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HyperthyroidismHyperthyroidism

于明香

Endocrinology Department

Zhongshan Hospital, Fudan University

Endocrinology Department

Zhongshan Hospital, Fudan University

复旦大学附属中山医复旦大学附属中山医院院

Introduction

Definition ： Function of thyroidism

metabolism many systems excitability

Most common is diffuse toxic goiter (Graves disease, GD) , 85%

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Various causes

Graves disease: 85% Autonomous toxic adenomas of the thyroid:

Plummer's disease or toxic multinodular goiter

Jodbasedow disease(Iodine-induced HT) Functioning thyroid carcinoma TSH hypersecretion by the pituitary Struma ovarii Subacute thyroiditis Hashimoto's thyroiditis Thyrotoxicosis factitia Carcinoma accompanying thyrotoxicosis

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85%Male to female 1:4-6Chief clinical findings

Graves diseaseGraves disease

Symptoms due to Hypermetabolism

goitor

Ophthalmopathy

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Abnormal immune: TRAb Heredity Infection: Molecular mimicry

Cytokine

Superantigen Spirit irritation

Etiology and Pathophysiology

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Clinical manifestation

Common Symptoms 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

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图3

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Nervous system: Nervousness, emotional

lability, irritability, fine tremor of hands. Cardiovascular: Palpitation, tachycardia,

atrial fibrillation, widened pulse pressure. Gastrointestinal: Increased appetite,

Hyperdefecation, diarrhea Hematologic system: Moderate

neutropenia, mild anemia. Others: Muscle atrophy, oligomenorrhear.

Clinical manifestation

Common

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Clinical manifestation

Exceptive T3 Toxicosis: initial phases or a relapse of GD T4 Toxicosis Apathetic hyperthyroidism Thyrotoxic crisis Thyrotoxic myopathy: Hypokalemic periodic

paralysis etc. Hyperthyroidism in pregnancy Cardiac complications: atrial fibrillation

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Laboratory Diagnosis

Serum T3, T4, FT3, FT4

Sensitive TSH assay

Serum TRAb

Test of TRH irritation

Radioactive iodine uotake:

Normal: 3h 5-25%, 24h 20-45%, peak at 24h

Thyroid scan: 131I, 99mTc

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Diagnosis

Symptoms

Signs

Laboratory examination

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Differential diagnosis

Other causes of thyrotoxicosis Anxiety neurosis or mania Some states of hypermetabolism without

thyrotoxicosis: severe anemia, leukemia, etc. Cardiac disease: atrial fibrillation, angina Pheochromocytoma Other causes of ophthalmoplegia (myasthenia

gravis) and exophthalmos (orbital tumor) Others: COPD, DM, cirrhosis of the liver.

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Treatment

Antithyroid drugs: Thionamides

Radioactive iodine(131I)

Thyroid surgery

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Thionamides :

Treatment

Common use: a. Methimazole

b. Propylthiouracil Dosage and duration of thionamides Adverse action: agranulocytosis,

rash( including hives), Hepatitis(with PTU),

Arthralgia, myalgia, neuritis,

cholestasis(with MMI) Relapse

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Iodinating agents

Beta-blocking agents: Propranolol

Thyroid hormone

Treatment

Other medicine

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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 is 40%.

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Thyroid surgery

Treatment

Indication:

Contraindication:

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Treatment

Thyrotoxic crisis

Infiltrating exophthalmos

Somastatin

Hyperthyroidism in pregnancy

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谢 谢！谢 谢！