%)<o:p></o:p></div>
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less
than 5</div>
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5-19,9</div>
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20-29,9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.35pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 81.0pt;" width="135">
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more
than 30</div>
</td>
</tr>
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Thyroid
gland volume rate more than 97 percentiles (%)<o:p></o:p></div>
</td>
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<div align="center" class="MsoNormal" style="text-align: center;">
less
than 5</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 63.0pt;" width="105">
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5-19,9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.95pt;" width="165">
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20-29,9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 81.0pt;" width="135">
<div align="center" class="MsoNormal" style="text-align: center;">
more
than 30</div>
</td>
</tr>
<tr style="height: 27.85pt; mso-yfti-irow: 4;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 146.8pt;" width="245">
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Median
of iodine excretion with urine (ug/1)<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 94.1pt;" width="157">
<div align="center" class="MsoNormal" style="text-align: center;">
more
than 1 00</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 63.0pt;" width="105">
<div align="center" class="MsoNormal" style="text-align: center;">
50-90</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.95pt;" width="165">
<div align="center" class="MsoNormal" style="text-align: center;">
20-49</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 81.0pt;" width="135">
<div align="center" class="MsoNormal" style="text-align: center;">
less
than 20</div>
</td>
</tr>
<tr style="height: 27.85pt; mso-yfti-irow: 5;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 146.8pt;" width="245">
<div align="center" class="MsoNormal" style="text-align: center;">
Median
of thyroglobulin concentration in blood (ng/ml)<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 94.1pt;" width="157">
<div align="center" class="MsoNormal" style="text-align: center;">
less
than 10</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 63.0pt;" width="105">
<div align="center" class="MsoNormal" style="text-align: center;">
10-19.9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.95pt;" width="165">
<div align="center" class="MsoNormal" style="text-align: center;">
20-39.9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 27.85pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 81.0pt;" width="135">
<div align="center" class="MsoNormal" style="text-align: center;">
more
than 40</div>
</td>
</tr>
<tr style="height: 40.8pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 40.8pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 146.8pt;" width="245">
<div align="center" class="MsoNormal" style="text-align: center;">
Median
of TSH level in blood more than 5 mu/1 newborns), %<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 40.8pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 94.1pt;" width="157">
<div align="center" class="MsoNormal" style="text-align: center;">
less
than 3</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 40.8pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 63.0pt;" width="105">
<div align="center" class="MsoNormal" style="text-align: center;">
13-19.9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 40.8pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.95pt;" width="165">
<div align="center" class="MsoNormal" style="text-align: center;">
20-39.9</div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 40.8pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 81.0pt;" width="135">
<div align="center" class="MsoNormal" style="text-align: center;">
more
than 40</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center; text-indent: 27.0pt;">
<b><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Pathogenesis.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
Iodine Deficiency caused the secretory ability of the thyroid gland and
promotes goitrogenesis. <span style="color: #0070c0;">The decrease of thyroid
hormone in blood leads to increasing of TSH hormone production and to the
development of iodine deficiency hypothyrosis. As a result it promotes
follicles hypertrophy, strengthening of bloodstream in a gland and iodine
absorption - compensatory mechanisms. After that thyroid gland hyperplasia
develops. This adaptive mechanisms allow to support an euthyroidism for the
long time in the conditions of insufficient iodine supply. Goiter, as the basic
manifestation of iodine insufficiency, is also a display of adaptation
possibilities of organism.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="color: #0070c0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Thyroid hormone increases in pubertal age, during pregnancy, at the
serious somatic or infectious diseases. At this situations develop hyperplasia
thyroid gland acquires a nodular character. Nodules and adenomas appear in a
gland. A diffuse endemic goiter grows into diffuse-nodular goiter. Adenomas and
nodules are able to grow into thyrotoxic in case of sufficient iodine supply.
