内科学教学课件：Hyperthyroidism.pptVIP

Contraindication Pregnant, lactation Effect Cure rate 85% Complication Thyroiditis Thyroid crisis GO Hypothyroidism Surgery Indication Very large goiter Severe hyperthyroidism,drug failure (non-effective, relapse). Post sternal thyroid gland with hyperthyroidism Nodular goiter with hyperthyroidism Pregnancy(ATD no effect) Contraindication Severe infiltrated exophthalmos improper to operation for severe cardiac, hepatic, renal disease Early and later pregnancy Complication Thyroid crisis Hypothyroidism, hypoparathyroidism Respiratory obstruction Infection, hemorrhage, nerve injury Other therapy Iodine solution: inhibit TH release β-receptor blocker Treatment of thyroid crisis Treatment of precipitating factor ATD: first: PTU 500-1000mg p.o. (through gastric tube), then 250mg Q4h p.o. Iodine solution: SSPI 1h after PTU administration, 5 drops, Q6hs. ?-receptor blocker: propranolol 60-80mg/d, Q4h Hormone (hydrocortisone) : First 300mg ivgtt. Then 100mg Q8h Reduce level of TH: dialysis Reduce temperature Others: support treat *  inflammation and hypertrophy of the tissues around the eyes causing swelling Pretibial myxedema Dermopathy（皮肤病变） of GD, autoimmune reaction. Skin raised thickeded, nodule, orange appearance. 1/3, dorsum of foot（足背）. Early feature of pretibial myxedema: thickening of the skin over the lower legs Special clinical manifestation and type Special clinical manifestation Thyroid crisis Precipitating factor: infection, operation, wound, psychological High fever, heavy sweating, HR (140↑), restless, delirium（谵妄）, nausea, vomiting, diarrhea, heart failure, shock, coma Hyperthyroidism heart disease Heart failure(young/old) Arrhythmia Graves ophthalmopathy, GO 25-50% GD, male patient is common. EGO (euthyroid GD), lab test: T3, T4: normal, TSH ↓, TRAb(+). Special type Apathetic hyperthyroidism Old patient Insidious（隐袭的） onset: apathy, fatigue, somnolence（困倦）, slow reaction, weight loss. Pregnancy hyperthyroidism TBG HCG infant hyperthyroid