MALE SEXUAL DEFICIENCY AND INFERTILITY-TREATMENTS

MALE SEXUAL DISORDERS-MALE INFERTILITY

Sexual disorders and infertility are not uncommon in both male and female in modern days.These defects are frequently correlate with our diet,lifestyle,and emotional atmosphere.Stress and diet are playing important roles for hypogonadism the sexual dysfunctions of the male and female gonads followed by diseases and other organal disorders.In this post we concentrate about male sexual problems such as infertility,impotence and over activity of the sex organs.

The Hormones Of Sex in Men

There are variety of sex hormones are produced in men by various organs such as testes,the male sex organs prostate adipose tissues and adrenal glands.The predominant and the active forms are testosterone and dihydrotestosterone secreted by testes.These two hormones are accounting 99% male sexual characters.Out of these two hormones the dihydrotesosterone is more powerful and produce variety of androgenic reactions in our body.The most unwaned effect of his hormone is the enlargement of prostate gland and we will not deal with this here.

Testis also produce Androsterone,Androstenedione a testosterone metabolite.Androsterone is a weak horemone and its role of male sexual nature is negligible and it is formed by metabolizing dihydrotestosterone..The precursor hormone androstenedione will be converted into testosterone by peripheral tissues as per the need.

Adrenal glands also secretes in small amount of a male sex hormone known as Dehydroepiandrosterone which is also not very active.

There are metabolites of dihydrotestosterone  known as 5-a-androstane-3-a,17-beta-diol,and androsterone which are also weak in action.
In out side the testes some tissues especially brain tissues metabolise testosterone into female sex hormone the estradiol in men which is accounting and giving calmness and closure of the penis in resting periods most probably after a coitus or ejaculation.Esradiol is produced by testes also.Approximately 50 mic grams of estradiol is produced in normal man.Overproduction may result in feminism in men.
For treatments of hypogonadism it is found to be moral to administer Testosterone either by mouth or by other routes according to above studies.But the problem is the liver which readily metabolize testosterone 100% on administration by any route and inactivate it.To prevent this there are oral and pareneral preparations testosterone which is esterified to protect it from inactivation.These esters when they pass liver they get metabolized by liver and release testosterone into the circulation without inactivation.Oral testoserone and dihydrotestosterone are not effective than injections.
Recent findings have given an advantage oral preparation of modified testosterones such as methaneolone acetate and testosterone undecanoate.and these orally successful.
In oral preparations fluoxymesterone is a good androgen but a poor precursor of estrogen
But 19-nortestosterone is as strong as dihyrotestosterone in androgenic effects. 

SYNTHESIS AND SECRETIONS OF MALE SEX HORMONES

Testosterone in plasma usually occurs at high concentrations usually in three phases of life.

1.At the embryonic phase in this stage the plasma testosterone beginst to appear when a ovum is fertilized as a male embriyo and rises day by day reaches its peak high level at the eighth week and declines to bottom at the time of delivery.

2.At the neo natal period. After the birth it sarts again to reach its peak level at neonatal period of about one year and decline to bottom at the age pre-puberty.At puberty the pituitary hrough the hypothalamus secretes two hormones known as Luteinizing Hormone(LH) and Follicle Stimulating Hormone (FSH).

Gonadoropins begins to secrete in a pulsative manner as puberty progresses during both sleep and wake positions.During puberty the hypothalamus and pituitary both respond to the feed back mechanism of gonadotropin secretions very weakly.

