Thyrotoxicosis or Plummer's dsease is the clinical syndrome caused by increased levels of circulating thyroid hormones. Thyrotoxicosis represents an exaggerated manifestations of the effects of thyroid hormones that are in excess:

-General Plummer's disease symptoms: weight loss (with normal or increased appetite), intolerance to heat, insomnia, psycho-emotional lability, anxiety, irritability, nervousness, and hyperkinesias with psychomotor agitation.

- Cardiovascular events: rhythm disturbances (sinus tachycardia, extra systoles, atrial fibrillation), marked peripheral vasodilatation (with greater differential BP) apexian intense shock, circulatory hyperkinetic syndrome.
- Neuromuscular manifestations: fatigue, muscle tremors of the extremities (due to exhaustion adrenergic receptors).

-Skin manifestations: warm skin, soft, thin, wet, thinning hair and nails, central temperature increased moderately (due to increase metabolism).

-Digestive manifestations: diarrhea, jaundice with hepatic steatosis.

- Genital Plummer's disease symptoms: decreased sexual activity in men, infertility, gynecomastia, dysmenorrhea in women.

-Ocular manifestations: upper eyelid retraction (the sclera visible above the corneal arc - Dalrymple sign), periorbital hyper pigmentation (sign Jelinek), spasmodic movements of the eye, bright eyes (the "live").



Thyrotoxicosis cases include: Graves disease (most common form of thyrotoxicosis), a toxic solitary or multinodular goiter (Plummer disease), and hyperthyroidism secondary to a TSH secreting pituitary adenoma or secondary hyperthyroidism excess hormones islands of ectopic thyroid tissue. Thyroids crisis is a medical emergency and is manifested by severe tachycardia, fever, confusion and disorientation.

-Epidemiology:  The disease affects primarily in females (ratio B: F = 1:7) at middle age (30-50 years), but can occur in adolescents, during pregnancy or menopause.

-Pathogenesis: Pathogenesis is represented by the presence of antibodies to TSH receptors on the surface of thyroid follicular cells, which stimulate the receptor and cause excessive secretion of thyroid hormones. Productions of anti-thyroid receptors can occur as a result of a lack of LTS that permit LTH Action stimulate production of clones of LB or triggering an immune response due to altered cell surface antigens post-iradiation thyroid.
Pathology: macroscopic - gland is diffusely and uniformly increased volume and microscopic - dusted small follicles may be observed by a cylindrical epithelium (hiperfunctional), with a small quantity of colloid and augmented blood supply, and there may be a limfoplasmocitar infiltrated.



Signs and symptoms of Plummer disease:

-Diffuse goiter;

- Thyrotoxicosis -Infiltrative orbitopathy: protrusion of the eyeballs due to enlarging bilateral retro bulbar tissue, over-and infra-orbital edema, congestion and swelling of the conjunctiva

-Infiltrative dermopathy with increased content of hyaluronic acid and condroitinsulfati: pretibial myxedema.

- Blast on gland listening. The data compression mechanics of formation Neighborhood: hoarseness, voice bitonic (due to compression nerve larynges appellant), dysphasia (due to compression of esophagus) syndrome Claude Bernard-Horner (miosis, exophthalmia, ptosis - due to compression inferior cervical sympathetic ganglion), dipnee (trachea due to compression), cyanosis and jugular turgor (due to jugular vein compression).