甲亢英文

Hyperthyroidism,Introduction,Definition：Function of thyroidism metabolism many systems excitability Most common is diffuse toxic goiter (Graves disease, GD) , 85%,Various causes,Graves disease: 85%Autonomous toxic adenomas of the thyroid: Plummers disease or toxic multinodular goiter Jodbasedow disease(Iodine-induced HT) Functioning thyroid carcinoma TSH hypersecretion by the pituitary Struma ovarii Subacute thyroiditis Hashimotos thyroiditis Thyrotoxicosis factitia Carcinoma accompanying thyrotoxicosis,85%Male to female 1:4-6Chief clinical findings,Graves disease,Symptoms due to Hypermetabolism goitor Ophthalmopathy,Abnormal immune: TRAb Heredity Infection: Molecular mimicry Cytokine Superantigen Spirit irritation,Etiology and Pathophysiology,Clinical manifestation,CommonSymptoms due to Hyper metabolism: Heat intolerance, excessive perspiration, warm moist smooth skin, fatigue, weight loss. Goitor: Enlargement or nodules Ophthalmopathy: A sense of irritation in eyes, excessive tearing, exophthalmos, blurred vision, easy tiring of the eyes, double vision.,图1,图2,图3,图4,Nervous system: Nervousness, emotional lability, irritability, fine tremor of hands.Cardiovascular: Palpitation, tachycardia, atrial fibrillation, widened pulse pressure.Gastrointestinal: Increased appetite, Hyperdefecation, diarrheaHematologic system: Moderate neutropenia, mild anemia. Others: Muscle atrophy, oligomenorrhear.,Clinical manifestation,Common,Clinical manifestation,ExceptiveT3 Toxicosis: initial phases or a relapse of GDT4 ToxicosisApathetic hyperthyroidismThyrotoxic crisis Thyrotoxic myopathy: Hypokalemic periodic paralysis etc.Hyperthyroidism in pregnancyCardiac complications: atrial fibrillation,Laboratory Diagnosis,Serum T3, T4, FT3, FT4 Sensitive TSH assay Serum TRAbTest of TRH irritationRadioactive iodine uotake: Normal: 3h 5-25%, 24h 20-45%, peak at 24hThyroid scan: 131I, 99mTc,Diagnosis,SymptomsSignsLaboratory examination,Differential diagnosis,Other causes of thyrotoxicosisAnxiety neurosis or maniaSome states of hypermetabolism without thyrotoxicosis: severe anemia, leukemia, etc.Cardiac disease: atrial fibrillation, anginaPheochromocytomaOther causes of ophthalmoplegia (myasthenia gravis) and exophthalmos (orbital tumor)Others: COPD, DM, cirrhosis of the liver.,Treatment,Antithyroid drugs: ThionamidesRadioactive iodine(131I)Thyroid surgery,Thionamides :,Treatment,Common use: a. Methimazole b. PropylthiouracilDosage and duration of thionamidesAdverse action: agranulocytosis, rash( including hives), Hepatitis(with PTU), Arthralgia, myalgia, neuritis, cholestasis(with MMI)Relapse,Iodinating agentsBeta-blocking agents: PropranololThyroid hormone,Treatment,Other medicine,Treatment,Radioactive iodine(131I),Indication:Contraindication: female in pregnancy or the person less than 25y, etc.Complication: Hypothyroidism, the incidence is significant during the first year or two after treatment and continues to increase at a rate of 5%y thereafter. The incidence of postradioiodine hypothyroidism at 5 y is 30% and at 10 y