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1、甲亢英文IntroductionlDefinition：Function of thyroidism metabolism many systems excitability lMost common is diffuse toxic goiter(Graves disease,GD),85%山东农业大学 计算机科学系Various causes=Graves disease:85%=Autonomous toxic adenomas of the thyroid:Plummers disease or toxic multinodular goiter=Jodbasedow disease(
2、Iodine-induced HT)=Functioning thyroid carcinoma=TSH hypersecretion by the pituitary=Struma ovarii=Subacute thyroiditis=Hashimotos thyroiditis=Thyrotoxicosis factitia=Carcinoma accompanying thyrotoxicosis 山东农业大学 计算机科学系=85%=Male to female 1:4-6=Chief clinical findingsGraves diseaseGraves diseaseXSymp
3、toms due to Hypermetabolism Xgoitor XOphthalmopathy=Abnormal immune:TRAb=Heredity=Infection:Molecular mimicry Cytokine Superantigen=Spirit irritation Etiology and Pathophysiology山东农业大学 计算机科学系Clinical manifestationCommon=Symptoms due to Hyper metabolism:Heat intolerance,excessive perspiration,warm mo
4、ist 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.山东农业大学 计算机科学系图图1图图2图图3图图4山东农业大学 计算机科学系=Nervous system:Nervousness,emotional lability,irritability,fine t
5、remor 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 manifestationCommon山东农业大学 计算机科学系Clinical
6、 manifestationExceptive=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山东农业大学 计算机科学系Laboratory Diagnosis=Serum T3,T4,
7、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山东农业大学 计算机科学系Diagnosis=Symptoms=Signs=Laboratory examination山东农业大学 计算机科学系Differential diagnosis=Other causes of thyrotoxicosis=Anxiety neurosis or man
8、ia=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.山东农业大学 计算机科学系TreatmentlAntithyroid
9、drugs:ThionamideslRadioactive iodine(131I)lThyroid surgery山东农业大学 计算机科学系lThionamides:TreatmentXCommon use:a.Methimazole b.PropylthiouracilXDosage and duration of thionamidesXAdverse action:agranulocytosis,rash(including hives),Hepatitis(with PTU),Arthralgia,myalgia,neuritis,cholestasis(with MMI)XRela
10、pse山东农业大学 计算机科学系XIodinating agentsXBeta-blocking agents:PropranololXThyroid hormoneTreatment=Other medicine山东农业大学 计算机科学系TreatmentlRadioactive iodine(131I)XIndication:XContraindication:female in pregnancy or the person less than 25y,etc.XComplication:Hypothyroidism,the incidence is significant during
11、 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%.山东农业大学 计算机科学系lThyroid surgeryTreatmentXIndication:XContraindication:山东农业大学 计算机科学系TreatmentlThyrotoxic crisislInfiltrating exophthalmos SomastatinlHyperthyroidism in pregnancy山东农业大学 计算机科学系谢谢谢谢 谢！谢！谢！谢！山东农业大学 计算机科学系谢谢大家！