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    Hyperthyroidism refers to a variety of etiologies that lead to thyroid hormone ( TH ) secretion caused by too much clinical syndrome. Its etiology is very complex, but the most common Graves disease. The main clinical symptoms in TH hypersecretion syndrome: such as high metabolism caused by fatigue, cold sweating, skin is warm and moist, weight reduction, low; nerve, spirit system symptoms: as many words are restless, nervous, irritable, insomnia, memory loss; cardiovascular system such as heart palpitations, chest pain, shortness of breath:; digestive symptoms: such as hyperthyroidism appetite, eating more emaciated. In addition, still can appear thyrotoxic myopathy, hypotonia, muscle atrophy, women with amenorrhea, male impotence, breast development. At the same time, patients may present with varying degrees of diffuse, symmetric goiter, soft, no tenderness, often can hear and vascular murmur. Some patients may appear exophthalmos. Suspected hyperthyroidism patients should be performed thyroid function ( FT3, FT4, TT3, TT4, TSH ) determination of B ultrasound, thyroid, thyroid scan, thyroid antibodies and other checks the thyroid function and a clear cause, to endocrine specialist for regular treatment. Thyrotoxicosis the clinical disorders including several kinds of special diseases, with a high metabolism and high serum free thyroid hormones as features. With hyperthyroidism ( Graves ) or thyrotoxicosis remains some controversy. Some authors tend to use thyrotoxicosis as clinical disorders including hyperthyroidism (defined as increased thyroid hormone synthesis and secretion) as a cause. In hyperthyroidism and thyrotoxicosis are synonyms. Etiology may be due to hyperthyroidism thyroid thyroid hormone ( T3 and T4 ) increased synthesis and secretion of the results, this is the result of serum thyroid stimulating factor or autonomy caused by hyperthyroidism, may also be due to excessive release of thyroid thyroid hormone and no increase in hormone synthesis. The most common cause is secondary to a variety of causes of thyroiditis caused by destructive changes caused by hyperthyroidism in the final one of the main reasons is intentional or accidental ingestion of excess thyroid hormone, called the factitious thyrotoxicosis. Hyperthyroidism etiologic classification according 杭州看甲亢的医院有哪些 to radioactive iodine absorb and have no circulating thyroid stimulating factor. Graves's disease ( diffuse toxic goiter ), with thyroid function hyperfunction and The one or more symptoms. : goiter, exophthalmos, pretibial myxedema. Graves disease as the most common cause of hyperthyroidism, such as autoimmune disease, slow course with remission and relapse. The etiology of Graves disease is resistant to thyroid TSH receptor antibodies continue excited thyroid lead to excessive synthesis and secretion of T3 and T4 Graves disease ( and Hashimoto's thyroiditis ) sometimes associated with other autoimmune diseases, including IDDM, vitiligo, pernicious anemia, premature white hair, collagen disease, multiple deficiency syndrome. Infiltrating process seen in Graves's disease, pathogenesis and very little is known about, but is most common in active hyperthyroidism. Also visible in the incidence of hyperthyroidism before or after 15~20 years, exophthalmos improved and intensified does not depend on the clinical course of hyperthyroidism. Infiltrative exophthalmos may be directed to extraocular muscle and orbital fibroblast specific antigens and immunoglobulin A antibody, which is different from the start Graves hyperthyroidism antibodies. Normal thyroid function typical of exophthalmos is called normal thyroid function in Graves disease. Inappropriate secretion of TSH all hyperthyroidism is the main problem which can not be detected serum TSH, except TSH secretion Anterior pituitary tumor or pituitary on thyroid hormone resistance. These two kinds of disease of TSH biological activity than normal TSH, serumα - subunit of TSH increased secretion of tumor marker is - mole, choriocarcinoma and vomiting of pregnancy, these three kinds of disease and increased serum HCG, the latter is weak thyroid excited factor. The first 3 months of pregnancy the highest HCG, leading to increased serum FT4 and TSH mild mildly reduced sometimes occurs in early pregnancy. A hydatidiform mole and choriocarcinoma women HCG generally