Iodine-induced thyrotoxicosis develops following this mechanism</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">. In
these conditiones functional autonomy of the thyroid gland is developing. At
iodine deficiency, number of autonomously-functioning thyrocytes is increasing,
they formed into nodular and multinodular forms, often with thyrotoxicosis. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">In
pathogenesis of clinical displays of endemic goiter certain role is played by
natural immunity inhibition.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center; text-indent: 27.0pt;">
<b><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">Clinical features.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Appear<b> </b></span><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">increasing of thyroid gland. The
degree of increasing</span><span style="font-size: 14pt;"> can be different. Usually the </span><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">increase is diffuse, but sometimes it is diffuse-nodular. With mild and
moderate iodine deficiency the increase of the thyroid gland takes place
slowly, achieving maximal sizes during 10-15 years and more. Clinically the
goiter is usually euthyroid, with gradual development of the hypothyroidism.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Goiter is only the external display of iodine deficiency. Clinical
features are caused by a hypothyroidism. Fatigue, deceleration of psychical
reactions, dysmenorrhea, galactorrhea, abnormalities of the reproductive
ability arc connected with hypothyroidism. <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Characteristic signs of hypothyroidism:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: .5in;">
<!--[if !supportLists]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">constipations,<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: .5in;">
<!--[if !supportLists]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">physical and mental fatigue, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: .5in;">
<!--[if !supportLists]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">somnolence, chillness, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: .5in;">
<!--[if !supportLists]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">growth of body weight, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: .5in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #00b0f0; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">anemia</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">In
severe cases endemic cretinism develops which is manifested by disorders of the
nervous system.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Diagnosis. </span></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<b>
</b><span style="color: #c00000;">Thyroid hormones in blood is decreasing.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l9 level1 lfo5; tab-stops: list .5in; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">TSH in blood plasma is
increasing.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l9 level1 lfo5; tab-stops: list .5in; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Goiter size.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l9 level1 lfo5; tab-stops: list .5in; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Testing of ioduria.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l9 level1 lfo5; tab-stops: list .5in; text-align: justify; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Ultrasound examination of the
thyroid gland enables to determine its size and presence of nodules.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">On indication: - Nodules formations are punctuated.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 70.8pt; text-align: justify; text-indent: 35.4pt;">
<span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> - Scanning with
radioactive iodine.</span><span lang="RU" style="color: #c00000; font-size: 14.0pt; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 70.8pt; text-align: justify; text-indent: 35.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Treatment.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><i><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">1. <span style="color: red;">Diffuse
endemic goiter</span></span></i></b><i><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> </span></i><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> prescribe <b>iodides</b> in daily dose up to 200</span><span style="color: red; font-size: 16.0pt; mso-ansi-language: EN-US;">μg</span><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> in
case of a <b><i><span style="color: red;">big
goiter </span></i><span style="color: red;">(</span></b></span><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">2nd degree) <b>L-thyroxin</b> is prescribed to decrease TSH
concentration in blood.</span><span style="font-size: 14pt;"> The dosage of L-thyroxin is from </span><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">25 to 100 </span><span style="color: red; font-size: 16.0pt; mso-ansi-language: EN-US;">μg </span><span style="color: red; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">per day</span><span style="font-size: 14pt;">. Patient's
condition must be strictly monitored and controlled to achievement an
euthyroidism.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Surgical intervention</span></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> is
necessary for patients with large goiters or in case of presence syndrome of
compression and dysfunction. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><i><span style="font-size: 14pt;">2. Nontoxic Nodular and Multinodular goiter. </span></i></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">There are three methods of
treatment: surgical, medicamental, and active supervision of the nodule. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US;">- <u>Medical tactics</u>
depends on functional condition of the nodule, cellular compound, growth
velocity. The medicamental treatment of nodular goiter by L - thyroxine is
applied in case of hypothyrosis. The purpose of the treatment is a replacement
therapy, achievement of euthyrosis, inhibition of further enlargement of nodes.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- <u>Surgery</u></span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"> is applied in case of node <b>malignization</b>, autonomic adenomas,
quickly enlarged retrosternal nodes, compression of trachea or esophagus,
mediastinum.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">- <u>Active supervision</u></span><span style="font-size: 14pt;"> is applied to patients with <b>nodes (10-30 mm</b> in diameter) without
signs of proliferation, which does not enlarge during dynamical ultrasound
investigation, usually these are mature and elderly people.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Prevention.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Iodine deficiency may be prevented by realizing <b><i>mass, group and individual iodine prophylaxis.</i></b></span><b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Mass prophylaxis</span></b><span style="font-size: 14pt;"> is carried out for all inhabitants
of an iodine deficient area. <b><i>Iodized
salt</i></b> consumption is a tried and tested method. Iodination is made by
using potassium iodide, 20 -40 mg/kg of salt, that provides matriculation of
150 </span><span style="font-size: 16.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 14pt;"> of iodine every day. For mass prevention oily dine solution (lipiodol)
is also used. Ingestion of this product provides a body with a sufficient
amount of iodine for 6 to 12 months and intramuscular introduction - for 1 to 3
years.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">For <b>individual and group</b> prevention <b><i>iodine preparations</i></b> are used, primarily antistrumin, 1
tablet 1-2 times a week, as well as iodides (Iodide-Farmak, IodBalance and Iodomarin)
