Clinical Manifestations of Thyrotoxicosis

The signs and symptoms of thyrotoxicosis, regardless of the cause, may include the following: increased basal metabolic rate, heat intolerance, tachycardia, widened pulse pressure, cardiac arrhythmias, skeletal muscle weakness, muscle wasting, tremor, hyperreflexia, emotional instability, nervousness, insomnia, change in menstrual pattern, frequent bowel movements (occasionally diarrhea), and weight loss despite an increased appetite. In addition, very frequent manifestations of all forms of thyrotoxicosis, irrespective of the underlying cause, are retraction of the upper eyelid (evident as the presence of a rim of sclera between the lid and the limbus) and lid lag. These ocular manifestations appear to be due largely to increased adrenergic stimulation and are ameliorated by adrenergic antagonists and reversed promptly upon successful treatment of the thyrotoxico-sis. These eye signs do not indicate Graves' infiltrative ophthalmopathy and are not accompanied by protrusion of the eyes.

In Graves' disease, the autoimmune processes mediate the enlargement of the thyroid gland, the infiltrative ophthalmopathy with exophthalmos, and the dermopa-thy and thereby distinguish Graves' disease from other causes of thyrotoxicosis.

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