Hyperthyroidism-What is Hyperthyroidism?
Hyperthyroidism, also known as Graves' disease or diffuse toxic goiter.Hyperthyroidism is an autoimmune disease, clinical manifestations are not limited to the thyroid, but a multi-system syndrome, including: the group of high metabolic disease, diffuse goiter, eye symptoms, skin lesions and thyroid extremitiesdiseases. The majority of patients also have high metabolic disease and goiter. Thyroid other than the performance of invasive endocrine exophthalmos can stand alone and not accompanied by a high metabolic disease.
Hyperthyroidism - disease descriptionFemale endocrine disorders can also cause hyperthyroidism typical cases the diagnosis is generally not difficult. In patients with mild cases of elderly and children, clinical manifestations of less rather than the typical diagnosis often be through laboratory tests.(A) The diagnostic significance of clinical manifestations and special attention to heat intolerance, sweating, agitation, satisfied Kang associated with weight loss, resting heart rate too fast, special eye sign, and goiter. Found in the thyroid vascular murmur, tremor, even with diagnostic significance.
(B) Under normal circumstances, the thyroid function tests in patients with hyperthyroidism T3, rT3 and and T4 increased blood concentrations of elevated T3 than T4, obviously. TSH below normal only seen in the more sensitive immunoradiometric assay.
The etiology of this disease is unknown, it is therefore not a cause of treatment and control of high metabolic disease group. Net of mental stress and other negative factors of the disease. The beginning of treatment, be proper rest and a variety of supportive therapy, and add enough calories and nutrients such as sugar, protein and various vitamins to correct the disease caused by consumption. Control hyperthyroidism disease group: ① anti-thyroid drugs; ② radioisotope iodine; ③ surgery.
Hyperthyroidism from all causes loss of feedback control mechanism of the normal thyroid secretion, caused by the abnormal increase of the main features of the disease a general term systemic hypermetabolism circulating thyroid hormone.
Hyperthyroidism - symptoms and signsThe clinical manifestations of the the exophthalmos therapy of hyperthyroidism hyperthyroidism include goiter, brash, easily agitated, insomnia, his hands trembling, heat intolerance, sweating, skin moist but weight loss, appetite, hyperactivity, weight loss, heart palpitations, rapid pulse, strong (regular pulse rate above 100 beats per minute, rest and sleep is still faster), increased pulse pressure (mainly due to elevated systolic blood pressure), endocrine disorders (such as menstrual disorders), as well as weakness, fatigue, and limb-side muscle atrophy and so on. Pulse rate and pulse pressure is particularly important, and often can be used as an important symbol to determine severity and treatment effects.
Hyperthyroidism is a common endocrine disease caused by excessive secretion of thyroid hormone caused by a variety of factors. The main clinical manifestations of food, weight loss, fear of heat, sweating, palpitations, agitation high excitability of the metabolic syndrome, nerves and blood vessels to enhance, as well as varying degrees of goiter and exophthalmos, and other characteristics. The disease is more common and women into a few years the incidence of childhood hyperthyroidism upward trend. Slow onset, more than six months to one year after the onset of treatment. Typical cases are often the following performance: a high metabolic syndrome; 2, goiter; 3, exophthalmos;, nervous system symptoms; symptoms of the cardiovascular system; 6, the symptoms of the endocrine system; 7 digestive symptoms; 8, symptoms of blood and hematopoietic system; reproductive system symptoms; 10 motor system symptoms; 11, symptoms of the skin and extremities. Integrative Medicine, what method of treatment, according to medical advice. Must not casually buy drugs to cope with, be sure to doctors under the guidance system, the entire full amount of treatment. Avoid not treated early, inappropriate, not change card profusion. Western medicine is convenient, safe, usually does not cause irreversible thyroid damage, but its long course of treatment, recurrence rate, remission rate was 40% -60%, and Integrative Medicine and low recurrence rate, remission rate
