甲状腺功能亢进症临床表现与治疗

Hyperthyroidism hyperthyroidism abbreviation, is due to thyroid hormone excess caused by a group of endocrine diseases. Hyperthyroidism is found in the plasma as a long-acting thyroid stimulating immunoglobulin, it does not suffer from pituitary control of slow and long-lasting, directly promotes the synthesis and release of thyroid hormone, and pathogenesis.

( 1) the clinical manifestation of hyperthyroidism is more common in women aged 20-40, mostly slow onset, the typical performance are as follows: 1 ) thyroid hormone excess syndromes of nervous system manifestations: Neuroticism, easy excited, say more apprehensive, more impetuous, hands out the appearance of tremor;②metabolite recognition performance : the fear of increased heat sweating, the skin warm and humid, hyperthyroidism appetite and weight loss; the cardiovascular system: palpitations, shortness of breath, heart rate more than 100 times / min, the first heart sound hyperfunction, pulse pressure difference increasing, arrhythmia, heart enlargement induced heart failure;④digestive manifestations: hyperthyroidism appetite, stool thinning and increased the number of. In addition to the occurrence of malnutrition, hypotonia, menstrual disorders, male impotence, millet liquid edema.

2) thyroid enlargement: diffuse thyroid enlargement, which can be heard on vascular murmur and feel the tremor. 3) exophthalmos: eye cleft broadening one's eyes brimming with radiating vigour when eyes, eyes closed eyelid vibration, watching when the last binocular convergence adverse; if be afraid of light, tears, diplopia, intraocular foreign body sensation called malignant exophthalmos. 4) thyroid crisis: high fever, irritability, dizziness, sweating rate often more than 140 times / min, often diarrhea, vomiting, white blood cell and neutrophil increase, arrhythmia or heart failure, acute pulmonary edema. 5) auxiliary examination: basal metabolic rate is higher than 15%; iodine 131 uptake rate than normal; T3, T4 increased.

( 2) treatment of hyperthyroid patients should first be reduced mental tension and avoid all kinds of stimulation, to ensure adequate rest, when necessary the use of sedatives such as diazepam (Valium ), barbiturates; give high calorie, high protein and high vitamin diet; heartbeat rate available to have tea with ( propranolol ) and other drugs. At the same time also should be given to the following: 1) the treatment of antithyroid drugs. Common tapazole orally, daily 3 times, each time 10 mg, when reduced to 2.5 - 5 mg / time, to maintain not less than 1 years, the total duration of treatment need 1.5 - 2 years.

Other drugs used during, should be 2 - 4 weeks to review the first white blood cell counting and classification of white blood cell count, if less than 3 × 109/L or neutrophils is less than 5 × 109/L should be considered when the temporary withdrawal, dressing to consider or combined with prednisone treatment. Treatment of hyperthyroidism and antithyroid drug therapy in the most serious side effect is neutropenia, agranulocytosis, due to granulocytic small systemic resistance decreased significantly, resulting in severe systemic infection, the threat to life great.

2) radioactive iodine 131 therapy for age greater than 35 years, is the use of antithyroid drug therapy, inappropriate or relapse after operation. Radioactive iodine 131 scintigraphy in patients with easily lead to hypothyroidism / A, mainly refers to the permanent hypothyroidism / A.

3) partial resection of thyroid people apply various non operation treatment is ineffective in patients. 4) intervention suitable for all ages, all cases of hyperthyroidism, and has the advantages of safety and reliability, short course of treatment, without recurrence characteristics, the treatment of various human complications.

5) in the treatment of thyroid crisis rapid control of hyperthyroidism, selection of compound iodine solution first oral dose of 50-60 drops, later every 4 - 6 hours 30, 45 drops; or sodium iodide ( k ) 0.5 - 1 grams of dissolved in 500 ml of liquid intravenous infusion every 8 hours, 1, relief of symptoms after the gradual reduction of stop medicine;②large doses of methimazole, the first dose of 60 mg, 3 times a day orally, relief of symptoms after changed into general usage, also can choose other antithyroid drugs: the general Tuluoer ( propranolol ) 40 mg every 4 - 6 hours, 1 times: the rapid physical and drug cooling, can choose to hibernate therapy: the hydrocortisone 300 daily and 500 mg intravenous infusion: the use of anti infective drugs; the correct water, electrolyte disturbance, oxygen inhalation, supplementary dose of vitamin B, correcting function not congruent.