Hyperthyroidism is the hyper function of the thyroid gland. Graves disease is also known as Basedow's disease or Parry disease and is a disease that is characterized by 3 major manifestations: hyperthyroidism with diffuse goiter, dermopathy and ophthalmopathy. These major events do not always occur together.



Basedow disease is a relatively common disease that may occur at any age but is most common in 3rd and 4th decades of life, its frequency being increased in women. In geographical areas where goiter is endemic men to women ratio is 7:1 compared to geographical regions with endemic goiter where the ratio is much lower.

Graves disease symptoms are classified to reflect events associated to thyrotoxicosis and Basedow disease specific. The most common Graves disease symptoms are: emotional lability, nervousness, tremors, insomnia, excessive sweating and intolerance to heat and increased peristalsis. Also weight loss is common despite maintenance or increased appetite. The presence of proximal muscle weakness with reduction in force is often manifested by difficulty in ascending the stairs.

Periomenopause in women tends to trace the appearance of amenorrhea. Young people are generally dominated by nervous symptoms while the predominant symptoms in the elderly are cardiovascular and eye tests. Specific manifestations of Graves disease are: - Hyper functional diffuse goiter; - Dermopathy; - ophthalmopathy.

These symptoms occur in different combinations and with a highly variable frequency, the most common being goiter. Diffuse goiter and lobular hyper functions may be asymmetrical. Detection of the thyroid gland usually indicates this thyrotoxicosis, but this sign is sometimes present in other forms of thyroid hyperplasia. Differential diagnosis is made with the murmur of breath, venous and carotid. On palpation of thyroid can be detected an increased pyramidal lobe.

Dermopathy usually manifests itself in the rear part of the legs and is called pretibial mixed. This is a late phenomenon that occurs in approximately half of patients in active stage of thyrotoxicosis and virtually in all patients with ophthalmopathy.

Dermopathy (manifestations of skin) is characterized by: - Skin is soft, warm, moist, fine, erythematous (redness especially the emotions in the region prior to the neck and chest); - Itching skin; - Hyper pigmentation in the certain areas (Jellinek sign), and at the elbows, hands or diffuse hyper pigmentation; - Vitiligo; - Alopecia (in the scalp is low, soft, very friable); - The hair on the body is fine and reduced - Nails are thinner; they become soft, loose and shiny.

Ophthalmopathy is characterized by:
- Upper eyelid retraction determine the discovery of a large portion of the sclera giving the patient a fixed, fearful that creates the impression of apparent exophthalmia. This causes delay in achieving the upper eyelid descent causing strange movements of the eye. The reasons for this mechanism are represented by high muscle spasm due to higher eyelid increased sympathetic nervous system activity (activity blockers)

- Corneal surface moist and glossy
- Exophthalmia - it consists in prominent eyeballs. Exophthalmia is commonly bilateral and rarely meets unilaterally. The look here is fixed and due to excessive opening of the fissure and tears to the eyes is double. Sometimes exophthalmia can progress to malignant form, setting up blindness.

- Congestion of the conjunctiva which is more intense at the edge of circumscribing the eyelids accompanied by hyper secretion; - limiting upward movement of the eyeball to a certain threshold; - inability to perform eye movements