复旦大学附属中山医院
Hyperthyroidism
于明香
Endocrinology Department
Zhongshan Hospital,Fudan University
复旦大学附属中山医院
Introduction
? Definition,Function of thyroidism
metabolism many systems excitability
? Most common is diffuse toxic goiter (Graves
disease,GD),85%
复旦大学附属中山医院
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
复旦大学附属中山医院
? 85%
? Male to female 1:4-6
? Chief clinical findings
Graves disease
? Symptoms due to Hypermetabolism
? goitor
? Ophthalmopathy
复旦大学附属中山医院
? Abnormal immune,TRAb
? Heredity
? Infection,Molecular mimicry
Cytokine
Superantigen
? Spirit irritation
Etiology and Pathophysiology
复旦大学附属中山医院
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
图 2
图 3
图 4
复旦大学附属中山医院
? 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
复旦大学附属中山医院
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
复旦大学附属中山医院
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
复旦大学附属中山医院
Diagnosis
? Symptoms
? Signs
? Laboratory examination
复旦大学附属中山医院
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,
复旦大学附属中山医院
Treatment
? Antithyroid drugs,Thionamides
? Radioactive iodine(131I)
? Thyroid surgery
复旦大学附属中山医院
? 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
复旦大学附属中山医院
? Iodinating agents
? Beta-blocking agents,Propranolol
? Thyroid hormone
Treatment
? Other medicine
复旦大学附属中山医院
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%,
复旦大学附属中山医院
?Thyroid surgery
Treatment
?Indication,
?Contraindication,
复旦大学附属中山医院
Treatment
? Thyrotoxic crisis
? Infiltrating exophthalmos
Somastatin
? Hyperthyroidism in pregnancy
复旦大学附属中山医院
谢 谢！