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Virtually all the symptoms and signs of Graves' disease result from the direct and indirect effects of hyperthyroidism, with exceptions being Graves' ophthalmopathy, goitre and pretibial myxedema (which are caused by the autoimmune processes of Graves' disease). These clinical manifestations are dramatic and involve virtually every system in the body. The mechanisms that mediate these effects are not well-understood. The severity of the symptoms and signs of hyperthyroidism is related to the duration of the disease, the magnitude of the thyroid hormone excess, and the patient's age. There is also significant variability in the individual response to hyperthyroidism and individual sensitivity to thyroid hormone fluctuations generally. On top of that, Graves' disease patients can undergo periods of ''hypo''thyroidism (for further information, see symptoms of hypothyroidism): finding the right dosage of thyroid hormone suppression and/or supplementation can be difficult and takes time. The body's need for thyroid hormone can also change over time, like in the first months after radioactive iodine treatment (RAI). Thyroid autoimmune diseases can also be volatile: hyperthyroidism can interchange with hypothyroidism and euthyroidism.〔Psychische stoornissen bij endocriene zieken, 1983, C. van der Meer en W. van Tilburg (red.)〕 ==General symptoms and signs== * Goitre (enlarged thyroid). If the thyroid grows large enough, it may compress the recurrent laryngeal nerve, producing vocal cord paralysis, dysphonia, and even respiratory stridor. Compression of the sympathetic chain may result in Horner's syndrome.〔Surgical management of multinodular goiter with compression symptoms. Ríos A, Rodríguez JM, Canteras M, Galindo PJ, Tebar FJ, Parrilla P, Arch Surg. 2005;140(1) 49; Compression syndromes caused by substernal goitres. Anders HJ, ''Postgrad Med J.'' 1998;74(872) 327.〕 * Graves' ophthalmopathy (protrusion of one or both eyes) * Pretibial myxedema * Cardiovascular features may include hypertension, and heart rate that may be rapid or irregular in character; these may be perceived as palpitations.〔Graves' Disease and the Manifestations of Thyrotoxicosis - Leslie l. De Groot, Thyroid Disease Manager, Chapter 10 (http://www.thyroidmanager.org/Chapter10/10-frame.htm)〕 Less common findings include left ventricular hypertrophy, premature atrial and ventricular contractions, atrial fibrillation, congestive heart failure, angina, myocardial infarction, systemic embolization, death from cardiovascular collapse and resistance to some drug effects (digoxin, coumadin).〔 * Hyperreflexia, with a rapid relaxation phase.〔 * A distinctly excessive reaction to all sorts of stimuli.〔 * A marked increase in fatigability, or asthenia, is often prominent. This increased weariness may be combined with hyperactivity; patients remark that they are impelled to incessant activity, which, however, causes great fatigue.〔 * Insomnia〔A survey study of neuropsychiatric complaints in patients with Graves' disease. Stern RA, Robinson B, Thorner AR, Arruda JE, Prohaska ML, Prange AJ Jr, ''J Neuropsychiatry Clin Neurosci.'' 1996;8(2) 181.〕 * Tremor (usually fine shaking; tremor of the outstretched fingers). In a small study of newly diagnosed hyperthyroid patients, tremor was observed in 76% of them.〔Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH, ''J Neurol Neurosurg Psychiatry.'' 2000;68(6) 750.〕 Some studies lay the cause for hyperthyroid tremor with a heightened beta-adrenergic state, others suggest an increased metabolism of dopamine.〔Propranolol as an adjunct therapy for hyperthyroid tremor. Henderson JM, Portmann L, Van Melle G, Haller E, Ghika JA, Eur Neurol. 1997;37(3) 182; Hyperthyroidism exaggerating parkinsonian tremor: a clinical lesson. Kim HT, Edwards MJ, Lakshmi Narsimhan R, Bhatia KP, ''Parkinsonism Relat Disord.'' 2005;11(5) 331.〕 * Weight loss despite normal or increased appetite. Some patients (especially younger ones) ''gain'' weight due to excessive appetite stimulation that exceeds the weigh loss effect.〔Graves' disease. Influence of age on clinical findings. Nordyke RA, Gilbert FI Jr, Harada AS, Arch Intern Med. 1988;148(3) 626.〕 * Increased appetite.〔 * Weakness or muscle weakness (especially in the large muscles of the arms and legs). This latter occurs in 60 to 80 percent of patients with untreated hyperthyroidism.〔Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH, J Neurol Neurosurg Psychiatry. 2000;68(6) 750; Electromyographic and histological findings in the muscles of patients with thyrotoxicosis. HAVARD CW, CAMPBELL ED, ROSS HB, SPENCE AW, Q J Med. 1963;32:145; Electromyography in thyrotoxicosis. Ramsay ID, Q J Med. 1965;34(135) 255.〕 Muscle weakness is rarely the chief complaint. The likelihood and degree of muscle weakness is correlated with the duration and severity of the hyperthyroid state, and becomes more likely after the age of 40. Muscle strength returns gradually over several months after the hyperthyroidism has been treated. * Muscle degeneration * Shortness of breath〔 * Increased sweating〔 * Heat intolerance〔 * Warm and moist skin〔Cutaneous manifestations of thyroid disease. Heymann WR, ''J Am Acad Dermatol.'' 1992;26(6) 885.〕 * Thin and fine hair * Redness of the elbows is frequently present. It is probably the result of the combination of increased activity, an exposed part, and a hyperirritable vasomotor system.〔 * Chronic sinus infections * Brittle nails * Plummer's nail * Abnormal breast enlargement in men〔The hypothalamic-pituitary-testicular axis in thyrotoxicosis. Kidd GS, Glass AR, Vigersky RA, J Clin Endocrinol Metab. 1979;48(5) 798.〕 * Gastrointestinal symptoms. This includes increased bowel movements, but malabsorption is unusual.〔 * Augmented calcium levels in the blood (by as much as 25% - known as hypercalcaemia). This can cause stomach upset, excessive urination, and impaired kidney function. * Diabetes may be activated or intensified, and its control worsened. The diabetes is ameliorated or may disappear when the thyrotoxicosis is treated.〔 * Evidence of mild or severe liver disease may be found.〔 * Reproductive symptoms in men may include reduced free testosterone (due to the elevation of testosterone-estrogen binding globulin level),〔 diminished libido, erectile dysfunction and (reversible) impaired sperm production with lower mean sperm density, a high incidence of sperm abnormalities, and reduced mobility of the sperm cells.〔 Women may experience infrequent menstruation or irregular and scant menstrual flow along with difficulty conceiving, infertility and recurrent miscarriage.〔Gleicher N, Weghofer A, Barad DH (2011). "Do chromosomally abnormal pregnancies really preclude autoimmune etiologies of spontaneous miscarriages?". Autoimmun Rev. 2011 Apr;10(6) 361-3. Epub 2010 Dec 30.(" PMID 21195806" )〕 * Neurological seizures, neuropathy from nerve entrapment by lesions of pretibial myxedema, and hypokalemic periodic paralysis may occur.〔 Athetoid, choreia, and corticospinal tract damage, are rare. An acute thyrotoxic encephalopathy is very rare.〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Symptoms and signs of Graves' disease」の詳細全文を読む スポンサード リンク
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