甲亢与毒性弥漫性甲状腺肿（Graves病或Basedow病

    Hyperthyroidism ( hyperthyroidism, referred to as hyperthyroidism) refers to by a variety of etiologies that lead to thyroid hormone ( TH ) secretion caused by too much clinical syndrome. Hyperthyroid patients is complex, with Graves disease (GD) the most common. Graves disease (GD ), also known as diffuse toxic goiter or Basedow disease, is a kind of complicated with thyroid hormone ( TH ) secretion organ specific autoimmune diseases. 杭州甲状腺检查医院 [ ] GD as the etiology and pathogenesis of autoimmune thyroid disease is a kind of special type, but with other autoimmune thyroid disease, such as chronic lymphocytic thyroiditis, idiopathic mucinous edema are more closely linked. GD have a familial predisposition, and with some HLA types, but in different regions and ethnic susceptibility to HLA type is not the same. Generally, the disease to genetic susceptibility as the background, in the infection, trauma and other factors, evoked the in vivo immune function disorder. Thyroid autoantibodies to tissue antigen or antigenic components are mainly TSH, TSH receptor, thyroid globulin ( TG ), thyroid peroxidase ( TPO ) and ( Na+/I- ) symport protein. The incidence of GD and thyroid stimulating autoantibody very close relationship. TSH and TSH receptor antibody ( TRAb ) can be used with TSH receptor binding. TRAb can be divided into two categories, namely, thyroid stimulating antibody ( thyroid stimulating antibody, TSAb ) and TSH ( binding ) blocking antibodies ( TSH-binding antibody, TBAb ). [ ] in 1 thyroid pathology showed varying degrees of diffuse, symmetrical enlargement, or with isthmus. In 2 eyes of infiltrative exophthalmos of the retrobulbar tissues often fat infiltration, fibrosis, and deposition of GAG mucopolysaccharide, hyaluronic acid increased, lymphocyte and plasma cell infiltration. Muscle fiber thickening, texture fuzzy, muscle fiber degeneration, fracture and damage, the muscle cell glycosaminoglycans also increases. 3 of pretibial myxedema skin lesion biopsies in light microscopically visible protein sample deposition of hyaluronic acid, with most with the degranulation of mast cells, phagocytes and endoplasmic reticulum enlarged fibroblast invasion; under the electron microscope much micro fiber with mucin and acid precipitation of GAG. 4 other skeletal muscle, cardiac muscle is similar to the above changes, but the lighter. [ ] in 1 clinical manifestations of thyroid hormone hypersecretion syndrome ( 1) high metabolic syndrome: due to excessive secretion of T3, T4 and sympathetic nerve excitability, promote metabolism, oxidation accelerated so that heat production, heat radiation increased significantly. Patients are often tired, afraid of heat sweating, skin is warm and moist, weight loss and low heat, crisis may have high fever. TH promotes intestinal glucose absorption, accelerated glucose oxidation using and hepatic glycogenolysis, can result in impaired glucose tolerance or the exacerbation of diabetes mellitus. TH promotes fat synthesis, decomposition and oxidation, cholesterol synthesis, transformation and excretion are accelerated, often caused by blood total cholesterol reducing. Protein catabolism enhancement induced negative nitrogen balance, weight loss, increased excretion of urinary creatine. ( 2) mental, nervous system: Neuroticism, say more active, nervous, irritable, insomnia, restlessness, distracted, memory loss. Sometimes a fantasy, even is expressed by a subpopulation of mania or schizophrenia. Few of them show indifference, lack of response to the things around, reticent depression. ( 3) the cardiovascular system: palpitations, chest tightness, sinus tachycardia, cardiac arrhythmia, atrial premature contraction with rare, serious can occur with atrial fibrillation or flutter, pulse pressure difference increasing, the apical area of the heart in hyperthyroidism. ( 4) the digestive system: hyperthyroidism appetite, eating more emaciated. Due to gastrointestinal peristalsis speed, diarrhea. I see patients with anorexia, severe anorexia in older persons.杭州甲状腺疾病治疗哪个医院最专业 ( 5) the musculoskeletal system : can appear periodic paralysis occurs more frequently in young men, at the onset of reduce blood potassium. Some patients with thyrotoxic myopathy, hypotonia and muscle atrophy, more common in the scapula and the pelvic girdle muscles. ( 6) reproductive endocrine system: women often reduce menstruation or amenorrhea. Men with impotence. Serum prolactin and estrogen elevation. 2 the vast majority of patients with thyroid, mild diffuse, symmetric goiter, soft, no tenderness; swelling degree and hyperthyroidism weight no significant relationship; in front of the neck can often hear systolic blowing or continuous systolic enhanced vascular murmur. 