-10 and 200 </span><span style="font-size: 16.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 14pt;"> in tablets.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Group prevention</span></b><span style="font-size: 14pt;"> is an additional introduction of iodides on the back-ground of the mass
prophylaxis for the categories of people with an increased iodine requirement: <b>pregnant women, nursing mothers,
adolescents</b>.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Individual prevention</span></b><span style="font-size: 14pt;"> is prescribed
to some patients in case of an increased iodine requirement. These patients will
include: women one year before a scheduled pregnancy, recovers after severe
somatic or infectious diseases, after antibiotic therapy courses or sulfonamide
treatment, persons with affected alimentary organs, if abnormal iodine
absorption may occur.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoHeading7">
Iodine
requirement for different age categories</div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 65.0pt; mso-padding-alt: 0in 2.0pt 0in 2.0pt; mso-table-layout-alt: fixed;">
<tbody>
<tr style="height: 13.45pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background: white; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 3.0in;" width="360">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">Children under 1
years old</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="background: white; border-left: none; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 1.75in;" width="210">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 10pt;">50</span></b><span style="font-size: 10pt;"> </span><span style="font-size: 11.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 10pt;">/day</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 1;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 3.0in;" width="360">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">Children 1-6
years old</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 1.75in;" width="210">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 10pt;">80</span></b><span style="font-size: 10pt;"> </span><span style="font-size: 11.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 10pt;"> /day</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 2;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 3.0in;" width="360">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">Children 6-12
years old</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 1.75in;" width="210">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 10pt;">120</span></b><span style="font-size: 10pt;"> </span><span style="font-size: 11.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 10pt;"> /day</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 3;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 3.0in;" width="360">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">Children older
than 12years old <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">and adults</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 1.75in;" width="210">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 10pt;">150</span></b><span style="font-size: 10pt;"> </span><span style="font-size: 11.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 10pt;"> /day</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 13.9pt; mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 13.9pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 3.0in;" width="360">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">Pregnant women
and <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 10pt;">nursing mothers</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 13.9pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 1.75in;" width="210">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 10pt;">150</span></b><span style="font-size: 10pt;"> to <b>200</b> </span><span style="font-size: 11.0pt; mso-ansi-language: EN-US;">μg</span><span style="font-size: 10pt;"> /day</span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 18pt;">Thyrotoxicosis.</span></b><span style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 14.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US;">Thyrotoxicosis</span></b><span style="color: #c00000; font-size: 14.0pt; mso-ansi-language: EN-US;"> (synonym:
Basedow's, Graves' s - diffuse toxic goiter) is a disease characterized by
excessive production of thyroid hormones (hyperthyroidism) and by diffuse
enlargement of the thyroid gland.</span><span style="font-size: 14pt;"> Changes in other organs caused by
influence of thyroid hormones and autoimmune disorders. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Graves' disease is
mostly a disease of women of 20-50. <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Etiology.</span></b><span style="font-size: 14pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Thyrotoxicosis
occurs in consequence of the thyroid-stimulating globulins formation, which
compete with TSH receptors on a surface of thyreocytes and induce a cell growth
and excessive secretion of thyroid hormones. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Factors</span></b><span style="font-size: 14pt;"> that lead to autoimmune disorders can be:
<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l7 level1 lfo6; tab-stops: list .5in; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">excessive amount
of iodine,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l7 level1 lfo6; tab-stops: list .5in; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">treatment by
lithium,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l7 level1 lfo6; tab-stops: list .5in; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">infectious
diseases (a flu, quinsy, chronic tonsillitis, a scarlet fever, whooping cough,
rheumatism, encephalitis).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Some viruses can
form complexes with thyreocytes surface proteins, changing its structure and
antigenic characteristics.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">As <b>provocative moments</b> of disease
manifestation can act<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l14 level1 lfo7; tab-stops: 81.0pt; text-align: justify; text-indent: 63.0pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">an excessive
insolation,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l14 level1 lfo7; tab-stops: 81.0pt; text-align: justify; text-indent: 63.0pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">a mental trauma,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 50.2pt; mso-list: l14 level1 lfo7; tab-stops: 81.0pt; text-align: justify; text-indent: 63.0pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">pregnancy and
postnatal period.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Pathogenesis.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Thyrotoxicosis is
classified as a disease which develops due to the mechanism of hypersensitivity
of the slow type. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Genetic defect </span></b><span style="font-size: 14pt;">is located in organ-specific CD-8 -
lymphocytes (<b>T-supressors</b>). Because
of the suppression of "forbidden" T-lymphocytes clones is not carried
out they survive and cooperate with organ-specific antigenes of a thyroid
gland.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Clones of lymphocyte that are sensibilized to the
antigenes of a thyroid gland stimulate B-lymphocytes to synthesis of antibodies
to thyroid-stimulating</span></b><span style="font-size: 14pt;"> hormone receptor. Thyroid-stimulating immunoglobulins
of class G cooperate with follicular epithelium receptors and induce
thyreocytes to excessive production of thyroid hormones and to hypertrophy and
hyperplasia.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">It is impossible
to explain completely a pathogenesis of diffuse toxic goiter by action of
thyroid-stimulating immunoglobulins. They are also found at subacute and
autoimmune thyroiditis. In these cases they do not stimulate but depress the
function of a thyroid gland. In pathogenesis of a diffuse toxic goiter a major
importance is given to lymphocytic infiltration of the gland which produces a