Prior to puberty when the organs not well matured the plasma concentration of testosterone in a male 20 ng/dl.(0.7 nM)

as the puberty progresses the secretions also correlate with it and the male reaches the adult age the plasma concentrations of the testosterone is 300 to1000 ng/dl(10 to 35 nM) and the rate of production is 2.5 to 11 mg per day.In plasma 40% of the testosterone are bound to androgen binding globulin,58% are bound to other plasma proteins.2% is free in plasma which contributes to the androgenic activity.
Albumin bound testosterone is dissociating in the capillary bed for ready entry into the cells for actions.
LH and FSH from pituitary are regulating the development of testicles,and the production of sperm.Growth hormone also synergize the activities of LH and FSH.Estrogens suppress the LH action and reduce the secretion of testosterone.
Testoserone is a steroid and it is synthesized from cholesterol by the testes by the stimulating effect of pituitary LH on the Ledig cells of the testes.FSH on the other hand stimulate the seminiferous tubules to produce sperm.FSH also has an augumenting effect on LH.The spermatogenetic effects of both LH and FSH are all through the production of testosterone.
The injection of Human Chorionic Gonadotropin represents only the effects of LH. 
Administration of testosterone to men with hypogonadism and men who have been castrated(Eunuchism) is affecting the functions of LH and FSH.
In normal man estradiol is produced by testes and as well as brain.Brain and other tissues are converting a fraction of male sex hormone o female sexhormone the estradiol in a similar manner to testes.15% of he estradiol secreted by testes in a normal man.
In normal man the adrenal cortex is producing a minor quantity of testosterone through its precursor androsenedione but is not sufficient to represent the male nature.But in case of adrenocortex hyperplasia or cancer the production will be large.
Physiological effects of Male Sex Hormones
Androgens at the embroyanic age minutely secreted by testes and adrenal cortex withou any pituitary stimulation is virilizing regulating and maintaining the male urogenital parts of the male embryo.
In neo natal age they help the sexual developments within the central nervous system
At puberty they help the boy to become a well developed adult man.At this age the testes begins to enlarge.The penis and scortum start to grow,and pubic body hair beard and mustache begins to appear.Early in puberty,penial erections,nocturnal ejaculation and masturbations are frequent in most boys.
At the same time the growth promoting nature of the androgens contribute to increase in height,well established bone structure and musculin protein anabolic developments will leads into increase in height and weight.Physical vigor is increased.Testes developed into its full size.The skin become thick and oily.More proliferated sweat glands which are prone to plugging ang infections which results in pimples and acne formations.
Subcutaneous fat is lost and the veins under the skin appear prominently.Voice becomes deep. 
Secondary sexual characters begins to appear.
Heriditary appearance like baldness may begins to start like recession of the hairline at the temples and thinning of the hair at the crown.
At the end of this stage the bone growth attains to end.After this a further 1 or 2 cm growth is possible.
On behavior also androgens have major role.Men's aggressive rough and rude behavior are all due to androgens.Administration of male sex hormones may definitely influence the mood of a normal individual.These are the bases for treatments of male insufficiency with androgens.
When androgens are given to an prepuberty boy or a eunucoid young man the events of normal puberty are duplicated but there may be a time of laps (1 to 2 or more years) may take to establish the full virilization.
Shortly after starting the treatment inapropriate  erections with embarrassing frequencies may begins to surface with discomforts.Tolerance will develop as the treatment continues and these discomfort will be eased and subsided.Increased physical vigor and a general feelings of wellbeing ensued after a few weeks of the treatments.
The penis begins to grow followed by a distinct change in the voice.
Auxillary and pubic hair become more luxuriant.
The rapidity of the skeletal and muscular growth is very impressive in boys treated at or before the time of normal puberty.
The height growth increase 10 cm or more during the first year of treatments followed by diminishing for next 2,3 years.
With continued treatment development with the growth of a beard and body hair as a late expression of therapy.

Actions of Androgens On Normal Male

Normally,at the second month of the fetal life androgens start to be secreted by the baby's testicles and establish their important role of differentiation and development of the male reproductive system.

 

 

INFLAMMATORY DISEASES-I -ASTHMA

ASTHMA

ASTHMA a tracheobronchial  inflammatory disease in which air flow restrictions happen due to bronchospasm results in wheezing,breathing difficulty,cough and cold.Of the two types of asthma namely allergic and non allergic the allergic type is more common which 95% of the people suffer.

