Care and mobility considerations
If untreated euthyroid goitre usually progresses slowly but adverse effects are limited to the increasing cosmetic defect of the swelling and the possibility of secondary pressure effects. Once treated the size of the gland should gradually regress over a period of several months. No residual disability and no variability in the condition would be expected.
Myxoedema can produce a significant degree of illness and untreated can lead to coma and possible death. Once recognised it can be treated effectively and recovery occurs quickly, usually within three months. However difficulties with establishing control and an effective replacement dose of thyroxine may delay full recovery by up to six months. Hypothyroidism in infants and children can lead to serious failure to thrive, small stature and failure of intellectual development (the syndrome of cretinism) which if unrecognised or untreated can result in permanent impairment of intellectual development and leads to severe dependency.
Once treated the effects of myxoedema would not be expected to cause significant disability with no continuing effect on function of the limbs, the spine, the cardiovascular system or mental state.
The effects of thyrotoxicosis depend on the duration of the condition, the age of the patient and response to treatment.
It can result in a severe thyrotoxic crisis with fever, delirium or coma, seizures, vomiting, diarrhoea and jaundice, death being caused by arrhythmias, heart failure or hyperthermia.
However, the condition is usually recognised well before such dramatic presentation occurs and once the cause has been established it can be treated effectively. Delay in establishing effective dosage of medication or recovery from surgery may impede progress but full recovery to normal existence is expected in all but a few cases.
In some cases signs of thyrotoxicosis can occur without increase in activity of the thyroid gland. This occurs in some forms of thyroiditis and in cases where excess doses of thyroid hormone have been taken as treatment of hypothyroidism. Malignant disease of the thyroid gland, rarer forms of thyroid disease or the particular effects of ionising radiation on thyroid function can cause complex long-term illness and require separate consideration.