Hyperthyroidism - Diseases etiologyThe hyperthyroidism characterization can be divided into: primary, secondary and high-functioning adenomas into three categories according to the cause of the hyperthyroidism.(1) primary hyperthyroidism is the most common symptoms of hyperthyroidism in a goiter at the same time. Patient age in between 20 to 40 years. Swollen glands, diffuse, bilaterally symmetrical, often accompanied by exophthalmos, it is also known as Graves' disease.② secondary hyperthyroidism is less common, such as secondary hyperthyroidism in nodular goiter; the patient is first nodular goiter for many years, appeared after the symptoms of hyperthyroidism. The age of onset more than 40 years. Glands showed a nodular swelling on both sides more than asymmetric, no eye, and prone to myocardial damage.③ high-functioning adenomas, rare, single, autonomous high-functioning nodules, nodules surrounding thyroid tissue in the thyroid gland showed atrophy changes. Patients had no exophthalmos.Hyperthyroidism - pathophysiologyGestational hyperthyroidism primary hyperthyroidism cause has not yet completely clear. TSH concentration in the blood of patients is not high, and some lower than normal; even applications of TSH promote shock wrapped also failed to stimulate the TSH concentration in the blood of these patients later found in the blood of patients with two types stimulate the thyroid gland autoantibodies, primary hyperthyroidism - kind of autoimmune disease.Types of antibodies, one is to stimulate thyroid function with TSH, but the substance of the role of time lasting than that of TSH (TSH half-life of only 30 minutes and the substance for 25 days) so called "long-acting thyroid hormone; another thyroid stimulating immunoglobulin, two types of substances belong to the class G immunoglobulin, derived from lymphocytes, can inhibit TSH and TSH receptor binding, and thus strengthen the thyroid cell function, secretion of a large number of T3 and T4 .As for the cause of secondary hyperthyroidism and high-functioning adenomas, but also not entirely clear. Patient straight in the long-acting thyroid stimulating hormone, such as the concentration is not high, perhaps with nodular itself autonomous secretion disorder.Hyperthyroidism - hyperthyroidism typeThere are many types of hyperthyroidism, one of the most common diffuse toxic goiter, Graves' disease. Diffuse toxic goiter incidence and genetic and autoimmune factors, but whether the symptoms of hyperthyroidism and a number of predisposing factors (environmental Kang Su). If you avoid these triggers may not be the symptoms of hyperthyroidism, or delay the symptoms of hyperthyroidism, or alleviate the symptoms of hyperthyroidism.In addition to the typical hyperthyroidism on clinical common:(1) T3 hyperthyroidism. T3 hyperthyroidism is the clinical manifestation of hyperthyroidism, serum TT4 and FT4 is normal or even low, only T3 increased a class of hyperthyroidism.(2) T4 in hyperthyroidism, also known as thyroxine hyperthyroidism by serum of TT4 and FT4 increased, TT3, FT3 normal type of hyperthyroidism. In 1975, Turner First report the name of the T4 hyperthyroidism, its clinical manifestations and typical of hyperthyroidism, can occur in Graves' disease, toxic nodular goiter, subacute thyroiditis, more common in middle-aged general poor, such as severe infection, surgery, malnutrition and other patients. Of TT3 and FT3, normal laboratory tests of serum TT4 and FT4 increased. Thyroid photo 131I rate was significantly higher thyroid tablets or T3 suppression test abnormalities.The needs of this disease and acute stress-induced hyperthyroidism (false T4 hyperthyroidism) identification. Stress in patients with hyperthyroidism is suffering from various acute or chronic systemic disease, because of the relationship of these diseases, the serum TT4, FT4 increased, TT3, FT3 normal or reduced, with the exception of a small number of patients with goiter outside other no hyperthyroidism evidence, when the primary disease is cured, the above-mentioned laboratory parameters in the near future return to normal.(3) children with hyperthyroidism. The incidence gradually increased to 3 years of age the highest incidence rate of 11-16-year-old girls than boys, a few call all children have a diffuse goiter and typical metabolic syndrome, exophthalmos is more common.