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 1:4-6 Chief 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,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,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,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,Iodinating agents Beta-blocking agents: Propranolol Thyroid 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 is 40%.,Thyroid surgery,Treatment,Indication: Contraindication:,Treatment,Thyrotoxic crisis Infiltrating exophthalmos Somastatin Hyperthyroidism in pregnancy,谢 谢！,