In many cases of asthma increased numbers of inflammatory cells such as eosinophils,lymphocytes and macrophages are found to be present in the alveolar fluids.These are not found much in the alveolar lavage of the normal individual.These inflammatory cells are even found in the asthmatic person's broncho alveolar lavage who's lung function is at normal baseline and no recent asthma exacerbations.These inflammatory cells are found in both allegic and non allergic asthmatic patients.

Hence asthma is purely an inflammatory disease. 
Causes of Asthma  
1.Inflammation of the bronchial wal
2.Constriction of the bronchial smooth muscle
3.Increased mucus secretions
Clinical symptoms
Shortness of breath
coughing
Wheezing
Use of accessary muscles of respiration such as mouth breathing
Chest tightness
Precipitators of Asthma
Allergens  
These agents stimulate mast cells to release various inflammatory agents like histamins,leucotriens,and chemotactic factors that promote bronchiolar spasm and thickening of the
 mucus.
Infections  
Like viral upper respiratory infections exclusively in children in whom commonly these infections precipitate asthma.
Psychological factors 
These factors like stress and other confused states may cause asthma but not readily recognizable 

Treatments

The treatment options are as follows and fortunately all the available asthma treatment options described below are safely and aggressively can be used for pregnant ladies without any harm.

1.Sympathomimetic agents 

Mostly beta-2 adrenergic agonists are more suitable in this class of drugs as they are powerfully dilating the bronchial trunk by increasing cyclic Adinosine Monophosphate (cAMP)

(e.g)Pirbuterol;

        Terbutalin

        Albuterol and

        Salmeterol

These medicines can be safely administered by inhalation and because heir absorption in the systemic circulation is poor and hence side effects are minimal

These are the drugs of choice to get immediate releif from an acute attack as the onset of their action is quick.

Side effects Tremor and tachycardia.

2.Corticosteroids

Steroids reduce inflammations by reversing mucosal edema,by decreasing the capillary permiability and they inhibit the release of inflammatory agents such as leucotrienes,and cytokines.

Corticosteroids can be used both acute and chronic asthma.Since corticosteroids are not broncho dilators and hence a bronchodilator also must be included in the treatment regimens.

For acute exacerbations systemic steroids should be given via oral or i.v. routes followed by a maintenance therapy by inhalation.

(e.g.) 1.Beclomethasone

          2.Flunisolide

          3.Triamcinolone

          4.Fluticasone.

Side effects

Inhaled steroids may sometimes produce cough,oral thrush and dysphonia

Systemic steroids like prednisone can cause glucose metabolism defects,increased hungry;weight gain;hypertension,adrenal deficiency

3.Anticholinergics

Anticholinergics can cause bronchodilation and decreased mucosal secretions by blocking cholinergic nervous system. 

(e.g.) Ipratropium (Atrovent) is the best example in this class of anti asthmatics.

Uses 1.Asthma

         2.Chronic Obstructive Pulmonary Disease (COPD)

Side effects

1.Dry mouth

2.Sedation

3.Blurred vision

4.Urinary retension

5.Constipation. 

Because of inhalation many of the above side effects may not be seen as the drug is poorly go into the circulation.

4.Leucotriene Inhibitors

They inhibit the formation of leucotrienes from ecosatetranoic acid (Arachidonic acid)

e.g. 1.Zileuton (Zyflo)

        2.Zafirlucast (Accolate)

They can be taken orally

These medicines are used for chronic maitenance therapy and should not be used for acute attacks.

Side Effects

1.Zileuton is causing liver damage

2.Zafirlukast-Allergy

5.Theophyllin

Similar to sympathomimetic agents this also causes bronchodilation by increasing cAMP level.It is also having anti inflammatory effect.

Drug interactions Serious drug interactions are observed if theophyllin is used concomitantly with cimetidine end erythromycin as the later medicines will increase the theophyllin plasma concentration by competitively inhibiting its metabolism by liver cytochrom 450 enzyme.

