Hyperthyroidism于明香EndocrinologyDepartmentZhongshanHospital,FudanUniversityIntroductionDefinition：Functionofthyroidism

metabolismmanysystemsexcitability

Mostcommonisdiffusetoxicgoiter(Gravesdisease,GD),85%山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系VariouscausesGravesdisease:85%Autonomoustoxicadenomasofthethyroid:Plummer'sdiseaseortoxicmultinodulargoiter

Jodbasedowdisease(Iodine-inducedHT)FunctioningthyroidcarcinomaTSHhypersecretionbythepituitaryStrumaovariiSubacutethyroiditisHashimoto'sthyroiditisThyrotoxicosisfactitiaCarcinomaaccompanyingthyrotoxicosis山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系85%Maletofemale1:4-6ChiefclinicalfindingsGravesdiseaseSymptomsduetoHypermetabolismgoitorOphthalmopathy

Abnormalimmune:TRAb

HeredityInfection:MolecularmimicryCytokine

Superantigen

Spirit

irritation

EtiologyandPathophysiology山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系ClinicalmanifestationCommonSymptomsduetoHypermetabolism:Heatintolerance,excessiveperspiration,warmmoistsmoothskin,fatigue,weightloss.Goitor:EnlargementornodulesOphthalmopathy:Asenseofirritationineyes,excessivetearing,exophthalmos,blurredvision,easytiringoftheeyes,doublevision.山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系圖1圖2圖3圖4山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系Nervoussystem:Nervousness,emotionallability,irritability,finetremorofhands.Cardiovascular:Palpitation,tachycardia,atrialfibrillation,widenedpulsepressure.Gastrointestinal:Increasedappetite,Hyperdefecation,diarrheaHematologicsystem:Moderateneutropenia,mildanemia.Others:Muscleatrophy,oligomenorrhear.ClinicalmanifestationCommon山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系ClinicalmanifestationExceptiveT3Toxicosis:initialphasesorarelapseofGDT4ToxicosisApathetichyperthyroidismThyrotoxiccrisisThyrotoxicmyopathy:Hypokalemicperiodicparalysisetc.HyperthyroidisminpregnancyCardiaccomplications:atrialfibrillation山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系LaboratoryDiagnosisSerumT3,T4,FT3,FT4SensitiveTSHassaySerumTRAbTestofTRHirritationRadioactiveiodineuotake:Normal:3h5-25%,24h20-45%,peakat24hThyroidscan:131I,99mTc山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系DiagnosisSymptomsSignsLaboratoryexamination山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系DifferentialdiagnosisOthercausesofthyrotoxicosisAnxietyneurosisormaniaSomestatesofhypermetabolismwithoutthyrotoxicosis:severeanemia,leukemia,etc.Cardiacdisease:atrialfibrillation,anginaPheochromocytomaOthercausesofophthalmoplegia(myastheniagravis)andexophthalmos(orbitaltumor)Others:COPD,DM,cirrhosisoftheliver.山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系TreatmentAntithyroiddrugs:ThionamidesRadioactiveiodine(131I)Thyroidsurgery山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系Thionamides:

TreatmentCommonuse:a.Methimazole

b.PropylthiouracilDosageanddurationofthionamidesAdverseaction:agranulocytosis,rash(includinghives),Hepatitis(withPTU),Arthralgia,myalgia,neuritis,cholestasis(withMMI)Relapse山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系IodinatingagentsBeta-blockingagents:PropranololThyroidhormoneTreatmentOthermedicine山東農(nóng)業(yè)大學(xué)計(jì)算機(jī)科學(xué)系TreatmentRadioactiveiodine(131I)Indication:Contraindication:femaleinpregnancyorthepersonlessthan25y,etc.Complication:Hypothyroidism,theincidenceissignificantduringthefirstyearortwoaftertreatmentandcontinuestoincreaseatarateof5%ythereafter.Theincidenceofpostradioiodinehypothyroidismat5yis30%andat10yis40%.