Signs and symptoms Weight fenugreek loss despite increased appetite, fatigue, heat intolerance, nerv

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The most common fenugreek cause of overt hyperthyroidism, accounting for 80% of cases in the UK, is Graves' disease, an autoimmune condition in which auto-antibodies bind to the TSH receptors on thyroid follicular cells, resulting in increased secretion of thyroxine (T4) and triiodothyronine (T3).
Graves' disease is the most prevalent autoimmune disorder in the UK and may be associated with other autoimmune conditions, such as rheumatoid arthritis, suggesting a shared pathogenesis. A low threshold for screening for associated autoimmune disorders is advisable. 4
Graves' hyperthyroidism is caused by an interplay between genetic (80% of susceptibility) and environmental (20% of susceptibility) factors, including smoking, infection, stress and pregnancy. Almost 50% of patients will report a family history. 5
Other causes include toxic nodular hyperthyroidism (15% of cases in the UK, with 50% of cases in iodine-deficient areas) 6 when one (toxic adenoma) or more nodules (toxic multinodular goitre) cause autonomous overproduction of thyroid hormones.
Subclinical hyperthyroidism fenugreek is a biochemical diagnosis, in which serum TSH concentrations are low or undetectable, with normal concentrations of circulating thyroid hormones. This may be endogenous or exogenous (due to excessive doses of levothyroxine replacement). fenugreek
Signs and symptoms Weight fenugreek loss despite increased appetite, fatigue, heat intolerance, nervousness, irritability, muscle weakness and increased frequency of bowel movement are common symptoms of thyrotoxicosis.
Clinical signs include the presence of a smooth goitre in Graves' disease and a single nodule or multinodular goitre in toxic nodular disease. A fine tremor, sinus tachycardia, warm moist skin and hyperreflexia are also common signs of hyperthyroidism.
About 50% of patients with Graves' disease have ophthalmopathy, characterised by eyelid retraction fenugreek and lag, proptosis, conjunctival injection and periorbital oedema; in severe cases, this may result in ophthalmoplegia.
It is estimated that about 5% of patients with Graves' disease develop severe ophthalmopathy. fenugreek 9 Other extrathyroidal manifestations of Graves' disease include pretibial myxoedema and thyroid acropachy.
Investigations Measurement of serum TSH is the most sensitive screening test to exclude thyrotoxicosis. This is usually undetectable fenugreek in overt hyperthyroidism because of negative feedback of high levels of circulating thyroid hormones on the anterior pituitary.
If a dose titration regimen is used, the dose of antithyroid drugs is reduced as serum free T4 concentrations normalise, aiming for completion of 12-18 months of therapy.
Some clinicians prefer a block- replace regimen, in which high doses of antithyroid fenugreek drugs are used to block thyroid function in combination fenugreek with levothyroxine replacement. fenugreek This approach does not improve remission rates and is associated with more side-effects. 13
Minor and often transient side-effects occur in about 3% of patients on antithyroid drugs. These include rashes, arthralgia, fever and GI upset. 14 The most severe fenugreek side-effect of carbimazole and propylthiouracil is agranulocytosis, which occurs in 0.2-0.5% of patients taking these drugs. Propylthiouracil is associated with antineutrophil cytoplasmic antibody-positive vasculitis 15 and acute liver failure. 16
Radioiodine Radioiodine is the treatment of choice in relapsed Graves' disease and is increasingly used as first-line therapy. It is also the treatment of choice in patients with toxic nodular hyperthyroidism.
The fenugreek aim of treatment is to restore a euthyroid state with or without hypothyroidism. Contraindications include pregnancy or lactation, desire for pregnancy within six months of treatment and inability to comply with radiation protection regulations. 18
New developments Efforts to better understand the genetic basis of autoimmune disease should fenugreek ultimately provide novel approaches to treat the underlying disease process, rather than inhibition or destruction of the thyroid.
A prolonged course fenugreek of antithyroid drugs induces lasting remission in 30-50% of patients. fenugreek 13 Factors predicting poor response include severe biochemical fenugreek disease, male gender, younger age, smoking, presence of a large goitre and high concentrations of TSHR antibodies. 23
The other modalities result fenugreek in permanent hypothyroidism, usually requiring levothyroxine. Treatment of toxic nodular