Generally it is caused by viral or bacterial infections and also by some autoimmune diseases that causes the inflammation. The common signs off pneumonia include fever, chills, productive cough and chest pain.
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Abstract Over the past few decades, there has been an increase in the number of reports about newly recognized atypical or unusual manifestations of Graves' disease GDthat are related to various body systems.
One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism.
Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations.
The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment.
This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease.
Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundice may develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients.
Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD.
It usually presents with the common well- known symptoms and signs goiter, ophthalmopathy, weight Typical and atypical development, nervousness, tremors, palpitations, sweating, etc. We can observe another group of manifestations, such as periodic paralysis, apathy, or psychosis, which are less common and less distinctive despite being well documented in relation to GD Table 1.
Over the past few decades, there has been an increase in the number of reports about newly recognized atypical or unusual manifestations of hyperthyroidism that are related to various body systems and may create a wide range of differential diagnosis [ 23 ].
Most of these atypical manifestations are mainly reported in patients with GD Table 1either due to a specific relation to the autoimmune thyroid disorder, or because GD accounts for the majority of hyperthyroidism cases.
Occasionally, one of the atypical manifestations is the main presenting feature of GD [ 2 ]. The atypical manifestations of GD represent a wide spectrum of clinical and laboratory findings, and in this review we will focus on the clinical part of that spectrum.
For example, while hematological manifestations of GD include thrombocytopenia, leucopenia, anemia, and pancytopenia; we will discuss anemia as the clinical presenting feature. Other atypical clinical presentations of GD that will be discussed here are vomiting, jaundice, and right heart failure.
These manifestations can be attributed to a wide variety of hematological, gastrointestinal, and cardiopulmonary causes, and each of them represents a very common clinical condition.
Anemia Anemia is not uncommonly found in association with GD. It is somewhat challenging to face anemia as the presenting manifestation of GD, especially when the typical clinical features of hyperthyroidism are subtle or overlooked.
Regardless of the incidental association of GD with other forms of anemia e. As an autoimmune disease, GD was found to be associated with other autoimmune diseases that include pernicious anemia, celiac disease, and autoimmune hemolytic anemia [ 67 ].
Because of its clear relation to GD, and its cure following hyperthyroidism treatment, this type of anemia may be termed GD anemia [ 4 ]. In GD anemia the mean corpuscular volume MCV could be normal [ 8 ] or, probably more commonly, low [ 49 ].
Generally the anemia that coexists with GD is observed to be mild and is commoner with severe disease [ 5 ] When GD anemia is microcytic, iron indices are normal and hereditary hemoglobinopathies are readily excluded [ 10 ]. Anemia may be the sole haematological abnormality, or it may be combined with thrombocytopenia, or leucopenia; and occasionally it may be present as a part of a GD-associated pancytopenia [ 91112 ].
Erythropoietin levels are within normal reference ranges [ 4 ] and bone marrow, if examined, is hypercellular or, less commonly, normocellular; with normal iron stores [ 913 ].
The exact pathogenesis of GD anemia remains unclear [ 8 ]; however an effect of the excess thyroid hormones has been postulated [ 10 ]. The hypercellular marrow may indicate that erythropoiesis is enhanced due to hyperthyroidism, but in the same time it is ineffective, hence the finding of anemia with low MCV [ 10 ].
Hematologically, anemia in the presence of hypercellular marrow could be related to either organ sequestration such as observed in hypersplenism, an enhanced removal of circulating red blood cells by an immune or toxic mechanism, or a hemopoietic stem cell dysfunction such as myelodysplasia [ 9 ].
One or both of the latter 2 mechanisms could be responsible for the GD anemia, with myelodysplasia being the most widely accepted explanation [ 91013 ]. The finding that thyroid-stimulating hormone TSH receptor antibodies nonspecifically attach to the surface of the red blood cells, may suggest an autoimmune basis for GD anemia [ 14 ].The first half of the book, discussing normal patterns of growth and development, is cross-referenced to equivalent chapters in the second half, discussing atypical conditions.
These connections serve to emphasise the continuities between, and similarities of, children with typical and atypical problems. The following is a list of when 75% of children have mastered speech sounds.
(Photo Articulation Test, , Pendergast et al, and Stoel-Gammon, ). Atypical child development 1. Atypical Child DevelopmentTypical Development: Child development refers to the biological and psychological changes that occur in human beings between birth and the end of adolescence, as the individual progresses from dependency to increasing autonomy.
OCD medications are discussed as to how they affect dopamine and serotonin in the brain. Typical and atypical antipsychotics - haloperidol - Haldol, Zyprexia, . Pneumonia is an inflammatory condition within the lungs produced as a result of infection that primarily affects the alveoli.
Generally it is caused by viral or bacterial infections and also by some autoimmune diseases that causes the inflammation. Free online resources to make sure your child's development is on track.
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