Side effects and symptoms of overdose

1.Tremor;2.Insomnia;3.G.I.distress.

6.Mast cell stabilizers

e.g.Cromolin and Nidocromil

Can be used for prevention

Side effects Cromolyn causes pulmonary edema,cough and wheezing

Nedocromil causes mouth bitterness 
To download this article into your computer for an offline reference please click here 

 

ANEMIA-TREATMENTS

ANEMIA-AN OVERVIEW

Anemia is defined as a condition at which there are below normal levels of Red Blood Cells (RBC),Hemoglobin,and Hematocrits concentrations.

Hematocrit refers to the RBC count in total percentage.It is otherwise meaning that RBC in Packed Cell Volume(PCV) or Erythrocyte Volume Fraction(EVF).

Increasing the blood plasma volume disrespect to its hematocrit may also produce a temporary anemic condition as during pregnancy.

Comprehensively the growth factor known as erythropoietin a hormone secreted mainly from the kidneys and a little from liver acts on the bone marrows to produce and release RBCs in the blood.In emergency situations like accidents,starving and other incidents that causes heavy blood loss while RBC counts go down below normal the cells present at the cortex of the kidneys works hard and produce and release 100% erythropoietin in the blood.In this case the participation of liver is negligible.

Lack of erythropoietin will produce several forms of anemias and most importantly during Chronic Renal Failure.

Erythropeitin is not the sole responsible factor for erythropoiesis because it need several cofactors such as more importantly the sufficient supply of iron.In the absence or deficiency of iron the bone marrow will not properly respond to erythropoietin..

Uses of Erythropoietin

This medicines are used to correct anemias associated with Chronic Kidney Failure and Bone Marrow Failure 

Side effecs 

Can cause thrombosis and hypertension because of excessive over production of erythrocytes. 

Types of Anemias

1.Microcytic anemia is defined as the presence of very small discoloured or pale coloured (microcytic hypochromic) red blood cells which are unable to carry sufficient oxygen because of its hemoglobin deficiency.Mostly this anemia is caused by insufficient dietry supply of iron and blood loss through internal bleeding such as ulcer bleeding in the stomach and menstural bleeding.

Children at the ages of rapid growth need more iron.If they do not get sufficient iron supply in that ages (the teen ages) they would possibly develop this kind of anemia.

Iron :-Most of the iron in our body is present as hemoglobin and the remaining portion is present as transporter protein known as transferrin,ferritin and hemosiderin

Iron supplements should be given only to iron deficiency anemias.

Iron in the form of ferrous compound is more advantageous to be taken to produce the required benefits.Oral ferrous supplements are more convenient to take as parenteral preparations such as deep intra muscular injections may often cause muscular necrosis and pain.These are reserved only for emergency situations.

Toxicities 

1.Iron if taken carelessly on an empty stomach may produce damages and necrosis at the stomach and intestinal walls 

2.On high dosages iron can produce shock,metabolic acidosis,and even death

Treating Iron intoxications

Produce deep emesis and remove the unabsorbed drug from the stomach by vomiting( Excess ingetion of coconut milk may be help full)

Give Deferoxamine a chelating agent to inactivate the iron already mixed with the digestive juice.

Regular phlebotomy (A regular periodical blood testing) should be performed.

2.Pernicious Anemia and Vitamin B-12 Deficiency

Pernicious anemia  is well defined as a condition in which there is very insufficient quantity of RBC,and it is differing from Iron Deficiency Anemia (IDA) in which there is sufficient quantity of RBC is present but all of them are micro sized under developed and inefficient to carry oxygent because of their hemoglobin and iron deficiency.

Symptoms

1.Tiredness

2.Weakness

3.Shortness of Breath

4.Pale skin

5.Chest Pain

6.Hand and Foot Numbness

7.Difficult to balance on standing and walking.

Causes

Our stomach cells are producing a substance known as the intrinsic factor.Vitamin B-12 with the help of this factor keep and maitain the red blood cells healthy.