tumor necrosis factor and alpha interferon.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Pathogenesis of
clinical symptoms of diffuse toxic goiter is connected with increased
cathabolic impact of excessive amount of thyroid hormones.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Clinical features.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Most prominent <b>clinical symptoms</b> of disease are:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">increasing irritability,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">nervousness, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">tachycardia,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">weight loss with normal nourishment, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">weakness,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">a tremor of all
body,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">sweating, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">heat intolerance, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">diarrhea,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 152.45pt; mso-list: l0 level1 lfo8; tab-stops: list 152.45pt; text-align: justify; text-indent: -89.45pt;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">tearfulness.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">The skin is wet
and warm. In some patients an uneven <b>hyperpigmentation
</b>of all body is observe. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">In some patients a <b>pretibial
swelling</b> (thyroid acropathy, <b>pretibial
myxedema</b>) is observed. The skin is characterized by swelling of pretibial
areas, brownish in color.On feet the leather skin is horned, crawls over
phalanxes of fingers. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US;">The eyes signs are
characteristic to the majority of patients with a diffuse toxic goiter – <b>Ophtalmopathia.<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l8 level1 lfo10; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">Palpebral fissures are widely
opened with expression of surprise - <b>Delremplin's
symptom.</b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l8 level1 lfo10; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">The<b> exophtalmus </b>is determined, more often on both eyes. Exophotalmus
can affect one eye, for instance a rare
winking - <b>Shtelwag's symptom;</b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l8 level1 lfo10; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US;">Retraction of upper lid, owing to what during the movement of an eyeball
downwards between upper lid and an iris appears a white strip of sclera - <b>Gref's symptom </b> or during the movement of an eyeball upwards -
<b>Coher's symptom</b>.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l8 level1 lfo10; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">Disorders of
convergence of eyeballs is called - <b>Moebius's
symptom.</b></span><b><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US;">The most typical clinical symptoms of thyreotoxicosis
are changes in <b>cardiovascular system</b>.
The most common is <b>sinus tachycardia</b>.
The pulse rate reaches 100 beats per a minute and more. May be: - extresystole,<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 177.0pt; text-align: justify;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US;"> - atrial fibrillation.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Symptoms of
thyrotoxicosis and their frequency</span></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 83.0pt; mso-padding-alt: 0in 2.0pt 0in 2.0pt; mso-table-layout-alt: fixed;">
<tbody>
<tr style="height: 13.45pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background: white; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Symptom</b><b><o:p></o:p></b></div>
</td>
<td style="background: white; border-left: none; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Frequency
(%)</b><b><o:p></o:p></b></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 1;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Goiter<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
85-100<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 2;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Tachycardia<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
85-100<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 3;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Sweating<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
70-90<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 4;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Heat
intolerance<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
70-80<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 5;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Tremor<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
70-90<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 6;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Increased
systolic blood pressure<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
60-80<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 7;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Weight
loss<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
60-80<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 8;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Hyperkinesia<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
60-80<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 9;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Muscle
weakness<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
60-80<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 10;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Eye
signs<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
50-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 11;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Diarrhea<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
20-10<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 12;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Ophtalmopathia<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
30-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.95pt; mso-yfti-irow: 13;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Increased
appetite<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.95pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
40-60<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 14;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Atrial
fibrillation<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
10-30<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 15;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Pretibial
myxedema<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
2-3<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 16;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Dysmenorrhea<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
3-5<o:p></o:p></div>
</td>
</tr>
<tr style="height: 13.45pt; mso-yfti-irow: 17; mso-yfti-lastrow: yes;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 199.95pt;" width="333">
<div align="center" class="MsoNormal" style="text-align: center;">
Vitiligo<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 98.1pt;" width="164">
<div align="center" class="MsoNormal" style="text-align: center;">
1-2<o:p></o:p></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">The systolic </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">blood pressure increased and diastholic blood
pressure is reduced. It is connected with increase cardiac output (systolic
blood pressure) and peripheral vasodilatation (diastolic blood pressure).
Borders of relative heart dullness are displaced to the left, heart tones are
loud and strengthened. A systolic murmur may be often heard. The origin of
murmur is connected with enlargment of atrioventricular ostiums and bloodstream
acceleration. The gemodinamic changes includes increased stroke and minute
volumes of bloodstream, volume of circulating blood, bloodstream. Heart insufficiency
develops in 15-20 % of cases, mainly in patients with atrial fibrillation.