3 eye syndrome GD patients is about 25%～ 50% with exophthalmos. With hyperthyroidism exophthalmos occurred at the same time, but also in the hyperthyroid symptoms appear before or after hyperthyroidism treated by drugs, a few only exophthalmos and lack of other clinical manifestations. [ ] in 1 types of special clinical manifestations and thyroid crisis: the early performance of original hyperthyroidism a worsening of symptoms, and high heat ( 39 ℃), heart rate ( 140 ～240 /min ), can be associated with atrial fibrillation or flutter, irritability, sweating, delirium and coma. Blood FT3, FT4, TT3, TT4 increased, TSH decreased, 2 hyperthyroid heart disease ( abbreviation of hyperthyroid heart disease ) accounted for about 10%～ 22% hyperthyroidism, increases with age, is more common in males nodular goiter with hyperthyroidism. Manifested as cardiac enlargement, serious arrhythmia or heart failure. Exclusion of coronary heart disease and other organic heart disease, and in the control of hyperthyroidism, arrhythmia, cardiac enlargement and angina pectoris were able to restore this disease can be diagnosed. 3 apathetic hyperthyroidism, mostly seen in elderly patients. Insidious onset, no high metabolic syndrome, eye disease and thyroid gland in. Clinical manifestations of mental fatigue, sleepiness, indifferent, unresponsive, obvious emaciation. Some are only present as unexplained paroxysmal or persistent atrial fibrillation, the old can be associated with angina, myocardial infarction. 4 three triiodothyronine ( T3 ) type of hyperthyroidism and thyroid hormone ( T4 ) type of hyperthyroidism: type T3 hyperthyroidism is more common in diffuse, nodular or mixed goiter patients with early, treatment or relapse after treatment and the patients with hyperthyroidism iodine deficiency area. The same type of hyperthyroidism with unusual clinical manifestations, but the symptom is lighter. Characteristics of blood TT3 and FT3 were increased, TT4, FT4 normal. Thyroid 131I uptake rate of normal or higher, but not influenced by exogenous T3 inhibition. T4 TT4, FT4 increased in hyperthyroidism with blood, TT3, FT3 normal or low as features, mainly in GD with serious somatic disease or radioiodine cases, may be associated with the T4 converted to T3 reduction. 5 of subclinical hyperthyroidism is characterized by blood T3, T4, TSH decreased. Patients with asymptomatic or have hyperthyroidism certain performance, and can lead to cardiovascular, muscle or bone damage. 6 gestational hyperthyroidism: ( 1) pregnancy combined with hyperthyroidism: pregnancy due to a variety of physiological change and high estrogen levels can cause blood TT3, TT4 increased and palpitations, sweating, heat and high metabolic syndrome appear even physiology goiter, sometimes identification difficult, needs comprehensive judgement. ( 2) HCG hyperthyroidism: HCG and TSH Yaki, both receptor molecule is very similar, HCG and TSH and TSH receptor binding in the presence of cross reaction. Risk of choriocarcinoma, Portuguese Amoy fetal, multiple pregnancy, a large number of HCG or HCG analogue stimulation of TSH receptors and the emergence of hyperthyroidism, blood FT3, FT4 increased, TSH decreased, HCG was increased. Hyperthyroidism with termination of pregnancy or after delivery. Laboratory examination and other [ ] [ ] 1 in differential diagnosis of simple goiter diffuse thyroid enlargement, T4 normal or low, normal or high T3, TSH normal or high. 2 nerve disorder, mental nerve syndrome, thyroid function in normal. 3 diabetic early manifestation of hyperthyroidism appetite, accompanied by thirst, excessive sweating, but hyperglycemia, early can only showed elevated postprandial glucose to differentiate. [ ] 1 treatment of general treatment : proper rest, added B vitamins and nutrients such as protein, nervousness, insomnia severity can be given a sedative. 2 antithyroid drugs ( 1) thiourea: methylthio pyrimidine propylthiouracil 300～ 450mg/d and 2～orally 3 times, from 1 to 2 months after remission of symptoms or thyroid function returned to normal杭州甲状腺结节哪里看好 after, gradually reduced to 50～ 100mg/d, maintain 1.5 ～2y. ( 2) imidazole methimazole ( methimazole ), carbimazole ( hyperthyroidism Ping ) 30 ～ 40mg/d, 2 ～3 and 1 ～ 2m after oral administration every 2～ 4W reduction time, reduction of 5～ 10mg each time to complete elimination of symptoms, signs significantly better minimized maintenance dose of 5 ～10mg/d, maintain 1.5 ～2y. [ indications ] A. thyroid was mild to moderate swell. B. for various reasons not operation. C. 131I before and after treatment with adjuvant therapy of radioactive. Side effects: a small number of cases may occur in severe liver damage or agranulocytosis; drug rash is more common, available antihistamines control, generally do not have to stop drug, rash exacerbation should stop drug. ( 3) compound iodine oral solution applies only to the preoperative preparation and thyroid crisis.杭州甲状腺结节医院 ( 4) receptor blockers for multiple beta blockers are available. Used to improve the symptoms of thyrotoxicosis such as F Naylor 10 ~ 40mg, 3 ~ 4 times daily. ( 5) radioactive doses of 131I according to the estimation of thyroid weight and maximum 131I uptake rate calculation. General per gram of thyroid tissue in a given 131I 12.6～ 37MBq ( 70 ～ 100uCi) radiation quantity. ( 6) operation treated with subtotal thyroidectomy, cure rate 70% above.