Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University Endocrinology Department Zhongshan Hospital, Fudan University

复旦大学附属中山医院 Introduction Definition ： Function of thyroidism metabolism many systems excitability Most common is diffuse toxic goiter (Graves disease, GD), 85%

复旦大学附属中山医院 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

 85%  Male to female 1:4-6  Chief clinical findings Graves disease  Symptoms due to Hypermetabolism  goitor  Ophthalmopathy

复旦大学附属中山医院  Abnormal immune: TRAb  Heredity  Infection: Molecular mimicry Cytokine Superantigen  Spirit irritation Etiology and Pathophysiology

复旦大学附属中山医院 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.

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复旦大学附属中山医院  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

复旦大学附属中山医院 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

复旦大学附属中山医院 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: 131 I, 99m Tc

复旦大学附属中山医院 Diagnosis  Symptoms  Signs  Laboratory examination

复旦大学附属中山医院 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.

复旦大学附属中山医院 Treatment Antithyroid drugs: Thionamides Radioactive iodine( 131 I) Thyroid surgery

复旦大学附属中山医院 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

复旦大学附属中山医院  Iodinating agents  Beta-blocking agents: Propranolol  Thyroid hormone Treatment  Other medicine

复旦大学附属中山医院 Treatment Radioactive iodine( 131 I)  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%.

复旦大学附属中山医院 Thyroid surgery Treatment  Indication:  Contraindication:

复旦大学附属中山医院 Treatment Thyrotoxic crisis Infiltrating exophthalmos Somastatin Hyperthyroidism in pregnancy

复旦大学附属中山医院 谢 谢！