Thyreotoxic cardiomiopathy develops under influence of excessive amount of
thyroid hormones and catecholamines, which received a clinical name
«hyperthyroid heart». <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Electrocardiographic </span></b><span style="font-size: 14pt;">examination
shows the signs of a left ventriclar hypertrophy. High waves R, S and T,
shortening of interval S-T, sinus tachycardia are fixed. As soon as heaviness
of «hyperthyroid heart» increases the waves size decreases and wave T becomes
twophase or negative, the depression of S-T segment and atrial fibrillation are
observed.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Changes of <b>muscular system</b> are shown by thyrotoxic miopathy.
Significant muscular. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Half
of patients suffer from changes of <b>digestive system</b>. Defecation becomes more
frequent, it can be up to 20 times a day. Weight loss is one of the most
typical symptom of thyrotoxicosis. It is caused by increased catabolism due to
high amount of thyroid hormones. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Characterize
presents of <b>psychic and nervous symptoms</b> in clinical picture, f.e. a
nervous hysteria. Patients appear to be nervous, anxious, irritate with no
reason, start crying. Changes of mood are often. Tremor of fingers of the
extended hands (<b>Mari's symptom</b>) is typical. Tremor is constant. In case
of serious clinical course of thyrotoxicosis depression, delirious conditions
and delirium are possible.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">On the part of <b>skeletal system</b> an intensification of osteoporosis
is possible as a result of stimulating impact of thyroid hormones on
osteoclasts.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Dysfunction of other <b>glands of internal secretion</b>, in particular,
<b>reproductive glands</b> is frequently observed during thyrotoxicosis. Half
of women with thyrotoxicosis have deranged menstrual cycle and dysmenorrhea. In
case of mild forms of thyrotoxicosis menorrhea. The menstrual cycle becomes
single-phase with insufficiency of lutein phase.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Males</span></b><span style="font-size: 14pt;"> has atrophic changes in testis, prostate
gland, reduced libido and potency. These specified symptoms are temporal,
reverse development occurs after the liquidation of thyrotoxicosis.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Function of <b>adrenal glands</b> is intensified, as a result -
hypocorticoidism develops, and chronic suprarenal insufficiency (<b>Addison's
desease</b>).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Patients with thyrotoxicosis may have <b>reduce tolerance to
carbohydrates</b> even to development of a diabetes.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">The <b>thyrotoxic crisis</b> develops within several hours to one day. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14pt;">Symptomatology:</span></b><span lang="RU" style="font-size: 14.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Excitation increases</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Tachycardia - 200 beats per a
minute</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Extrasystole </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Atrial fibrillation</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Systolic arterial blood pressure
increases </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Diastolic arterial blood pressure
decreases.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Sweating is increased</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">The skin is warm and wet to touch</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">The body temperature increases and
can arise up to 40 °C </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Psychical and emotional excitation</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Psychical excitation - acute
psychosis with a disorientation, delirium, hallucinations</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">The diarrhea</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Vomiting </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Muscular weakness up to adynamia</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Patients can lose consciousness -
Thyreotoxic coma</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Other complectation - acetone
appears, ketonurine</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Acute hepatic insufficiency</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Reduction of diuresis up to anury</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo9; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">The systemic alkalosis,
hypokaliopenia</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14pt;">Diagnosis</span></b><span style="font-size: 14pt;"> is based on the establishment of excessive production of thyroid
hormones (hyperthyroidism) and on diffuse enlargement of the thyroid gland.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14pt;">The most <b>typical
clinical signs</b> are: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">excitability,<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">irritability, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">weight loss, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">weakness, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">tachycardia, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">atrial fibrillation, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">sweating,<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l17 level1 lfo11; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">tremor of all body.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14pt;">A <b>goite</b>r
in a patient diffuse hyperplasia </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Functional activity</span></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> of
a thyroid gland<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">1.
Level of thyroid hormones increased.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">2.