Either a deficiency in the supply of vitamin B-12 or the secretion of the intrinsic factor or both may cause pernicious anemia

Stomach cell damage by ulceration ,surgery,and tapeworm infection may cause the intrinsic factor secretion.

Vitamin B-12 can be given orally and as an intramuscular injection.

Side effects of vitamin B-12

Fortunately there are no known side effects to this vitamin have been established.

Folic Acid and Megalo Blastic Anemia (MBA)

Megloblastic Anemia is a condition in which there are unusually very large red blood cells (Megaloblastic or Macrocytic) without nucleous inside.

This is mainly due to the deficiency of folic acd which is needed by the cell to synthesize DNA.Lack of Vitamin B-12 may also can be a cause for this type of anemia but with sufficient supply of folic acid alone can cure this provided that there is no vitamin B-12 deficiency as because folic acid alone cannot cure the neurological defects.In such cases Folic acid with vitamin B-12 supplements should be prescribed.

Remember that body can store vitamin B-12 for longer time for years and years but folic acid stores will run out in months.Hence in most cases for treating MBA only folic acid supplements are enough but the deficiency of vitamin B-12 should first be ruled out. 

Folic acid is a well known needed vitamin during pregnancy as its deficiency will leads to neural tube defects.

Causes for folate deficiency 1.Inadequate dietary sources

2.Pregnancy

3.Drugs such as Phenytoin

4.Drugs such as oral contraceptives.
To download this article into your computer for offline reference please click here

 

CALCIUM HOMEOSTASIS-III-HYPERCALCEMIA

HIGHER BLOOD CALCIUM LEVELS-TREATMENTS

When the blood calcium levels rises above the normal range the condition is known by medical terms as Hypercalcemia.If left untreated it may result into serious unwanted consequences.

Symptoms

Although the patient is asymptomatic but he may demonstrate the following consequences:-

1.Weariness

2.Renal stones

3.Constipation

4.Stomach pain

5.Weakness

6.Confusion

7Delirium 

Causative Diseases

These causes can easily be remembered by the ananym CHIMPANZEES

Calcium suplementations used in excess

Hyperparathyroidsm

Iatrogenic (Urinary retension of calcium by overuse of thiazide diuretics)

Malignancy/Milk alkali syndrom caused by excessive intake of calcium and alkali through milk.

Paget's disease(Abnormal bone destruction and reformation) 

Addison's Disease

Neoplasm

Zollinger-Ellison's syndrom

Excess vitamin-D

Excess vitami-A

Sarcoid a disease in which there are abnormal collections of inflammatory cells to form granuloma 
TREATMENT OPTIONS
1.Rehydration with saline and diuresis with loop diuretics like furosamide
2.Bisphosphonates
3.Calcitonin
4.Gallium nitrae
5.Plicamycin
6.Glucocorticoids
1.Bisphosphonates
a)Etidronate
b)Pamidronate
Mechanism Bisphosphonates are working by inhibiting osteoclastic activity that means they reduce both bone resorption and bone formation of hydroxyapatite crystals.  
Routes of admn:- Etidronate by oral and i.v.
                              Pamidronate by i.v. only
Uses 1.Malignancy associated hypercalcemia
         2.Paget's disease
         3.Bone osteoporosis.
2.Calcitonin
A 32 member aminoacid peptide synthesized and secreted by the parafollicular C cells of the thyroid gland
Mechanism 
It decreases osteoclastic bone resorption as well as kidney calcium and phosphorus reabsorption.
Uses
1.Paget's disease
2.Hypercalcemia
3.Osteoporosis
Salmon fish calcitonin is more potent than humen calcitonin and have longer half life.
Side effects
1.Allergic reactions
2.Gastri Intestinal distress
3.Flushing,redness and tingling of the face.
3.Gallium nitrate
Gallium nitrate is working by bone resorption and thereby it decreases blood calcium levels.
Use Malignant hypercalcemia
Toxicity Nephrotoxic
4.Plicamycin
This is a cell destructing antibiotic reduces blood calcium levels
Mechanism
It inhibit the action of PTH on osteoclasts and also inhibiting the action of vit.D
Use Malignant hypercalcemia and Paget's disease
Toxicity 1.Thrombocytopenia and hemorrhage
               2.Liver and Kidney toxicity
               3.Nausea and vomiting and loss of appetite.
5.Glucocorticoids
(e,g) Prednisone
Mechanism These medicines work by decreasing calcium absorption by the intestines and increasing the calcium excretion by kidneys.
Uses Hypercalcemia due to lymphoma and sarcoid.

