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and sinus tachycardia Atrial fibrillation or atrial tachycardia occurs in about 8% of patients with thyrotoxicosis, more commonly in men, the elderly, and those with ischemic or valvular heart disease The ventricular response from the atrial fibrillation may be difficult to control Thyrotoxicosis itself can cause a thyrotoxic cardiomyopathy, and the onset of atrial fibrillation can precipitate congestive heart failure Ophthalmopathy is clinically apparent in 20 40% of patients with Graves disease and type I amiodarone-induced thyrotoxicosis, but in no other conditions causing hyperthyroidism It usually consists of chemosis, conjunctivitis, and mild exophthalmos (proptosis) More severe lymphocytic infiltration of the eye muscles occurs in 5 10%, pushing the eye forward, producing clinical exophthalmos and sometimes diplopia due to extraocular muscle entrapment There may be weakness of upward gaze (Stellwag s sign) The optic nerve may be compressed in severe cases, causing progressive loss of color vision, visual fields, and visual acuity Corneal drying may occur with inadequate lid closure Eye changes may sometimes be asymmetric or unilateral The severity of the eye disease is not closely correlated with the severity of the thyrotoxicosis Some patients with Graves ophthalmopathy are clinically euthyroid Exophthalmometry should be performed on all patients with Graves disease to document their degree of exophthalmos and detect progression of orbitopathy The protrusion of the eye beyond the orbital rim is measured with a prism instrument (Hertel exophthalmometer) Maximum normal eye protrusion varies between kindreds and races, being about 22 mm for blacks, 20 mm for whites, and 18 mm for Asians Diplopia can also be caused by coexistent ocular myasthenia gravis, which is more common in Graves disease and is usually mild, often with selective eye involvement Acetylcholinesterase receptor antibody (AChR Ab) levels are elevated in only 36% of such patients, and a thymoma is present in 9% Graves dermopathy (pretibial myxedema) occurs in about 3% of patients with Graves disease, usually in the pretibial region Glycosaminoglycan accumulation and lymphoid infiltration occur in affected skin, which becomes erythematous with a thickened, rough texture Thyroid acropachy is an extreme and unusual manifestation of Graves disease It presents with digital clubbing, swelling of fingers and toes, and a periosteal reaction of extremity bones It is ordinarily associated with ophthalmopathy and thyroid dermopathy Most patients are smokers The presence of thyroid acropachy is an indication of the severity of the autoimmunity; most patients have high serum titers of thyroid-stimulating immunoglobulin Patients with thyroid acropachy are at greater risk for having concurrent Graves dermopathy and severe ophthalmopathy However, acropachy itself does not usually cause clinical complaints Hyperthyroidism during pregnancy shares many of the features of normal pregnancy: tachycardia, warm skin, heat intolerance, increased sweating, and a palpable thyroid Pregnancy can have a beneficial effect on the thyrotoxicosis of Graves disease However, there is an increased risk of thyroid storm, preeclampsia eclampsia, congestive heart failure, premature delivery, and abruptio placentae Hypokalemic periodic paralysis occurs in about 15% of Asian or Native American men with thyrotoxicosis It usually.

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All the statements in your program execute in order Unfortunately, that s not very useful, unless you want your program to do exactly the same thing every time you run it In fact, often you won t want to execute all the code, but rather you ll want the program to do one thing if a variable has a certain value and something different if the variable has another value That means you need to be able to cause your program to pick and choose which statements to execute based on conditions that change as the program runs This process is called branching, and there are two ways to accomplish it: unconditionally and conditionally As the name implies, unconditional branching happens every time the branch point is reached An unconditional branch happens, for example, whenever the compiler encounters a new method call.

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levels of asialo-hCG, a subfraction of hCG with greater affinity for TSH receptors Thyrotoxicosis may also be caused by the high serum levels of hCG seen in molar pregnancy, choriocarcinoma, and testicular malignancies

Metastatic functioning thyroid carcinoma is a rare cause of thyrotoxicosis (See Thyroid Cancer section)

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