higher, but the vomiting of pregnancy women are usually normal . Recently suggested that the sialic acid in serum of the patients because of increased -HCG levels, increased thyroid stimulating activity, the hormone is compared powerful thyroid stimulating factor toxicity of solitary or multiple nodes goiter ( Plummer's disease ) toxic multinodular goiter common in the elderly . Recently, mutations in TSH receptor activation, caused by continuous thyroid excited, has been in solitary nodules found in. This discovery may explain at least some patients with hyperthyroidism nodules the mechanisms of pathogenesis of autoimmune autosomal dominant hyperthyroidism in this disease is familial autosomal dominant hyperthyroidism syndrome, appear in infancy, the etiology is TSH receptor Gene mutation, resulting in a constitutional receptor activation, sustained excitement thyroglobulin synthesis and release of excess thyroid hormone . Lithium induced goiter ingestion of lithium can induce with or without hypothyroidism with goiter, especially in Hashimoto's thyroiditis patients, mostly because the inhibition of thyroid iodine release . Although the ingestion of lithium, but can also occur in hyperthyroidism . Recently tips this is sometimes accompanied by coincidence, not taking lithium. Inflammatory diseases ( 's) thyroiditis types including lymphocytic thyroiditis, subacute thyroiditis and Hashimoto's thyroiditis ( three kinds of disease are discussed in the following thyroiditis ). Sporadic lymphocytic thyroiditis is rare, the early reports from the Midwest increased incidence may be associated with eating food containing bovine thyroid beef confused. Thyrotoxicosis is due to disruption of glands of the change, release the hormone storage rather than to increase by high dose radiotherapy in the treatment of cervical non thyroid malignancies can cause pain and transient hyperthyroidism thyroiditis. Radiotherapy after permanent hypothyroidism occurring rate is high. Thyroid function (serum TSH ) every 6~12 months an assessment of radiotherapy after a few years Graves exophthalmos ethylamine can occur. 杭州看甲亢哪个医院好 Iodine furosemide ketone andα - interferon induced thyroid changes a lot of discussion beyond the scope of this article has been reported; however these two drugs induced thyroiditis with hyperthyroidism, patients receiving these agents should be under strict supervision. Factitious thyrotoxicosis this disease patient intentionally or unintentionally taking the excess thyroid hormone leads to no goiter with hyperthyroidism. With other causes of hyperthyroidism, serum thyroglobulin is not high, almost always low or normal lower limit. Taking iodine induced hyperthyroidism iodine intake is associated with low thyroid radioiodine hyperthyroidism absorb the main reason, be regarded as true that hyperthyroidism, thyroid hormone synthesis and release is increased. The most common in non toxic nodular goiter patients ( especially in the elderly), these patients taking the drugs containing iodine ( such as amiodarone or iodine expectorant ) or because of radiology or cardiac examination using the enriched with iodine contrast agent for thyroid radioactive iodine absorb and iodine intake inversely, so low radioactive iodine absorb easy to understand, this is usually in low iodine or boundaries of iodine intake areas ( such as Western Europe ), but is also seen in the United States, despite adequate iodine intake. However iodine induced hyperthyroidism etiology is not clear, but can be composed of On the thyroid tissue autonomous district provides excess iodine induced hyperthyroidism . Don't put in excessive iodine, often continue to exist, and other causes of hyperthyroidism control more difficult. Metastatic thyroid cancer functional metastatic follicular carcinoma, especially in the lung, rare had high to produce thyroid hormones. Ovarian tumors containing enough thyroid organization of ovarian teratoma can be really hyperthyroidism, but the site in the pelvic cavity, thyroid radioactive iodine absorb is inhibited. Symptoms and signs on all types of hyperthyroidism patients most of the symptoms and signs the same, only with certain exceptions, such as infiltrative exophthalmos ( common) and skin lesions ( rare ) is Graves's disease autoimmune manifestations, not seen in other causes hyperthyroidism hyperthyroidism. Clinical manifestations may be sudden