甲亢Hyperthyroidism课件.pptVIP

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[,d??dba:zid?u] Functioning thyroid carcinoma TSH hypersecretion by the pituitary Struma ovarii Subacute thyroiditis [,s?b?kju?t] [,θa?r??da?t?s] Hashimotos thyroiditis Thyrotoxicosis factitia θa?r??,t?ks?k??s?s Carcinoma accompanying thyrotoxicosis 85% Male to female 1:4-6 Chief clinical findings Graves disease Symptoms due to Hypermetabolism goitor Ophthalmopathy[?fθ?lm??p?θ? 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[n?dju:lz] [n?dju:lz] 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. 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 Radioa