hyperthyroidism 于明香 endocrinology department zhongshan hospital, fudan university...
TRANSCRIPT
![Page 1: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/1.jpg)
复旦大学附属中山医院复旦大学附属中山医院
HyperthyroidismHyperthyroidism
于明香
Endocrinology Department
Zhongshan Hospital, Fudan University
Endocrinology Department
Zhongshan Hospital, Fudan University
![Page 2: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/2.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Introduction
Definition : Function of thyroidism
metabolism many systems excitability
Most common is diffuse toxic goiter (Graves disease, GD) , 85%
![Page 3: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/3.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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
![Page 4: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/4.jpg)
复旦大学附属中山医院复旦大学附属中山医院
85%Male to female 1:4-6Chief clinical findings
Graves diseaseGraves disease
Symptoms due to Hypermetabolism
goitor
Ophthalmopathy
![Page 5: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/5.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Abnormal immune: TRAb Heredity Infection: Molecular mimicry
Cytokine
Superantigen Spirit irritation
Etiology and Pathophysiology
![Page 6: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/6.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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.
![Page 7: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/7.jpg)
图 1
图2
图3
图 4
![Page 8: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/8.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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
![Page 9: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/9.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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
![Page 10: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/10.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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
![Page 11: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/11.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Diagnosis
Symptoms
Signs
Laboratory examination
![Page 12: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/12.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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.
![Page 13: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/13.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Treatment
Antithyroid drugs: Thionamides
Radioactive iodine(131I)
Thyroid surgery
![Page 14: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/14.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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
![Page 15: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/15.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Iodinating agents
Beta-blocking agents: Propranolol
Thyroid hormone
Treatment
Other medicine
![Page 16: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/16.jpg)
复旦大学附属中山医复旦大学附属中山医院院
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%.
![Page 17: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/17.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Thyroid surgery
Treatment
Indication:
Contraindication:
![Page 18: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/18.jpg)
复旦大学附属中山医复旦大学附属中山医院院
Treatment
Thyrotoxic crisis
Infiltrating exophthalmos
Somastatin
Hyperthyroidism in pregnancy
![Page 19: Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University](https://reader036.vdocuments.net/reader036/viewer/2022081501/56649f455503460f94c672e4/html5/thumbnails/19.jpg)
复旦大学附属中山医复旦大学附属中山医院院
谢 谢!谢 谢!