or hidden. Common signs and symptoms are goiter heartbeat; tachycardia; pulse pressure broadening; hot, fine, moist skin; tremor; eye syndrome; atrial fibrillation; neuroticism and increased activity; sweating; heat; palpitations; fatigue; increased appetite; insomnia; weakness hyperthyroidism ( occasional diarrhea and intestinal peristalsis ). With many symptoms similar to adrenal overexpressed . Older people, particularly toxic nodule Goiter patients may have atypical manifestations with indifference or latent hyperthyroidism. Hyperthyroid patient eye syndrome include gaze, winking lag, upper eyelid retraction, mild scleral hyperemia, these eye syndrome is largely adrenal can excited, often with hyperthyroidism treatment success and ease infiltrative exophthalmos is more serious, as the typical Graves, its characteristics are: orbital pain, tears, foreign body sensation, photophobia, after orbital tissue hyperplasia, exophthalmos extraocular muscles and lymphocyte infiltration, produce ocular myasthenia cause diplopia infiltrative skin lesion, also called pretibial myxedema (easy confusing terminology, because myxedema suggest hypothyroidism), and is characterized in protein infiltration, non-pitting edema, occurred in the anterior tibial area. No Graves' eye disease patient rare. Early lesions localized pruritus, red, then becomes solid. Like eye, infiltration skin lesions can occur in hyperthyroidism before or after a number of years. Mole, choriocarcinoma and vomiting of pregnancy induced hyperthyroidism is temporary, when the mole removal, choriocarcinoma appropriate treatment or vomiting of pregnancy after improvement, restoring normal thyroid function. Toxic nodular goiter patients without autoimmune manifestations, Without Graves's disease circulating antibodies. Finally, and Graves's disease in contrast, toxic nodule and multiple nodular goiter usually cannot alleviate. Thyroid crisis characteristics appear suddenly hyperthyroidism symptoms, accompanied by some of the symptoms of exacerbation and atypical symptoms, including fever, significant weakness, muscle wasting, extreme discomfort with emotional abnormality, confusion, mental illness, and even coma; hepatomegaly with jaundice. Patients can present with cardiovascular collapse and shock. Hyperthyroidism crisis is rare in children, due to untreated or inadequately treated, due to infection, trauma, surgical operation, thrombosis, diabetes, acidosis, toxemia of pregnancy or the production of hair hyperthyroidism crisis is a life-threatening emergency, needs immediate and special treatment ( table 8-3 ). In hyperthyroid patients serum T3 increased significantly more often than T4, probably because of increased secretion of thyroid T3, added peripheral T4 to T3 conversion. Some patients only increased the T3, called T3 thyrotoxicosis. T 3 visible to any cause of thyrotoxicosis hyperthyroidism, including Graves disease, multiple nodular goiter and autonomic function of solitary thyroid nodule. As of T3 thyrotoxicosis is not treated, the patient often develop into typical hyperthyroidism laboratory abnormalities , T4 and 123I draw increased. This tip T3 thyrotoxicosis hyperthyroidism is generally performed early, should also be treated. The diagnosis of hyperthyroidism diagnosis generally easy to clear, according to a detailed history and physical examination and suspicious of the high index and normal thyroid function tests. Serum TSH is the best choice for the test, because TSH is always suppressed in patients with hyperthyroidism, unless the etiology is TSH secreting pituitary tumors or pituitary resistance to thyroid hormone . Followed by the measurement of FT4, such as normal, should be measured 杭州看甲亢哪个医院最好 serum T3. Laboratory examination is clear, the main cause of hyperthyroidism can often be diagnosed clinically. However, etiology is not always obvious, there are further indications. Identification of etiology of hyperthyroidism is a way of thyroid radioactive 123I absorb almost all because of high producing hormones in patients with hyperthyroidism, thyroid radioactive iodine absorb all increased. T 3 virus disease diagnosis is difficult, because the assessment of thyroid function is usually not measured T3, unless the TSH inhibition and normal FT4 levels. Established diagnostic criteria are: ( 1) mild symptoms; ( 2) normal FT4; and ( 3 ) TSH inhibition in Graves's disease