(4) age-related hyperthyroidism. Due to physiological changes in the elderly, the function of body organs have varying degrees of loss, fibrosis and atrophy of the thyroid tissue to a certain degree of reduction in thyroid hormone secretion and peripheral tissue responses to thyroid hormone changes, senile hyperthyroidism clinical features: often not enlarged thyroid, or mild swelling, many accompanied by nodules; sudden eye or no obvious exophthalmos, high metabolic syndrome is not obvious, lack of appetite, hyperactivity, heat intolerance, sweating and irritability symptoms; often associated with other heart disease such as angina or myocardial infarction, and prone to arrhythmias and heart failure, more common in persistent AF; patients showed apathy was no desire like severe cases, lethargy, or was stupor, coma.(5) Apathetic hyperthyroidism. The type is a the hyperthyroidism special performance type. Contrary to the symptoms associated with typical symptoms of hyperthyroidism, manifested as a kind of nervous depression hyperthyroidism. Apathetic hyperthyroidism clinical manifestations: loss of appetite, nausea, chills, dry skin, depression and looked indifferent, indifferent to the surrounding things; the spirit of thinking activity is slow, while answering delay problem, and sometimes difficulty concentrating, lazy action of few words; palpitations those of common, often accompanied by cardiac enlargement, congestive heart failure, atrial fibrillation, eyes sunken, eyes Gao lag atheism, or even the eyelids droop.(6) occult hyperthyroidism. Occult hyperthyroidism is no typical symptoms of hyperthyroidism, the disease to a system for the outstanding performance of a class of hyperthyroidism. Clinical type ① spirit type, for the outstanding performance of mental disorders, the patients showed inattention, distractibility, hallucinations, paranoia, depression, dementia, paranoia, mania, and even suicidal ideation, rage episodes. ② gastrointestinal type, often for the outstanding performance of diarrhea. More common in middle-aged patients stool frequency several times a day to ten several times ranging from a paste or water samples, containing undigested food, and some patients with vomiting or abdominal pain. Gastrointestinal hyperthyroidism vomiting, diarrhea, often accompanied by water and electrolyte disturbance, improper treatment of a serious condition likely to cause thyroid crisis, and life-threatening. ③ myopathy type, gravis and periodic paralysis. The symptoms of hyperthyroidism is not obvious or appeared later. The clinical manifestations of acute and chronic thyrotoxic myopathy, periodic paralysis, myasthenia gravis and ophthalmoplegia.Hyperthyroidism - diagnostic testsHyperthyroidism diagnostic tests rely on the typical clinical manifestations, and sometimes also combined with some special check. Hyperthyroidism commonly used special inspection methods as follows:A. The basal metabolic rate measurement can be calculated according to the pulse pressure and pulse rate, or the determination of basal metabolism string determination. The latter is more reliable, but the former is simple. Commonly calculated as follows: basal metabolic rate = (pulse rate + PP) -111. Determination of basal metabolic rate in a completely quiet, empty stomach. Normal ± l0%; increased to +20% to 30% of mild hyperthyroidism / 30% 60% moderate, 10 to 60 percent or more severe.Two. 131 the amount of thyroid photo of 131I rate determination of normal thyroid uptake within 24 hours for 30% to 40% of the human total. If within two hours thyroid uptake of 131 iodometric more than 25% of the total of the human body, or more than 50% of the total of the human body within 14 hours, and early appearance of the absorption of iodine 131 peak, can be diagnosed hyperthyroidism.3. Serum T3 and T4 levels, the determination of hyperthyroidism, serum T3 may be higher than about 4 times normal, and T4 only the normal two and a half times, T3 determination with high sensitivity to hyperthyroidism attending Jin
Like hyperthyroidism - Surgical treatmentThe hyperthyroidism subtotal thyroidectomy than moderate hyperthyroidism is still the most commonly used and effective therapy, 90% to 95% of the patients get cured, surgical deaths string of less than 1%. The disadvantage of surgical treatment are some complications and about 4% to 5% of patients after recurrence of hyperthyroidism, a small number of patients with postoperative hypothyroidism.Indications for surgical treatment of: ① The secondary hyperthyroidism or high-functioning adenomas; ② moderate primary hyperthyroidism; ③ glands large, with compression symptoms or substernal goiter and other types of hyperthyroidism; ④ antithyroid drugs or 131I therapy for relapse or difficult to adhere to the long-term medication.In addition, in view of hyperthyroidism, pregnancy can