CALCIUM HOMEOSTASIS-PART-II

CALCIUM METABOLIC DEFECTS-TREATMENTS

HYPOCALCEMIA

 Symptoms 1.Muscular excitability

                    2.Parasthesiasis

                    3.Laryngospasm

                    4.Seizures

                    5.Tetany

                    Chvostek's and Troussean's sign

The facial muscle spasm that occurs when the facial nerve is streatched towards the anterior to the ear.This condition is known as Chvostek's syndrom

Carpal or carpopedal spasms in the hands during or after tied a tight cuff for a blood pressure measurement due to the occlution of the blood in that area.This condition is known as Troussean's syndrom

Common causes of Hypocalcemia

1.Chronic renal failure or End Stage Renal Failure

2.Parathyroid deficiency

3.Vitamin D deficiency

4.Malabsorption due to some diseases

5.Malnutritions.

Treatment options for Hypocalcemia

1.Calcium salts

a)Calcium chloride

b)Calcium gluceptate

c) Calcium gluconate

d)Calcium carbonate

Side effects

1.Peripheral vasodilation

2.Transienttigling

3.Rapid infusions may cause arrhyhmias

2.Vitamin D preparations 

a)Calcitrol a metabolite of vitamin D can cause quick raising of calcium levels

b)Ergocalciferol (Vit.D-2)

c)Cholecalciferol(Vit.D-3)

Mechanism Vitamin d is helping and facilitating calcium absorption at the intestine and decreasing its excretion by the kidneys.

Clinical Indications

1.Osteoporosis

2.End Stage Kidrey Failure

3.Rickets due to inadequate intake vit D

4.Rickets due to tissue resistance to vit- D

5.Osteomalacia

6.Hypoparathyroidism

Side effects

1.Vascular calcifications

2.Kidney calcium stones

3.Soft tissue calcium deposits.

 

CALCIUM HOMEOSTASIS-PART-I

CALCIUM METABOLISM

Calcium is an important mineral that our body needs for various functions.Unlike iodine which is almost available in our body mostly in the form of thyroid hormone,  plasma protein bound  and as a free iodine  ion or elemental iodine.Iodine may not stay in our body as a free ion unless for elimination.But in the case of calcium our body needed it in all the forms mostly ionic form for the contractions of various smooth muscles like heart,liver,kidney,pancreas,lungs and stomach etc.etc..About 80% of calcium is stored in bone as phosphates.

Calcium is distributed in our body almost in compartments including bones,plasma,intra-cellular (ICF) and extra-cellular(ECF) fluids.

Our bone contains most of the calcium content of our body  approximately 80% as phosphate salts.Approximately our body's total content of calcium is 1 kg.Bone serves as healthy and safety storage for calcium and phosphorus.10% of calcium is exchanged between bone and ECF in almost every day. 

Thus ECF serves as the next storage compartment,followed by blood plasma {2.3 mmol per liter(9.5 mg/dl) out of which the ionized calcium is 1.4mmol per liter(5.5 mg/dl) and ICF (>0.0002 mmol per liter)}

Calcium helps blood clotting factors by activating them at times of need.

