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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
Graves disease
85% Male
to female 1:4-6 Chief clinical findings
Symptoms due to Hypermetabolism
goitor
Ophthalmopathy
Etiology and Pathophysiology
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Clinical manifestation
Common 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.
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
Treatment
Antithyroid drugs: Thionamides Radioactive iodine(131I) Thyroid surgery
Treatment
Thionamides :
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
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
Abnormal immune: TRAb
Heredity Infection: Molecular mimicry Cytokine Superantigen Spirit irritation
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.
Diagnosis
Symptoms Signs Laboratory examination
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.
甲亢英文
Introduction
Definition：Function of thyroidism
metabolism
many systems excitability
Most common is diffuse toxic goiter (Graves disease, GD) , 85%
