Study On The Clinical Character Of Hospitalized Patients With Graves Disease

OBJECTIVE To study the clinical character of hospitalized patientswith Graves disease, investigate the difference of sex, age, course, familyhistory, treatment, the enlargement and function of thyroid gland betweenpatients with complications and without, such as hyperthyroidism heartdisease, aleucocytosis, Graves ophthalmopathy, osteoporosis, thyrotoxicperiodic paralysis, diabetes mellitus and hepatic lesion.METHODS Firstly, the cilinical character such as sex, age, course,family history, treatment, enlargement and function of thyroid gland of422 patients of Graves disease were investigated retrospectively. Then,the patients were divided into groups according to the differentcomplications. Compare were made between patients with complicationsand without, such as hyperthyroidism heart disease, aleucocytosis, Gravesophthalmopathy, osteoporosis, thyrotoxic periodic paralysis, diabetesmellitus and hepatic lesion. The different clinical manifestation ofdifferent stages of hyperthyroidism heart disease, different reason ofaleucocytosis and different levels of bone mineral density were analyzed.Finally, the clinical character of Graves disease and its complicationswere summarized.RESULTS 1. General situation. Most of the 422 patients withGraves disease were female (58.16%) at the age of 42.37±13.60. Thecourse was 46.46±3.13 months and the time treated in the hospital was11.01±5.97 days. A family history was found in the 12.65% patients andthere was no difference in sex. The positive rate of TG-Ab(41.53%)waslower than TPO-Ab (57.91%) and classâ…¡enlargement of thyroid gland(42.93%) was common. Medication was the most important treatmentmethod (94.80%) and 42.15% of patients had end-of-dose failure and repeated therapy. Hyperthyroidism heart disease was the most familiarcomplications (22.04ï¼…) and the main reasons for hospitalization(25.00ï¼…). The other reasons for hospitalization were diabetesmellitus(25.00ï¼…), Graves ophthalmopathy (14.29ï¼…), aleucocytosis(10.71ï¼…) and ¹³¹â… treatment (10.71ï¼…) respectively. The mainly deathwere caused by hyperthyroidism heart disease (57.14ï¼…), hyperthyroidismcrisis(28.57ï¼…)and aleucocytosis(14.29ï¼…).2. Compare with Graves disease without complications.The male patients were usually complicated with thyrotoxic periodicparalysis and osteoporosis (P＜0.05). The older patients always hadhyperthyroidism heart disease, aleucocytosis, Graves ophthalmopathy,osteoporosis, diabetes mellitus and hepatic lesion (P＜0.05). The hospitaltime were delayed due to aleucocytosis, Graves ophthalmopathy,osteoporosis and diabetes mellitus. The course was longer in patients withhyperthyroidism heart disease and diabetes mellitus.The level of thyroid hormone and enlargement of thyroid gland weredifferent in different state. The level of FT₃ was low in Gravesophthalmopathy and the same as TSH in aleucocytosis (P＜0.05). Most ofthe patients with aleucocytosis had classâ…¡enlargement of thyroid gland(P＜0.05) and the patients with Graves ophthalmopathy and osteoporosishad normal volume thyroid gland (P＜0.05).The treatment of patients with different complications was different.The patients with hyperthyroidism heart disease and hepatic lesionusually treated repeatedly (P＜0.05). Hospital during therapy were causedby aleucocytosis and Graves ophthalmopathy (P＜0.05). Osteoporosis wascommon in patients treated firstly (P＜0.05). The positive rate of TG-Abin patients with Graves ophthalmopathy, osteoporosis and thyrotoxicperiodic paralysis were lower than that without complications (P＜0.05).3. The patients with heart failure were different from that without. The course were longer in the patients with classâ…¢andâ…£heartfunction (P＜0.05). The hospital day was longer and the thyroid wasnormal in the patients with classâ…¡heart function. The level of TT₃ andTT₄ were lower and TSH was higher in the patients with classâ…£heartfunction (P＜0.05). Classâ…¢enlargement of thyroid gland was more in thepatients with classâ…¢heart function than that with classâ… heart function(P＜0.05).4. The reason of aleucocytosis is different: The level of FT₃ was higherClassâ… enlargement of thyroid gland were less in the patients withaleucocytosis induced by hyperthyroidism than that induced by drugs(P＜0.05).5. There was difference in patients with osteoporosis, low bone massand normal bone density: Most of the osteoporosis patients were old malewith high level of FT₄ and without enlargement of thyroid (P＜0.05). Thepatients with low bone mass had a lower level of FT₃,TT₃ and FT₄.CONCLUSION 1. Most of the patients with Graves disease wereyoung female with different degree of enlargement of thyroid gland. Thepositive rate of TG-Ab was lower than TPO-Ab in these patients and therecurrent rate of that treated by antithyroid drug was about 42.15ï¼…ï¼…. Themost familiar complication was hyperthyroidism heart disease. The mainreasons of hospitalization repeatedly were hyperthyroidism heart diseaseand complicating with diabetes mellitus. The main reasons of death werehyperthyroidism heart disease and hyperthyroidism crisis.2. Hyperthyroidism heart disease always occured in the patients whowere old, having a long course and treated repeatedly. Some of them candeteriorated into dilated cardiomyopathy and the heart function wouldbecame worse and worse. The level of TT₃ and TT₄ was lower in patient with heart failure than that with normal heart function and the degree ofheart failure is not parallel with the degree of enlargement of thyroidgland.The patients with aleucocytosis were old, with low level of TSH, withclassâ…¡enlargement of thyroid gland, being in the course of treatmentand having a long time of hospital. Aleucocytosis induced byhyperthyroidism often occured in the patients with high level of FT₃.Aleucocytosis induced by drugs always occured in the adult femalepatients.Graves ophthalmopathy occured in the old patients who had normalthyroid gland and were in treatment. The hospital day was long andTG-Ab was negative in most of the patients. It can also occur in thepatients with euthyroid.Osteoporosis occured in the elder male patients whose thyroid glandwas not enlarged. They were the initial treatment patients with a longtime of hospital and the TG-Ab of them was negative. There was nocorrelation between bone mineral density and the level of TH. The levelof blood phosphonium may be low.Thyrotoxic periodic paralysis occured in the young male with negativerate of TG-Ab. Diabetes mellitus occured in the old patients whose coursewas long and the time of hospital was long. Hepatic lesion occured in thepatients who were old, treated repeatedly. Hepatic lesion can be led byhyperthyroidism and antithyroid drugs.