can be - - Determination of resistance to thyroid TSH receptor antibodies, through the replacement of thyroid cell membrane 125I labeled TSH or excited culture thyroid cells produce (a cAMP Gland excited antibody test ) .TSH receptor antibody determination rarely necessary, except for the last 3 months of pregnancy may predict the occurrence of neonatal TSH receptor antibodies in Graves's disease, easily through the placenta, fetal thyroid. Although excited during antithyroid drug therapy for Graves's disease in remission at the time, this antibody reduces, but the method used for prediction of rare disease remission. Most of Graves patients with circulating anti-thyroid peroxidase antibodies and a few have antiglobulin antibody. Because these antibodies in most laboratories have determined, thus help to determine whether an autoimmune hyperthyroidism is caused by inappropriate secretion of TSH rare, when Hyperthyroidism Accompanied by FT4 and T3 concentration increased and normal or elevated serum TSH levels, the diagnosis can be established. During scanning, single " hot " all 123I and thyroid nodules by remaining portion is inhibited, and multiple regional draw 123I increases and decreases in multinodular goiter patients. Treatment of hyperthyroidism treatment depends on the etiology. Iodine pharmacological doses of iodine hours after inhibition of T4 and T3 release and iodine organification, fleeting effects of continuous a few hours to 1 week ( escape phenomenon ). Iodine for thyroid crisis emergency treatment, hyperthyroidism patients The emergency of thyroid surgery operation and hyperthyroidism patients undergoing subtotal resection preoperative preparation (due to reduce thyroid vessels ) . General dose of saturated potassium iodide solution 2~3 drops 3 times a day or 4 oral ( 300~600mg/d ) or 0.5g Nai add 0.9% saline 1L, every 12 hours 1 slow intravenous infusion. Iodine treatment complications include salivary gland inflammation, scleritis, rash. Furthermore, non toxic nodular goiter patients with iodine drugs and contrast agents can induce transient hyperthyroidism ( Jod-Basedow disease ) . Conversely, thyroid operation rapid preparation of the patient, when the standard method of failure after using the following method. Bile shadow amidine sodium and iopanoic acid containing large amounts of iodine, is the T4 to T3 transition powerful inhibitor and dexamethasone combination can be used within a week to alleviate symptoms of thyrotoxicosis, the plasma T3 returned to normal. Propylthiouracil and methimazole ( methimazole ) is to reduce iodine organification, damage coupling reactions to antithyroid drugs. Although reports are a, but any kind of medicine interrupt after 1~2 years, 16%~40% Graves's disease appears to still can alleviate. Thyroid volume returned to normal or decreased, TSH back to normal before treatment 杭州看甲亢哪家医院好of Graves's disease mild hyperthyroidism is long-term remission for good prognosis body Syndrome with antithyroid drugs and LT4 can improve the remission rate of Graves disease is controversial . Because of toxic nodular goiter rare can ease, so the antithyroid drug therapy alone as surgical treatment or 131I treatment readiness. Propylthiouracil (but not methimazole ) large doses of the same inhibition of peripheral T4 to T3 conversion, propylthiouracil starting doses of general 100~150mg every 8 hours 1 or methimazole 15~30mg/d oral. When patients with normal thyroid function, can be reduced to the minimum effective dose, usually 100~150mg/d 2~3 oral propylthiouracil and methimazole 10~15mg/d. general 3 months can gain full control . To quickly control by propylthiouracil 450~600mg/d. this dose or larger dose (800~1200mg/d ) generally only for severe hyperthyroidism, including thyroid crisis in patients. Maintenance dose according to the clinical situation can last for 1 years or more. With flat and used widely in Europe, the body rapidly into methimazole. Commonly used doses similar to methimazole, maintenance dose of 10~15mg/d. these drugs side effects include allergy, nausea, loss of taste, 1% patients had a reversible agranulocytosis. If the patient is on a drug allergy, can change to another Kind of medicine, but when there is cross immune reaction . If agranulocytosis, do not advocate the replacement of medication, can turn to the radical therapies, such as surgery or radioiodine. It's hard to say what