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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%
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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: 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
Graves disease 85% Male to female 1:4-6 Chief clinical findings • Symptoms due to Hypermetabolism • goitor • Ophthalmopathy
Etiology and Pathophysiology • Abnormal immune: TRAb • Heredity • Infection: Molecular mimicry Cytokine Superantigen • Spiritirritation
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.
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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.
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
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
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.
Treatment • Antithyroid drugs: Thionamides • Radioactive iodine(131I) • Thyroid surgery
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
Treatment • Other medicine • Iodinating agents • Beta-blocking agents: Propranolol • Thyroid hormone
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%.
Treatment • Thyroid surgery • Indication: • Contraindication:
Treatment • Thyrotoxic crisis • Infiltrating exophthalmos Somastatin • Hyperthyroidism in pregnancy
