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
Clinical manifestation
Exceptive T3 Toxicosis: initial phases or a relapse of GD T4 Toxicosis Apathetic hyperthyroidism Thyrotoxic crisis Thyrotoxic myopathy: Hypokalemic periodic
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
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
Thionamides :
Common use: a. Methimazole b. Propylthiouracil
Dosage and duration of thionamides Adverse action: agranulocytosis, rash(
atrial fibrillation, widened pulse pressure. Gastrointestinal: Increased appetite,
Hyperdefecation, diarrhea Hematologic system: Moderate
neutropenia, mild anemia. Others: Muscle atrophy, oligomenorrhear.
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: Molec图3
图2 图4
Clinical manifestation
Common Nervous system: Nervousness, emotional
lability, irritability, fine tremor of hands. Cardiovascular: Palpitation, tachycardia,
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.
Hyperthyroidism
Introduction
Definition：Function of thyroidism
metabolism many systems excitability
Most common is diffuse toxic goiter (Graves disease, GD) , 85%