Diffuse toxic goiter [Graves' disease-GD disease]

nodular toxic goiter

Autonomous hyperfunctioning thyroid adenoma

Destructive thyrotoxicosis: (thyroiditis)

Taking exogenous thyroid hormone

① The presence of autoantibodies against the thyroid gland - TSH receptor antibody TRAb in the serum

②Different degrees of lymphocyte infiltration in the thyroid gland

③There are T cells targeting thyroid antigens in the circulation and thyroid gland

④Combined with type 1 diabetes, Adision disease, and SLE

Simple exophthalmos (cause: thyrotoxicosis → sympathetic nerve excitement)

Infiltrative exophthalmos (Graves' ophthalmopathy) - marked protrusion

44% had hyperthyroidism first and then exophthalmos

Pathological basis: retroorbital (primary T cells) lymphocyte infiltration, secretion of mucopolysaccharides and glycosaminoglycans → swelling and damage of extraocular muscles and fat → exophthalmos

condition assessment

treat:

Location: Symmetrical skin lesions on the lower 1/3 of the tibia

Character: Orange peel or bark-like

Pathology: Swelling of muscle tissue (accumulation of mucopolysaccharides in the extracellular matrix)

T lymphocyte infiltration

Occurs from: Untreated/inadequate treatment of hyperthyroidism

Clinical manifestations: high fever, sweating, tachycardia, irritability, anxiety, delirium, nausea, vomiting, diarrhea

treat:

High output heart failure atrial fibrillation

elderly

Clinical manifestations: obvious weight loss, palpitations, fatigue, dizziness, apathy, diarrhea, atrial fibrillation, no thyroid enlargement

More common in the elderly (T3>T4 produced by hyperthyroidism)

Experimental value check: TT3↑, FT3↑

Self-limited with hyperemesis gravidarum

treat

sTSH (sensitive TSH) is a first-line indicator for screening for hyperthyroidism

One of the main indicators

TT4 refers to the hormone that binds to the TBG protein (its measurement is affected by TBG)

TBG↑→TT4↑: pregnancy, estrogen, acute viral hepatitis

TBG↓→TT4↓: androgens, glucocorticoids, hypoalbuminemia

T3 has low amount and high function (converted from T4), T4 has high amount

Including FT3, FT4

Traditional methods of diagnosing hyperthyroidism

Mainly used to identify the cause of thyrotoxicosis

Hyperthyroidism → thyrotoxicosis: blood flow signal is enhanced and distributed in patches

GD: The homogeneous distribution of nuclides is enhanced

Nodular toxic goiter: the radionuclide distribution is uneven, and the enhanced and weakened areas are distributed in a focal shape

Autonomous high-functioning thyroid adenoma: radionuclide concentration only in the tumor area

Function: Inhibits thyroid hormone synthesis

Thioureas

imidazoles

Definition of remission in the treatment of hyperthyroidism: 1 year off medication, normal TSH and thyroid hormones

Discontinuation indicators: euthyroid and TRAb negative

50% recurrence rate

Agranulocytosis: If neutrophils are <1.5×10*9/L, the drug should be discontinued

rash

toxic liver disease

Vasculitis

Causes fetal skin dysplasia