Depression of TSH. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Thyroid gland volume is determined by <b>ultrasound studies</b>. In case
of toxic goiter a thyroid gland is diffusely enlarged.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Treatment.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Thyrotoxicosis can be treated by medications, surgery or by using a
radioiodine.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Antithyroid drugs</span></b><span style="font-size: 14pt;"> is always used - mercasolile,
thyrosol, thiamazole, metisole. These medicaments block formation of organic
iodine in a thyroid gland, they inhibit the process of condensation of
iodotyrosines into triiodothyronine and thyroxine. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">In case of intolerance to mercasolil</span></b><span style="font-size: 14pt;">, other
medicaments with thyrostatic actions are prescribed, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l11 level1 lfo12; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">a)<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">iodides,</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l11 level1 lfo12; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">b)<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Lughole’s iodine solution is
prescribed up to 50 drops a day.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Beta-blockers</span></b><span style="font-size: 14pt;"> are prescribed with antithyroid
medicaments.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l6 level1 lfo13; tab-stops: list .5in; text-align: justify; text-indent: 1.0in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">propranolol is 120 mg per day<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l6 level1 lfo13; tab-stops: list .5in; text-align: justify; text-indent: 1.0in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">atenolol (50-100 mg per 24 day), <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l6 level1 lfo13; tab-stops: list .5in; text-align: justify; text-indent: 1.0in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">metoprolol (100-200 mg per day), </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l6 level1 lfo13; tab-stops: list .5in; text-align: justify; text-indent: 1.0in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">bysoprolol (5-10 mg per day).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Glucocorticoids</span></b><span style="font-size: 14pt;"> can be also used in case of
relative suprarenal insufficiency. The prednisolonum is prescribed in an
initial dose of 20-30 mg, reducing each five days to 5 mg or other
glucocorticoids in an adequate dose.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14pt;">Treatment of a
thyrotropic crisis</span></b><span style="font-size: 14pt;"> includes:</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: .5in;">
<span style="font-size: 14pt;">-Elimination of provoking factors (whenever it is possible);</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: .5in;">
<span style="font-size: 14pt;">-Blockade of thyroid hormones synthesis;</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: .5in;">
<span style="font-size: 14pt;">-Blockade of peripheral action of hormones;</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: .5in;">
<span style="font-size: 14pt;">-Maintenance of vital functions of an organism;</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 45.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="font-size: 14pt;">-Removing thyroid hormones and thyroidstimulating
immunoglob-ulines from an organism.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Blockade
of thyroid hormones synthesis is reached by oral introduction of mercasolil or
through nasogastral probe. Initial dose of mercasolil is 60 mg, further dose is
30 mg each 4 hours. Preparations of iodine are prescribed in 2 hours after
introduction of mercasolil. It excludes use of iodides for thyroid hormones
synthesis.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Intravenous drip-feed of 1000 ml of 5 % solution of glucose with 1 ml of
Lughole’s iodine solution is prescribed. 10 % natrium iodides solution is
injected, by 1 ml intravenously each 3 hours. Lughole’s iodine solution can be
given by oral introduction or through nasogastral probe by 30—40 drops each 3
hours.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Peripheral action of hormones is blocked by B-blockers, that is why a
pro-pranolol is injected intravenously from 1 up to 3 mg each 3 hours.
Glucocorticoids are also intravenously dropwise injected. Hydrocortison is
prescribed up to 500 mg per day or prednisolonum - 200 mg per day, dexamethazon
up to 20 mg per day. Strengthening of thyroid hormones excretion from an
organism is reached by assignment of phenobarbital, in dose up to 200 mg per
day.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Body temperature of patients is reduced by covering them with bubbles of
ice, cold blowing, by assignment of acetoamiphenum (paracetamol).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Excessive amount of thyroid hormones released from an organism with the
help of plasmapharesis, hemadsorbtion. The water regimen of an organism is
supported by introduction of a 5 % solution of glucose and 0.9 % solution of
natrium chloridis.<o:p></o:p></span></div>
<h2 align="center" style="text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 16.0pt; mso-bidi-font-size: 13.0pt;"> </span></h2>
<h2 align="center" style="text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 16.0pt; mso-bidi-font-size: 13.0pt;">Hypothyroidism</span><span style="font-family: "Times New Roman","serif"; font-size: 16.0pt; font-weight: normal; mso-bidi-font-size: 13.0pt;"><o:p></o:p></span></h2>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Hypothyroidism</span></b><span style="font-size: 14pt;"> is a disease, caused by a persistent
reduction of thyroid hormone impact on a target organs.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Classification.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14pt;">Nowadays the
following forms of hypothyroidism are distinguished:</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l19 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">1.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">Primary hypothyroidism</span></b><span style="font-size: 14pt;"> – as a result pathology in a thyroid gland.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l19 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">2.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">Central hypothyroidism</span></b><span style="font-size: 14pt;"> (hypothalamic-pituitary). Hypothyroidism develops due to a defeat of a
pituitary gland (secondary hypothyroidism) or hypothalamus (tertiary
hypothyroidism). <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l19 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">3.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">Peripheral hypothyroidism</span></b><span style="font-size: 14pt;">, caused by resistance of tissues to thyroid hormones action</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l19 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">4.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Subclinical hypothyroidism</span></b><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> is
a syndrome, which is characterized by increasing plasma level of TSH on a
background of a normal level of thyroxine and triiodothyronine.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l19 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">5.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 14pt;">Transient hypothyroidism</span></b><span style="font-size: 14pt;">. Hypothyroidism, which developed on a background of some diseases
(conditions) or reception of medical preparations and inclined to spontaneous
disappearance of its displays after elimination of etiological factors.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Etiology.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">It is known that primary hypothyroidism makes approximately 95 % of all
cases of hypothyroidism. Often it is an outcome of autoimmune thyroiditis, it
may be a display of congenital defects of thyoroid hormones biosynthesis, the
heaviest iodine deficiency, medicamentous or toxic effects.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Pathogenesis.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
<span style="font-size: 14pt;">The pathogenetic basis of hypothyroidism is an disorder of metabolism.
