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    Toxic multinodular goiter ( secondary hyperthyroidism, nodular hyperthyroidism)Toxic multinodular goiter: toxic multinodular goiter, also called nodular goiter with hyperthyroidism, nodular hyperthyroidism, Plummer disease, is a multinodular goiter based on the incidence of hyperthyroidism, usually occurring there has been many knot Book goiter patients. The general appearance of thyrotoxic symptoms at 40 甲状腺years of age or older, more toxic diffuse goiter in age of onset for female incidence was higher than the male. The disease most slow onset, illness are also lighter, and the symptoms of apparent early, easy to misdiagnosis or missed diagnosis, the need to go to the hospital examination to diagnosis system. Toxic multinodular goiter ( TOXICMULTINODULARGOI - TER ) it is also called secondary hyperthyroidism, is a multiple 杭州同济是国营还是私人医院 node thyroid based on the incidence of hyperthyroidism, hyperthyroidism before the occurrence of multiple nodular goiter often have existed for many years. Care should be taken to avoid the use of toxic nodular goiter is a term, because it includes toxic multinodular goiter, toxic thyroid adenoma two. In 1, the clinical manifestations: it occurs frequently in the existing multinodular goiter patients over the age of 50 years, female than male. The clinical manifestations and GRAVES disease is slightly different. The patient with multiple relatively slow onset, mild, often showed wasting, weakness.杭州同济同医院 A minority of patients due to taking the iodine and sudden hyperthyroidism. May be due to patients of older age, cardiovascular symptoms are common and prominent, prone to myocardial damage, including heartbeat tachycardia, atrial fibrillation, angina pectoris, may have heart failure, on digoxin treatment response is poor. Some patients may have thin, sweating, trembling. Neuropsychiatric symptoms are rare, but can have significant emotional lability, anxiety, insomnia. Goiter more serious, many on both sides of the asymmetry, often to the retrosternal extension, often causing compression symptoms, the thyroid can reach multiple nodules; patient without proptosis, eyelid retraction: but there can be no pretibial myxedema. If the patient has infiltrative exophthalmos, consideration should be given to GRAVES disease. In 2, and GRAVES compared tests: disease, toxic multinodular caused by excessive secretion of thyroid hormone levels often relatively minor, serum TT3, TT4 or FT3, FT4 levels increased slightly, especially for high normal serum T4. Thyroid uptake rate of 131 I did not significantly increase, its normal to. Reduction of TSH. T3 inhibition test or TRH stimulation test abnormalities, helps with non toxic multinodular goiter distinction: the former on elderly patients with heart dysfunction and more safety. Serum TRAB negative, but had low titer of TGAB and TMAB. Thyroid 131 I radioactive iodine scanning visible diffuse distribution is not uniform, or focus on a number of scattered nodules, extranodular thyroid tissue by inhibition of iodine absorption function. 3: for years, the diagnosis of nodular thyroid history in older patients, for wasting, weakness and unexplained cardiovascular system, such as atrial fibrillation, heartbeat tachycardia, angina and congestive heart failure, and the disease should be suspected of. Laboratory Determination of TT3, TT4 or T3, FT4 mildly elevated to a definitive diagnosis. 杭州同济堂医院 The diagnosis is in doubt when optional express TRH stimulation test or T3 inhibition test, both abnormalities, and diagnosis can be established. Thyroid 131 I scanning can provide morphological and functional information. Such as laboratory examination can make a definite diagnosis, and clinical suggestion of thyrotoxicosis performance, availability of antithyroid drugs for treatment trials. Thyroid adenoma in general there are two types : one is hyperthyroidism, thyroid scan revealed the tumor as a hot nodule ( radioisotope distribution concentration ), this condition is called toxic thyroid adenoma; another kind of circumstance is not caused by hyperthyroidism, thyroid scan revealed the adenoma is a warm nodule ( radioisotope distribution and normal thyroid histological similarity ) or cold nodule ( radioisotope distribution below the normal thyroid tissue ), this situation is called toxic thyroid adenoma, just a simple adenoma of thyroid. Toxic thyroid adenoma is due to the tumor enhancement, produce large amounts of thyroid hormones, thus a manifestation of thyrotoxicosis. Toxic thyroid adenoma in women, in 30 ~ 40 years old. Adenomas are usually single, a few more than 1. Patients with hyperthyroidism symptoms, physical examination can often be detected thyroid nodules, usually large, often up to several centimeters in size. Determination of serum T3, T4 levels were increased, T3 was higher obviously. The thyroid scanning confirmed sarcoidosis as a hot nodule, but the surrounding thyroid tissue radioisotope distributions are often absent or reduced. Nodular goiter in general there are two types : one is the normal thyroid function, no thyrotoxic manifestations; another is not normal thyroid function, occurrence of hyperthyroidism. Hyperthyroidism is often 杭州同济医院张建华in nodular goiter occurring after the onset of the. Incidence of hyperthyroidism goiter called toxic nodular goiter. This kind of hyperthyroidism in elderly people, also in females. Hyperthyroidism symptoms generally lighter, some patients only part of thyrotoxic symptoms, and other symptoms of lack or not obvious, such as the only manifestations of cardiac arrhythmia or heart failure; only display the weight, weight decreased significantly; only the performance of the whole body muscle weakness, to limb muscle weakness is more obvious; only display the psychomotor agitation, depression etc.. Check the body can be found in thyroid enlargement, as both sides symmetrical enlargement, and can reach a number of nodules, nodule size is dissimilar, generally no nystagmus and vascular murmur. Exophthalmos do not generally occur. Serum T3, T4 levels, of which a considerable part of the patient can only blood this news has a total of 2 page of 12