复旦大学：《内科学》课程教学资源（PPT课件讲稿）甲亢（英文版，主讲：于明香）

x ★ Hyperthyroidism Endocrinology Department Zhongshan Hlospital, Fuclan University 于明香 大斗 大学附属中山医院

复旦大学附属中山医院 Hyperthyroidism 于明香 Endocrinology Department Zhongshan Hospital, Fudan University

★ Introduction o Definition Function of thyroidism metabolism many systems excitability f o Most common is diffuse toxic goiter(Graves disease, GD),85% 大学附属中出医院

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

★ x Various causes Graves disease: 85% Autonomous toxic adenomas of the thyroid Plummers disease or toxic multinodular goiter Jodbasedow disease(lodine- induced HT) Functioning thyroid carcinoma TSH hypersecretion by the pituitary Struma ovarii Subacute thyroiditis Hashimoto's thyroiditis o Thyrotoxicosis factitia o Carcinoma accompanying thyrotoxicosis 算大学附属中山医院

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

x大 ★ Graves disease ●85% Male to female 1: 4-6 o Chief clinical findings Symptoms due to Hypermetabolism goiter Ophthalmopathy 平 x 附属中山医院

复旦大学附属中山医院 =85% =Male to female 1:4-6 =Chief clinical findings Graves disease X Symptoms due to Hypermetabolism X goitor X Ophthalmopathy

★ Etiology and Pathophysiology o Abnormal immune: TRAb ● Heredity Infection: Molecular mimicry Cytokine Superantigen Spirit irritation 大学附属中出医院

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

★ Clinical manifestation Common o Symptoms due to Hyper metabolism: Heat intolerance, excessive perspiration, warm moist smooth skin, fatique, weight loss o Goitor: Enlargement or nodules o Ophthalmopathy: A sense of irritation in eyes, excessive tearing, exophthalmos, blurred vision, easy tiring of the eyes, double visions 大学附属中出医院

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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★ Clinical manifestation Common o Nervous system: Nervousness, emotional lability, irritability, fine tremor of hands o Cardiovascular: Palpitation, tachycardia, atrial fibrillation, widened pulse pressure. o Gastrointestinal: Increased appetite, Hyperdefecation, diarrhea o Hematologic system: Moderate neutropenia, mild anemia o Others: Muscle atrophy, oligomenorrhea 学的院

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

★ Clinical manifestation Exceptive T3 Toxicosis; initial phases or a relapse of GD ●T4 Toxicosis Apathetic hy perth roidism ● Thyrotoxic crisis Thyrotoxic myopathy: Hypokalemic periodic paralysis etc. o Hyperthyroidism in pregnancy o Cardiac complications: atrial fibrillation 大学附属中出医院

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

★ Laboratory Diagnosis ● Serum T3,T4,FT3,FT4 ● Sensitive TSH assay o Serum TRAb O Test of TRH irritation o Radioactive iodine uotake: Normal: 3h 5-25%, 24h 20-45%, peak at 24h o Thyroid scan: 131I, 99mTc 大学附属中出医院

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: 131I, 99mTc