Metabolism is reduced, especially in organs and tissues, which quickly grow and
updated: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l15 level1 lfo15; text-align: justify; text-indent: 27.0pt;">
<!--[if !supportLists]--><span style="font-size: 14pt;">•<span style="font-size: 7pt;"> </span></span><!--[endif]--><span style="font-size: 14pt;">erythropoesis is slowed down and anemia occurs<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-size: 14pt;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Free fatty acids, triglyceridis,
cholesterol are collected in organism because of lipids metabolism delay<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-size: 14pt;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Proteins metabolism - accumulation
of glycosaminglycans - a mucinous swelling.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Clinical features.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">The disease develops slowly and gradually. Weakness, drowsiness,
sluggishness, memory impairment, chill, constipations are typical complaints of
patients. Frequently patients with anemias.</span><span lang="RU" style="font-size: 14pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 56.0pt; mso-padding-alt: 0in 2.0pt 0in 2.0pt; mso-table-layout-alt: fixed; width: 589px;">
<tbody>
<tr style="height: 13.45pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background: white; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Clinical
symptoms</b><b><o:p></o:p></b></div>
</td>
<td style="background: white; border-left: none; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Frequency
%</b><b><o:p></o:p></b></div>
</td>
</tr>
<tr style="height: 12.0pt; mso-yfti-irow: 1;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Weakness<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 2;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Dryness
of the skin<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 3;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Drowsiness<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.0pt; mso-yfti-irow: 4;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Speech
delay<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 5;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Chill<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 6;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Face
puffiness<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 7;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Increased
tongue<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 8;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Hair
loss<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 9;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Increased
borders of relative heart dullness<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
90-70<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 10;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Bradycardia<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.0pt; mso-yfti-irow: 11;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Memory
impairment<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 12;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Pallor
of a skin<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 13;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Yellowish
discoloration of the skin<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 14;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Weight
increase<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.0pt; mso-yfti-irow: 15;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Lack of
breathe<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 12.5pt; mso-yfti-irow: 16;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Hoarseness
of the voice<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 12.5pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
70-50<o:p></o:p></div>
</td>
</tr>
<tr style="height: 13.45pt; mso-yfti-irow: 17; mso-yfti-lastrow: yes;">
<td style="background: white; border-top: none; border: solid windowtext 1.0pt; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 261.0pt;" width="435">
<div align="center" class="MsoNormal" style="text-align: center;">
Hearing
impairment<o:p></o:p></div>
</td>
<td style="background: white; border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 13.45pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0in 2.0pt 0in 2.0pt; width: 92.3pt;" width="154">
<div align="center" class="MsoNormal" style="text-align: center;">
30-20<o:p></o:p></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Cardiovascular system</span></b><span style="font-size: 14pt;">. Abradycardia
in case of a significant anemia tachycardia occurs. The borders of relative
heart dullness are displaced due to dystrophic changes in myocardium and
accumulation of liquid in a pericardium. The diastolic pressure increases. On
electrocardiography the interval R-R is increased, voltage of waves is reduced,
there can be a depression of S-T segment, inversion of T wave.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Significant changes in <b>gastrointestinal system</b> are observed. A
decreased motility of the. The tongue is increased. The secretion is decreased,
the absorption of vitamin B<sub>12</sub> is disturbed, this process aggravates
anemia. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Essential changes are revealed in <b>nervous system</b>, both in
peripheral and in central. A hypothyroid patient is slow in thought, they less
able to concentrate and memorize. The mental potential of a person decreases.