cause adverse effects (abortion, premature birth, etc.), but pregnancy may exacerbate hyperthyroidism, therefore, early pregnancy, the medium-term patients with hyperthyroidism who are of the above indications, surgical treatment should be considered. Surgery Contraindications: ① young patients; ② mild persons; the ③ elderly patients or have serious organic disease can not tolerate surgery.Preoperative preparation hyperthyroidism in order to avoid patients with hyperthyroidism in the basal metabolic rate is high-pitched to the risk of surgery, preoperative should be taken fully prepared to ensure the smooth operation and prevent the occurrence of postoperative complications.A. General provisions for psychological tension or insomnia may be appropriate sedation and sleeping pills in order to eliminate the feelings of the patient's fear. Rapid heart rate, oral reserpine O. 25mg or propranolol (Inderal) 10mg, 3 times a day. The occurrence of heart failure, digitalis preparations should be.Two. In addition to the comprehensive physical examination and necessary laboratory tests should also include: ① neck fluoroscopy or radiography preoperative examination, to understand whether compression or displacement of the trachea; (2) detailed examination of the heart whether to expand, murmur, or arrhythmia and for ECG; ③ laryngoscopy to determine the function of the vocal cords; ④ Determination of basal metabolic rate, the degree of hyperthyroidism, select the timing of surgery.3. The drug preparation is an important part of the technique used to reduce the basal metabolic rate. There are two ways: ① The first thiourea drugs, by reducing thyroid hormone synthesis, and inhibition of in vivo lymphocyte to produce its own antibodies to control the symptoms of hyperthyroidism caused by thyroid hormone increased until symptoms of hyperthyroidism are the basic control, namely, change clothes 1-2 weeks of iodine, then surgery.Postoperative protection of hyperthyroidism 1. Anesthesia generally available cervical plexus block effects, understand the patient to pronounce avoid recurrent laryngeal nerve injury. Huge retrosternal goiter compression of the trachea, or nervous mental disorders in patients with hyperthyroidism, should still be selected endotracheal anesthesia in order to ensure airway patency and smooth operation.Two. Surgery should be gentle, careful, careful hemostasis, pay attention to the protection of the parathyroid glands and recurrent laryngeal nerve. Should also be noted:(1) fully exposed the thyroid gland. Should be close to the thyroid very ligation, cut off the thyroid artery and vein, to avoid injury to the superior laryngeal nerve; to the inferior thyroid artery ligation, and should leave the glands on the back as far as possible, rely on the common carotid artery ligation its trunk, to avoid the recurrent laryngeal nerve injury .(2) Removal of the gland number, should be determined according to the size of the glands or hyperthyroidism extent. It usually takes 80% to 90% of the Removal of the gland, and removal of the isthmus; each side of the residual glands such as adult thumb tip size appropriate (about 3-4g). Glands removal too easily lead to relapse, too much prone to hypothyroidism (myxedema). Must save both lobes of the gland on the back part, so as not to damage the recurrent laryngeal nerve and parathyroid.(3) strict stop the bleeding. The larger blood vessels (such as the thyroid artery and vein, the thyroid, vein), should be double ligation to prevent slippage bleeding. The surgical field should be routinely place a rubber piece drainage 24-48 hours, and to observe and timely drainage of blood clots within the incision, to prevent blood clots compression of the trachea, causing suffocation.3. Postoperative observation and care after surgery the same day should pay close attention to changes in the patient breathing, body temperature, pulse, blood pressure; the incidence of thyroid crisis prevention. Such as pulse rate too fast, you can use the reserpine intramuscularly. The patient semi-recumbent position to facilitate breathing and drainage incision, blood clots: to help the patient promptly eliminated from the sputum, and to maintain airway patency. In addition, postoperative patients to continue taking the compound potassium iodide solution, 3 times a day. 10 drops each, a total of about one week; or 3 times a day, each 16 drops daily each reduced by a drop.Attention to matters hyperthyroidism disorders iodine's role is to inhibit proteolytic