The nerve cells are very sensitive to calcium concentration of in plasma as a small decrease in calcium level below the normal range (Hypocalcemia)may cause the opening of the voltage gated sodium channel and sodium is leaked into the cells of nerve axons and causes nerve hyper excitability which results in muscular spasms a disease known as tetany and paraesthesia (a pricking skin sensation around the mouth and extermities)

Conversely if the plasma calcium level rises above the normal range (Hypercalcemia) the sodium exchange is restriced from out side to inside of the nerve and muscular cells and the nerves are hyper polarised,and lost their normal sense of excitability,and become weak and tired leads to smooth muscle weakness which causes,lethergy,anorexia,constipation and emotions.

Calcium gives the structure,shape and strength for bones by forming as phosphate salts (calcium hydroxyapatite)

Pharmacokinetics

A normal daily diet contains 30 mmol calcium out of which 6 mmol is absorbed by our intestine daily.

Calcium absorption is almost regulated by vitamin D-3 a cholesterol derivative prepared by our skin. 

95% of the calcium from the glomerular filterate is reabsorbed by the kidneys leaving a small fraction to be excreted.If this level is disturbed by some pathological defects such as defects in calcium metabolism or bone desorption then there are possibilities of kidney stone formations occurs.

 

  In general calcium is metabolized  by our body in three ways as follows

1.By a hormone secreted by parathyroid gland (PTH)

2.By calcitonin an hormone secreted by paraglobular cells of thyroid glands

3.By viamin D-3.
1.Parathyroid glands are two pairs in number and each pair is positioned at either lobe of the thyroid glands.As these glands are situated at the back of the thyroid glands these glands are not visible during an exhamination of neck.The usual weight of parathyroid glands are  30 gms in men and 35 gms in women.
The major function of this gland is to maintain calcium and phosphate levels in a very narrow ranges in order to regulate the neuro muscular functions properly.Thus the PTH takes active part in the homeostasis of calcium. 
To keep up the plasma calcium ion within almost in a stable range thyroid and parathyroid glands working in an opposite direction to each other.Thus when the plasma concentrations of calcium ion rises above the narrowly fixed set level (Hypercalcemia) the thyroid secretion of calcitonin act on it and bring it down to normal range.
Conversely if the plasma calcium level go down below the normal set level(Hypocalcemia) then Para Thyroid Hormone (PTH) secreted by parathyroid gland act on it to raise its level to normal range.
Pathology
Hypocalcemia
Hypercalcemia 
 

THYROID DISEASES-IV-HYPER THYROIDSM

THYROTOXICOSIS-TREATMENTS

This is the over whelming secretions of thyroid hormone above the body's need.Unlike in hypothyroidsm in this condition the main cause of defect is on the gland only and not originated from the pituitary or hypothalamus.

Graves's Disease

This is having a synonym as Diffuse Toxic Goiter .This is most probably attacking young children but rarely target adult.

In this condition the gland is stimulated on TSH receptors not by TSH from the pituitary but by the autoimmune antibodies in the blood.Hence when pituitary is normal,and hypothalamus is normal but the gland is overstimulated by the body's own defence system. 

These antibodies are having prolonged gland stimulating effects and since they are only mimiking the action of pituitary and testing for TSH in the blood may not give positive results.

The required results will be yielded only by the titration of these antibodies in the blood.

Symptoms 

1.Diffusely enlarged nontender goiter

2.Nervousness,weakness,and insomnia. 

3.Heat intolerance and heavy sweating.

4.Weight loss inspite of elevated appetite

5.Tremour,muscle weakness

6.Palpitation and tachky arrythmias

7.Incomplete and slow eye lid closing (Exophthalmos)

8.Loose motion

9.Periorbital edema.

Plummer's Disease

This a highly toxic form of nodular goiter.This is more common in adults over 50 years and mostly females.The actual cause is unknown but preferably arise from untreated long standing non toxic goiter. 

In this disease one or more adenomatous nodules of the thyroid gland autonomously secreting excess hormone without being stimulated by pituitary hormone.Enlargedv nodules are formed within the goiter.