Some of patients feel fears, disturbing-depressive syndrome is formed. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Changes in <b>peripheral nervous system –</b>as a result tunnel
syndrome. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The <b>bronchitis
and prolonged pneumonias</b> are. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">The changes of <b>muscles and joints</b> - edema of synovial structures
and capsules of joints of hands and legs – as a result pseudomyopathic syndrome
occurs. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Anemia</span></b><span style="font-size: 14pt;"> – decrease of hemoglobin synthesis,
reduction of iron absorbtion in digestive system, vitamin B<sub>p</sub> and
folic acid deficiency.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">Myxedema
coma.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
reason of its development is untreated hypothyroidism. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-size: 14pt;">Reasons</span></u></b><b><span style="font-size: 14pt;">:</span></b><span style="font-size: 14pt;"> - cold
exposures, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l5 level1 lfo16; tab-stops: list .5in; text-align: justify; text-indent: .25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">respiratory diseases, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l5 level1 lfo16; tab-stops: list .5in; text-align: justify; text-indent: .25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">surgical interventions, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l5 level1 lfo16; tab-stops: list .5in; text-align: justify; text-indent: .25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">narcosis, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l5 level1 lfo16; tab-stops: list .5in; text-align: justify; text-indent: .25in;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">food and medicamental
intoxications, </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l5 level1 lfo16; tab-stops: list .5in 1.0in; text-align: justify; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">medical drugs, that oppress central
nervous function (neuroleptics, tranquilizers, sedatives).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14pt;">In patogenesis</span></b><span style="font-size: 14pt;"> : - hypercapnia, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l10 level1 lfo17; tab-stops: list .5in; text-align: justify; text-indent: .75in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">hypoxia, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l10 level1 lfo17; tab-stops: list .5in; text-align: justify; text-indent: .75in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">water and electrolytic imbalance, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l10 level1 lfo17; tab-stops: list .5in; text-align: justify; text-indent: .75in;">
<!--[if !supportLists]--><span style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">hypothermia. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Hypoxia is caused by pulmonary hypoventilation. Adiposity, edema of
body, hydrothorax, ascites, mucinous swelling of alveoluscs promote hypoxia
development. Decreas of kidney’s bloodstream - hypercapnia - coma develops
gradually.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Clinic features</span></b><span style="font-size: 14pt;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo18; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Weakness, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo18; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Apathy, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo18; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Drowsiness occurs, <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo18; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Movements become slower. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Appearance
of patients with hypothyroidism is rather specific: puffy face with specially
strongly pronounced swelling lips, ears and eyelids. The skin is dry, pale,
rough with scales and it feels cold. The skin practically can not be taken in
folds because of significant mucinous swelling.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">The body temperature is reduced. Bradycardia. Boundaricss of heart
dullness arc displaced. <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Diagnosis and the differential diagnosis.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l16 level1 lfo19; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14pt;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Hypothyroidism is diagnosed on its
clinical symptoms and laboratories results of hormones in plasma of blood. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l16 level1 lfo19; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Reduction of triiodothyronine </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l16 level1 lfo19; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Thyroxine and increasing of TSH. </span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<b><span style="font-size: 14pt;">Instrumental diagnostics</span></b><span style="font-size: 14pt;">. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l3 level1 lfo20; tab-stops: list 63.0pt; text-align: justify; text-indent: -45.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14pt;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14pt;">Increased time of Achilles tendom
reflex - the limits of 270 ± 30 Msec. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l3 level1 lfo20; tab-stops: list 63.0pt; text-align: justify; text-indent: -45.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">An atrophy of a thyroid gland - ultrosound.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 14pt;">Treatment.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;">
<span style="font-size: 14pt;">Hypothyroidism is treated by synthetic analogues of thyroid hormones:
Levothyroxine and Liothyronin. There are also combined preparations of
Levothyroxine with Liothyronine and a potassium iodide (Thyrocomb, Thyrotom,
Novothyral e.a.)</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Thyrocomb</span></b><span style="font-size: 14pt;"> (70 ug of the Levothyroxine, 10 ug
of the Liothyronine, 160 ug of the potassium iodide).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Thyrotom</span></b><span style="font-size: 14pt;"> (40 ug of the Levothyroxine, 19 ug
of the Liothyronine).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Thyrotomorte </span></b><span style="font-size: 14pt;">(120 ug of the L-thyroxine, 30 ug
of the L-triiodothyronin).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Novothyral (</span></b><span style="font-size: 14pt;">120 ug of the Levothyroxine, 20 ug
of the Liothyronine).</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Euthyrox</span></b><span style="font-size: 14pt;"> with 25, 50, 75, 100, 125, 150,
175, 200 ug of levothyroxine.</span><span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 14pt;">Levothyroxine</span></b><span style="font-size: 14pt;"> is the most used preparation - for
adults is 1.6-2.2 ug /kg/ per day. The treatment begins with 1/4 of a day.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Calculated dose increasing each 2 weeks twice and
gradually leading up to a necessary effective therapeutic dose. The treatment
begins from 25 ug of the Levothyroxine per day leading up to 100-150 ug per
day. All the dose is taken in the morning after a breakfast. The efficiency of
the treatment is estimated by a regress of clinical symptoms regression and
normalization of the TSH.</span><o:p></o:p></div>
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