enzymes to reduce the decomposition of thyroglobulin, thus inhibiting the release of thyroid hormone, iodine can reduce the blood flow of the thyroid, the gland congestion reduction, and thus narrow the hardened . Commonly used iodine compound potassium iodide solution, 3 times a day; the first day of each 3 drops, 4 drops of each on the second day, after the daily increments of one drop to each 16 drops so far, and then maintain this dose. However, only iodine inhibit thyroid hormone release rather than inhibit its synthesis, so stop taking the iodine stored in the thyroid follicular thyroglobulin substantial decomposition. The re-emergence of symptoms of hyperthyroidism, even more serious than the original, who is not prepared to implement the surgery, not to take iodine.For routine use iodine or combined with alkali alloxan drugs can not be tolerated or ineffective, advocate with propranolol or together with the iodine for preoperative preparation. Propranolol is an adrenergic β-blockers, can control the symptoms of hyperthyroidism, shorten the time of preoperative preparation, and medication does not cause the gland congestion, surgical operation, effect of thiourea drugs bad or severe reactions could be replaced by this drug. Propranolol can selectively block β receptors on various target organs and tissues sensitivity to catecholamines, and inhibiting the effects of epinephrine to improve the symptoms of hyperthyroidism. Dose of oral administration of 1 every 6 hours, every 20 - 60mg, 4-7 in the future pulse rate dropped to normal levels, can perform an operation. Less than eight hours due to the effective half-life of propranolol in the body, so the last time oral propranolol before surgery l two hours; postoperative oral propranolol 4-7. In addition, before surgery, without atropine, so as not to cause tachycardia.Concurrent symptoms of hyperthyroidism. Postoperative respiratory difficulties and asphyxia occurred within 48 hours after surgery is most critical after complications. The common reasons: the ① incision bleeding compression of the trachea, due to surgery to stop bleeding (glands section hemostasis) imperfect, or vascular ligature slippage caused by the. ② laryngeal edema, mainly caused by surgical trauma. Can also be caused by tracheal intubation. ③ airway collapse. The wall of the airway long-term enlargement thyroid vine oppression, soften, softening of the tracheal wall lost support in most of the removal of the thyroid body. Patients of the latter two cases, due to airway blockage can occur Ming and acute respiratory resistance. The clinical manifestations of progressive shortness of breath, irritability, cyanosis. Or even suffocation. Such as swelling of the neck, the incision oozing blood, mostly incision bleeding caused. Found out that the situation must be immediately bedside rescue, cut sutures in a timely manner, open incision, the speedy removal of the hematoma; so when the patient breathing no improvement should be immediately implemented tracheotomy; the situation improved after sending the operating room for further of gold One, hemostatic, and other treatments. Therefore, patients should be routinely placed in the patient bedside sterile tracheotomy package and gloves to prepare for emergency.Two. Recurrent laryngeal nerve injury rate of about 0.5%. Mostly due to the surgical treatment of thyroid pole, accidentally recurrent laryngeal nerve cut, suture or setback folder, traction caused by permanent or temporary injury caused. A few also by hematoma, or scar tissue compression or traction. Closely related to the consequences of injury and the nature of the injury (permanent or temporary) and range (unilateral or bilateral). The recurrent laryngeal nerve containing motor nerve fibers dominated the vocal cords. Side of the recurrent laryngeal nerve damage, mostly caused by hoarseness after surgery, although by the contralateral vocal cord compensatory received to the ipsilateral excessive recovery pronunciation, but laryngoscopy shows ipsilateral vocal cord still not received, and therefore can not be restored the original tone. Full support of the bilateral recurrent laryngeal nerve injury, depending on the injury, before the branch or a different plane and the posterior branch, can lead to aphonia or severe breathing difficulties, or asphyxia, requiring immediate tracheotomy. Surgical cut, suture fell folder, traction and direct the recurrent laryngeal nerve injury, intraoperative immediate symptoms. Caused by hematoma compression, scar