Basically deficiency in dietary iodine may cause not only hypothyroidsm but some times cause hyperthyroidsm too as follows by counter activity.

a)Availability of less dietary iodine leads to less T-4 production.

b)Less T-4 production may induce more mutations and introductions of TSH cells.

c)TSH cells on pseudostimulation by body's auto immune antibodies will induce more nodular autonomous T-4 producing cells which secretes automatically without getting any pituitary stimulation excess T-4 hormone result in Hyperthyroidsm.

Symptoms

Many of the symptoms are similar to Graves disease except the goiter shows enlarged nodules inside and usually in this disease slow eye lid movement is absent.

Heart abnormalities are more impressive and predominant in this disease.

Jodebasedow Phenomenon

It is a kind of Hyperthyroidsm in which there is a over production of thyroid hormone due to sudden large intake of iodine.either by food,by drugs (e.g.Antiarrhythmic drugs like amiodarone) or by contrast media like radio iodine.

Factitious Hyperthyroidsm

This hyperthyroidsm occurs mostly by misguided weightloss treatments which involves excessive intake of thyroid replacement agents.

Many of the symptoms of hyperthyroidsm like exophtalmia,glandular swelling.and auto immune activity are all absent in the diagnosis of this disease.

TREATMENTS

1.Beta-adrenergic blockers-Propranolol

Propranolol can reduce some of the peripheral symptoms of hyperthyroidsm such as

Palpitations

Tremour

Tachycardia(Increased heart beats)

Sweatting

Nervousness

In addition to the above symptomatic releives propranolol also inhibit the conversion of T-4 to T-3 in the circulation.

2.Propylthiouracil and Methimazole

Chemically these are sulphur containing thiamides.

They suppress the production of T-3 and T-4 by inhibiting the coupling of thyroglobulin molecule.

Can be taken orally

Side effects 1.Agranulocytosis (Rare but very serious)

2.Rash(Most common)

3.Edema

3.Iodine salts

The mechanism is not clear.Usually thyroid gland cannot take iodide as it is unless it should be converted into nonpolar inorganic iodine molecule.Hence ingesting large quantity of polar iodide ion may well result in decreased conversion into polar form and decreased iodine uptake and eventually leads to decreased productions of the T-4,decreased vascularity and decreased gland size.

Iodides are nowadays not used as a sole thrapy but in conjunction with thioamide and propranolol in thyroid cresis.Iodides also can be used prior to surgery.

Preparations 1.A mixture of iodine and potassium iodide (Lugol's solution)

2.Potassium iodide.

Side effects

1.Anaphylactic reactions such as Angioedema and swelling of the larynx

2.Iodism charectorised by burning taste,and mouth

3.soreness of teeth and mouth

4.swelling of eyelids

5.Cold like  senses

6.Breathing problem

7.Enlargement of the salivary glands

4.Ionic inhibitors

These are perchlorates and thiocyanates.

They competitively inhibit the iodide transport mechanism.

Nowadays their use is limited in favour of other advanced therapies

5.Radio Iodine

The mechanism is thyroid gland can readily absorb iodine in radioform which can ablate the gland and decrease the hormone production.

It can be used very coveniently to adults ove 21 years.

This is very useful in treating Profuse Grave's Disease which is not responding properly to drugs and surgery.

One common advantage with iodine is that there is no any upto date proof  Iodine can cause cancer

Side effects 

Delayed hypothyroidsm has been observed.

Contraindications

Radio iodine is highly contraindicated in pregnancy and milk feeding. 

THYROID STROM 

It is a dangerous emergency situation caused by extreme effects of hyperthyroidsm.

This condition is elevated by sickness,trauma,stress and surgery of the patient who is already thyrotoxic.

Treatments include the treatments of hyperthyroidsm especially and preferably with the beta blockers like propranolol,and glucocorticoids to inhibit the plasma conversions of T-3 to T-4.

Other options are a)Propyl thiouracil and methimazole, 

b)I.V sodium iodide injections