于明香-甲亢.ppt

Hyperthyroidism
于明香
Endocrinology Department
Zhongshan Hospital, Fudan University
Introduction
Definition:Function of thyroidism
metabolism many systems excitability

mon is diffuse toxic goiter (Graves disease, GD) , 85%
山东农业大学计算机科学系
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 panying thyrotoxicosis
山东农业大学计算机科学系
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
山东农业大学计算机科学系
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.
山东农业大学计算机科学系
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山东农业大学计算机科学系
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
山东农业大学计算机科学系
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
plications: atrial fibrillation
山东农业大学计算机科学系
Laboratory Diagnosis
Serum T3, T4, FT3, FT4
Sensitive TSH assay
Serum TRAb
Test of TRH ir