tissue pulling may be a few days after surgery before the onset of symptoms. Cut the suture caused a permanent injury setback folder, stretch, due to hematoma compression is more timely processing of the temporary manager spa, the general may be in three to six months, gradually restored.3. Laryngeal nerve injury occurred to the handling of the thyroid pole, too far away from the glands, separated carefully and the nerve and surrounding tissue with a large bunch of ligation caused. Laryngeal nerve, since the beginning of (feeling) and outside (movement) two. If the damage to the external branch makes the cricothyroid muscle paralysis, causing the vocal cords relaxation, lower tone. The internal branch of injury, throat mucosal sensory loss, eating especially drinking, it is easy swallowing choking. General manager after the treatment can restore itself.4. Tetany due to involvement due to accidental injury during surgery and parathyroid glands or their blood supply, the serum calcium concentration decreased to below 2.0mmol / L, severe cases can be reduced to 1.0-1.5mmol / L (normal 2.25-2.75mmol / L) neuromuscular stress was significantly higher, more than three days of the postoperative l tetany. The majority of patients, only the face, lip or hand and foot acupuncture-like numbness or a sense of rigidity, after 2-3 weeks, intact parathyroid hyperplasia hypertrophy play a compensatory role, the symptoms can disappear. In severe cases, there may be persistent spasm, facial and hand, foot pain associated with feeling daily seizure overcharged. Each lasting 10 to 20 minutes or longer, severe cases can occur in the larynx and diaphragm spasm, causing suffocation and death. The Thyroidectomy care to preserve the integrity of the glands on the back part of the. Thyroid specimens cut double-check the back of the parathyroid correct cut, found that when trying to transplant to the sternocleidomastoid medium, are the key to avoid this complication occurred.Occurrence of tetany, meat, dairy and eggs and other foods should be limited (due to higher phosphorus, affect the absorption of calcium). Seizure, immediate intravenous injection of 10% calcium gluconate or calcium chloride 10 to 20ml. Mild symptoms of oral calcium gluconate or calcium lactate 2-4g, 3 times a day; severe symptoms or long-term recovery, plus vitamin D3, and 5 in case of 100 000 U a day to promote the calcium in the intestine absorption. Oral oxygen speed sterol (dihydrotestosterone rapid change steroids) (DT10) oil can significantly improve the content of calcium in the blood, reducing the stress of the neuromuscular Can also be used with blood vessels of the thyroid - parathyroid transplantation of allogeneic5 Thyroid storm is a serious complication of hyperthyroidism. Clinical observations: crisis occurred with the preoperative preparation is not enough, the symptoms of hyperthyroidism is not well controlled and surgical stress. Crisis patients mainly as follows: fever (> 39 ° C), pulse (120 beats / min) concomitant nervous, circulatory and digestive systems, severe functional disorders such as irritability, delirium, sweating, vomiting, watery diarrhea reflects The disease is caused due to thyroid hormone excess release of the fulminant adrenaline excitement phenomenon. Without timely treatment, the rapid development of coma, collapse, shock and even death, the mortality rate is about 20% to 30%.Treatment includes: (1) adrenergic blockers: the choice of reserpine 1-2mg intramuscularly, or guanethidine 10 ~ 20mg oral. 4-8 hours after the former drug crisis can be eased; the latter in 12 hours onset of action. Can also be used propranolol 5mg plus 100ml intravenous infusion of 5% a 10% glucose solution to reduce the response to adrenaline of the surrounding tissue. (2) potassium iodide solution of iodine: oral compound, for the first time 3-5ml, 500ml of 10% glucose solution by adding 10% sodium iodide-10m1 emergency intravenous drip to reduce the level of thyroxine in the blood. (3) hydrocortisone: daily 200-400mg, graded intravenous infusion to antagonize too much thyroid hormone response. (4) sedative: Common phenobarbital sodium 100mg, or the lytic cocktail n half the amount, intramuscular injection of 6-8 hours (5) cooling: antipyretic, hibernation drugs and physical cooling methods, to maintain body temperature at 37 ℃. (6) of intravenous glucose solution to replenish their energy and oxygen, in order to reduce tissue hypoxia. (7) have heart failure, the addition of digitalis preparations..
