Osteoarthropathy in hyperthyroidism

osteoartropathy main causes of hyperthyroidism, their clinical presentation, diagnostic methods and treatment principles.

main causes of hyperthyroidism

Hyperthyroidism - a pathological state of the organism that develops when excess tireogormonov in the body, often accompanied by an increased metabolism in the body.The most common causes of hyperthyroidism are:

  • diffuse or nodular diffuse toxic goiter,
  • thyrotropin-producing pituitary adenoma,
  • toxic thyroid adenoma,
  • autoimmune thyroiditis (Hashimoto's disease).

main clinical manifestations of arthropathy in hyperthyroidism.

When thyrotoxicosis bone mainly dominated by the processes of bone resorption (resorption) of the bone tissue, reducing its density.The speed of this process depends on the level of blood tireogormonov.Simultaneously with the processes of resorption of bone calcium absorption observed decrease in thyrotoxicosis in the intestine and vitamin D metabolism disorders in the body.All this leads to the development of os

teoporosis - bone density reduction and increased bone fragility.

osteoporosis in hyperthyroidism is diffuse in nature and is accompanied by symptoms of varying severity.This may be of bone pain and pathological fractures that can occur even with no apparent traumatic injuries, and kyphotic deformity of the spine.Particularly high risk of hip fractures in patients with thyrotoxicosis in old age - it increased by almost 2.5 times.If a timely and appropriate to carry out corrections in hormonal levels in these patients, the osteoporosis phenomena are alone, even without treatment.

In hyperthyroidism may cause arthropathy with a thickening of the nail phalanxes and periosteal reaction - the so-called thyrogenous akropatiya, (Marie-Bamberger syndrome or hypertrophic osteoarthropathy), in which the celebrated strain of nail phalanges in the form of drum sticks and nails - in the form of time windows.This is usually accompanied by muscle weakness and muscle pain (myalgia).One of the most frequent manifestations of lesions of bones and joints in hyperthyroidism is periarthrosis frozen shoulder (adhesive capsulitis, shoulder-brush syndrome) observed in 17.5% of patients, and carpal tunnel syndrome.

Hyperthyroidism may be associated with an increase in volume of the thyroid gland (goiter is formed), disorders of the heart (tachycardia, heart rhythm disturbances) and central nervous system (thyrotoxicosis), fatigue, emotional instability, vascular disorders (hyperhidrosis, tremors of hands and .d)..bilateral symmetrical exophthalmos (exophthalmia) can be observed In marked hyperthyroidism.

Diagnostics arthropathy in hyperthyroidism

  • Determination of serum high content of triiodothyronine and thyroxine, thyroid-stimulating hormone (thyrotropin when producing pituitary tumor).
  • Ultrasound examination of the thyroid gland (or MRI)
  • Radioisotope scanning.
  • biopsy of the thyroid gland under ultrasound guidance.
  • in peripheral blood (autoimmune thyroiditis) can be accelerated erythrocyte sedimentation rate and positive reaction Boyden
  • X-ray, CT scan or MRI of the skull and sella sighting (to detect pituitary adenoma), as well as advanced inspection neyrooftalmologichesky.
  • ultrasound or X-ray densitometry (to determine the degree of severity of osteoporosis).
  • ultrasonography of the shoulder joint, wrist and other joints (for the detection of shoulder periarthrosis, carpal tunnel syndrome it.d.).

treatment of arthropathy in hyperthyroidism.

Treatment of the underlying disease leads to a decrease arthropathy phenomena and reduce osteoporosis phenomena.But it must be strictly differentiated treatment after a full examination and determine the cause of the disease:

  • When goitre appoint thyreostatics (tyrosol, Mercazolilum and other drugs) or radioactive iodine.
  • autoimmune thyroiditis prescribe corticosteroids or immunosupresupressory.
  • thyrotoxicosis and / or diffuse nodular goiter, thyroid cancer treated promptly (strumectomy), pituitary tumors - radiation therapy and other specific treatments.
  • Pain in arthropathy treated symptomatically, for osteoporosis - treatment with bisphosphonates, calcium supplementation with vitamin D and other drugs.

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