Thyrotoxicosis: refers to a clinical syndrome mainly characterized by increased excitability and hypermetabolism in the nervous, circulatory, digestive and other systems caused by excessive TH in the blood circulation.

Hyperthyroidism: referred to as hyperthyroidism, is a thyrotoxicosis caused by excessive secretion of T due to increased thyroid function due to various reasons. It is characterized by enlargement of the thyroid gland, eye signs, increased basal metabolism, and dysfunction of the nervous system. . More common in women

TSH receptor antibody (TSAb): the pathogenic antibody of GD

genetics

Environment: infection, stress, sadness, etc.

hypermetabolic syndrome

goiter

Eye signs

Nervous system: increased central nervous system excitability, irritability, insomnia

Cardiovascular System

Digestive system: increased appetite, weight loss

musculoskeletal system

Reproductive system: reduced menstruation or amenorrhea, erectile dysfunction, and breast development

Blood system: white blood cells ↓, lymphocytes ↑ monocytes ↑, platelets shortened life span

Skin, hair and extremities

thyroid storm

General treatment: rest, eat properly

drug

Surgical treatment

Rest and activity: Increase the rest time appropriately, ensure adequate sleep, and do activities without fatigue; when the condition is severe, accompanied by heart failure or serious infection, strict bed rest should be performed.

Environment: The ward environment is quiet, well ventilated, and slightly dark. Use air conditioning in summer to maintain a comfortable temperature and humidity; avoid noise and reduce Take a deep look at people.

Diet care: high-calorie, high-protein, high-vitamin diet, rich in minerals and low-fiber diet. Avoid cold, greasy food, and avoid irritating food and drinks, such as alcohol, strong tea, coffee, etc., to avoid arousing the patient's mental excitement and aggravating the symptoms. Avoid foods containing iodine, such as seafood. Those with impaired glucose tolerance or combined with diabetes should be given a diabetic diet and pay attention to changes in blood sugar; those with severe exophthalmos should limit water intake

Eye care: When sleeping or resting, lie down with a high pillow and cover your eyes with saline-wet gauze; wear dark glasses or eye masks when going out; limit water during salt surges. If the eyelids are severe and the eyelids cannot be closed, follow the doctor's advice to use diuretics, eye drops during the day, and eye ointments during sleep at night.

Observe the patient's mental state, pay attention to changes in body temperature, breathing, pulse, blood pressure, and weight, and pay attention to the nausea and vomiting of the fingers. Clinical manifestations such as diarrhea, pay attention to the degree of exophthalmos and goiter, and understand the protection and medication of exophthalmos. Be alert to the occurrence of thyroid storm and report to your doctor immediately

1. Antithyroid drugs ① Instruct patients to take drugs on time and in regular amounts: the total course of antithyroid drug treatment is generally more than 1.5 years. Do not reduce or stop taking it on your own.

Adverse reactions: The main adverse reactions are leukopenia and drug rash in the first 1 to 2 months of taking the drug. In severe cases, granulocytopenia and exfoliative dermatitis may occur. Therefore, it is very important to follow up the total number and classification of white blood cells regularly, especially in the first 2 to 3 months, it should be checked once a week, and then every 2 to 4 weeks. (If the total number of white blood cells is lower than 4.0×10°/L, attention should be paid to observe whether there are signs of infection, and leukocyte-increasing drugs should be added, such as rexexine, vitamin B, etc. If the white blood cells are lower than 3.0×10°/L or neutral If the granulocytosis is lower than 1.5x10°/L, the drug should be temporarily stopped, closely observed, and protective isolation should be carried out to prevent cross-infection). Once agranulocytosis is confirmed, it must be isolated and emergency rescued, and other treatment methods should be used after recovery. For mild drug rash, antihistamines are given to make the rash subside, and generally there is no need to stop the drug. If the drug rash is severe, the drug should be discontinued and other antithyroid drugs should be used. If exfoliative dermatitis occurs, the drug should be discontinued immediately.

Observe the efficacy: Regularly review the blood picture and thyroid function. Weight gain is an indicator of the effectiveness of the treatment. Once symptoms recur, seek medical attention promptly.

During propranolol administration, attention must be paid to observing the heart rate to prevent bradycardia.

1. Avoid triggers: guide patients to adjust themselves psychologically and avoid infection, mental stimulation, trauma and other triggering factors.

Monitor the condition and observe changes in vital signs and mental state. In particular, it is necessary to closely monitor changes in body temperature and heart rate, and pay attention to serious complications such as heart failure, arrhythmia, and shock.

Emergency handling cooperation

Symptomatic care a. For patients with high fever, physical cooling such as ice compresses or alcohol baths and/or drug cooling (promethazine and pethidine) are used. Aspirin is prohibited. Use bed rails to protect agitated patients. Enhance skin and oral care for comatose patients and turn over regularly to prevent pressure sores and pneumonia.

Disease knowledge

Medication and monitoring: Take the medicine according to the dose and course of treatment. Do not stop the medicine or stop the dosage at will. Check your pulse by yourself in the morning and measure your weight regularly.

Fertility: Pregnancy after cure, use PTU that does not pass through the placenta. Breastfeeding is not suitable.

The FT3 indicators of triiodothyronine have all increased, making it the first choice, FSH↓ GD diagnosis basis: hyperthyroidism diagnosis established, diffuse thyroid enlargement Serum total thyroid TT4: the most basic screening indicator for judging thyroid function Thyroid-stimulating hormone TSH measurement: a sensitive indicator reflecting the function of the hypothalamus-pituitary-thyroid axis TSAb measurement: It is one of the important indicators for diagnosing GD. It can also be used as a treatment discontinuation indicator to determine disease activity and recurrence.