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Как справиться с этим распространенным заболеванием




Exams and Tests


Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional



Toxic nodular goiter involves an enlarged thyroid gland. The gland contains areas that have increased in size and formed nodules. One or more of these nodules produce too much thyroid hormone.


Toxic nodular goiter starts from an existing simple goiter. It occurs most often in older adults. Risk factors include being female and over 55 years old. This disorder is rare in children. Most people who devaelop it have had a goiter with nodules for many years.

Sometimes, people with toxic multinodular goiter will develop high thyroid levels for the first time. This mostly occurs after they take in a large amount of iodine through a vein (intravenously) or by mouth. The iodine may be used as contrast for a CT scan or heart catheterization. Taking medicines that contain iodine, such as amiodarone, may also lead to the disorder.


Symptoms are the same as those of an overactive thyroid gland (hyperthyroidism). However, the bulging eyeballs seen in Graves disease do not occur.

Symptoms may include any of the following:

·       Fatigue

·       Frequent bowel movements

·       Heat intolerance

·       Increased appetite

·       Increased sweating

·       Irregular menstrual period (in women)

·       Muscle cramps

·       Nervousness

·       Restlessness

·       Weight loss

Exams and Tests

A physical examination will show 1 or many nodules in the thyroid. There may be a rapid heart rate.

Other tests that may be done include:

·       Serum thyroid hormone levels (T3, T4)

·       Serum TSH (thyroid stimulating hormone)

·       Thyroid uptake and scan or radioactive iodine uptake

·       Thyroid ultrasound


Beta-blockers (propranolol) can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.

Certain drugs can block or change how the thyroid gland uses iodine. These drugs may be used to control the overactive thyroid gland in any of the following cases:

·       Before surgery or radioiodine therapy occurs

·       As a long term treatment

Radioiodine therapy may be used. Radioactive iodine is given by mouth. It then concentrates in the overactive thyroid tissue and causes damage. Some people, but not all, may need to take thyroid replacement afterwards.

Surgery to remove the thyroid may be done when:

·       Very large goiter or a goiter is causing symptoms by blocking the airway

·       Thyroid cancer is present

·       Rapid treatment is needed

Outlook (Prognosis)

Toxic nodular goiter is mainly a disease of older adults, so other chronic health problems may affect the outcome of this condition. An older adult may be less able to tolerate the effect of the disease on the heart. However, the condition is often treatable with medicines.

Possible Complications

Heart complications:

·       Heart failure

·       Irregular heartbeat (atrial fibrillation)

·       Rapid heart rate

Other complications:

·       Bone loss leading to osteoporosis

Thyroid crisis or storm is an acute worsening of hyperthyroidism symptoms. It may occur with infection or stress. Thyroid crisis may cause:

·       Abdominal pain

·       Decreased mental alertness

·       Fever

People with this condition need to go to the hospital right away.

Complications of having a very large goiter may include difficulty breathing or swallowing. These complications are due to pressure on the airway passage (trachea) or esophagus, which lies behind the thyroid.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of this disorder. Follow the provider's instructions for follow-up visits.


To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your provider suggests.


Source https://medlineplus.gov/ency/article/000317.htm


Dialysis - hemodialysis

What is Hemodialysis?

When to Start Dialysis

Dialysis at a Treatment Center

Dialysis at Home

When to Call Your Doctor


Dialysis treats end-stage kidney failure. It removes waste from your blood when your kidneys can no longer do their job.

There are different types of kidney dialysis. This article focuses on hemodialysis.

What is Hemodialysis?

Your kidneys' main job is to remove toxins and extra fluid from your blood. If waste products build up in your body, it can be dangerous and even cause death.

Hemodialysis (and other types of dialysis) does some of the job of the kidneys when they stop working well.

Hemodialysis can:

·         Remove extra salt, water, and waste products so they don't build up in your body

·         Keep safe levels of minerals and vitamins in your body

·         Help control blood pressure

·         Help produce red blood cells

During hemodialysis, your blood passes through a tube into an artificial kidney, or filter.

·         The filter, called a dialyzer, is divided into 2 parts separated by a thin wall.

·         As your blood passes through one part of the filter, special fluid in the other part draws out waste from your blood.

·         Your blood then goes back into your body through a tube.

Your doctor will create an access where the tube attaches. Usually an access will be in a blood vessel in your arm.

When to Start Dialysis

Kidney failure is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body's needs. Your doctor will discuss dialysis with you before you need it. Usually you will go on dialysis when you have only 10 to 15% of your kidney function left.

You also may need dialysis if your kidneys suddenly stop working due to acute renal failure.

Dialysis at a Treatment Center

Hemodialysis is most often done at a special dialysis center.

·         You will have about 3 treatments a week.

·         Treatment takes about 3 to 4 hours each time.

·         You may feel tired for several hours after the dialysis.

At a treatment center, your health care providers will handle all your care. However, you do need to schedule your appointments and follow a strict dialysis diet.

Dialysis at Home

You may be able to have hemodialysis at home. You do not have to buy a machine. Medicare or your health insurance will pay for most or all of your treatment costs at home or in a center.

If you have dialysis at home, you can use one of two schedules:

·         Shorter (2 to 3 hours) treatments done at least 5 to 7 days per week

·         Longer, nightly treatments done 3 to 6 nights per week while you sleep

You also may be able to do a combination of daily and nighttime treatments.

Because you have treatment more often and it happens more slowly, home hemodialysis has some benefits:

·         It helps keep your blood pressure lower. Many people no longer need blood pressure medicines.

·         It does a better job of removing waste products.

·         It's easier on your heart.

·         You may have fewer symptoms from dialysis such as nausea, headaches, cramps, and tiredness.

·         You can more easily fit treatments into your schedule.

You can do the treatment yourself, or you can have someone help you. A dialysis nurse can train you and a caregiver on how to do home dialysis. Training can take a few weeks to a few months. Both you and your caregivers must learn to:

·         Handle the equipment

·         Place the needle into the access site

·         Monitor the machine and your blood pressure during treatment

·         Keep records

·         Clean the machine

·         Order supplies, which can be delivered to your home

Home dialysis is not for everyone. You will have a lot to learn and need to be responsible for your care. Some people feel more comfortable having a provider handle their treatment. Plus, not all centers offer home dialysis.

Home dialysis may be a good option if you want more independence and are able to learn to treat yourself. Talk with your doctor. Together, you can decide what type of hemodialysis is right for you.

When to Call Your Doctor

Call your doctor if you notice:

·         Bleeding from your vascular access site

·         Signs of infection, such as redness, swelling, soreness, pain, warmth, or pus around the site

·         A fever over 100.5°F (38.0°C)

·         The arm where your catheter is placed swells and the hand on that side feels cold

·         Your hand gets cold, numb, or weak

Also call your doctor if any of the following symptoms are severe or last more than 2 days:

·         Itching

·         Trouble sleeping

·         Diarrhea or constipation

·         Nausea and vomiting

·         Drowsiness, confusion, or problems concentrating


Source: https://medlineplus.gov/ency/patientinstructions/000707.htm