MindMap Gallery Hyperthyroidism and hypothyroidism
This is a mind map about hyperthyroidism and hypothyroidism, summarizing the pathogenesis, clinical manifestations, Special clinical manifestations and types, laboratory tests, diagnosis, Treatment etc.
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This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about the reproductive development of animals, and its main contents include: insects, frogs, birds, sexual reproduction, and asexual reproduction. The summary is comprehensive and meticulous, suitable as review materials.
Hyperthyroidism and hypothyroidism
Hyperthyroidism (thyrotoxicosis)
concept
Hyperthyroidism
Caused by the thyroid gland itself producing too much thyroid hormone
Diffuse toxic goiter (graves' disease) → most common cause
Basic causes: genetic susceptibility and autoimmune abnormalities
nodular toxic goiter
Autonomous hyperfunctioning thyroid adenoma
Pathogenesis
Graves' disease (common autoimmune features include)
Presence of autoantibodies against thyroid gland in serum
Peroxidase antibody TPOAB
Thyroglobulin antibody TgAB
Distinct humoral features of graves syndrome→TSH receptor antibodies (TRAB)
Thyroid stimulating antibody TSAB (TRAB subtype)
Pathogenic antibodies for hyperthyroidism in graves disease
Thyroid stimulating antibody TSAB competes with TSH for binding to the TSH receptor (TSHR)
Overproduction of thyroid hormones (T3/T4↑)
TSH↓
Thyroid stimulating blocking antibody TSBAB (TRAB subtype)
Block the binding of TSH to TSHR
Hypothyroidism
Different degrees of lymphatic infiltration in the thyroid gland
Presence of circulating and thyroid T cells directed against thyroid antigens
★The significance of autoantibodies
Thyroid stimulating blocking antibody TSBAB
Blocks thyroid hormone production
Thyroid stimulating antibody TSAB
Stimulate thyroid hormone production
★T3/T4 rises, TSH falls
clinical manifestations
clinical manifestations
Caused by too much circulating thyroid hormone
May be accompanied by periodic paralysis (without muscle atrophy)
Frequently manifests weakness in lower limbs
Acute hyperthyroidism myopathy (with muscle atrophy)
physical signs
Most patients have varying degrees of thyroid enlargement
diffuse
Texture medium
No tenderness
Tremors and vascular murmurs can be palpated in the upper and lower levels of the thyroid gland
Autonomous hyperfunctioning thyroid adenoma with palpable solitary nodule
Eye manifestations
Simple bulging eyes
Mild proptosis of the eyeball/widening of the eye fissures
infiltrative bulging eye
The eyeball is obviously protruding → more than 3mm
graves manifest as → symmetrical diffuse enlargement with vascular murmur and tremor
Special clinical manifestations and types
Graves' ophthalmopathy (thyroid-related eye disease) (infiltrative bulging eye)
Retroorbital lymphocyte infiltration → Fibrocytes secrete large amounts of mucopolysaccharide deposition → Lead to extraocular muscle damage
Lymphocyte infiltration can be seen in the extraocular muscle tissue → mainly T cells
clinical manifestations
More common in men
Invasion of retroorbital extraocular muscles
There is a foreign body sensation in the eye
Pretibial myxedema
Multiple lower 3/1 parts of tibia
Skin lesions are mostly symmetrical
Thyroid storm (large amounts of thyroid hormone entering the circulation)
Cause (thyroid hormone enters circulation in large amounts)
More common in patients with severe hyperthyroidism and incomplete treatment
Performance
Infection/surgery/trauma
High fever/profuse sweating/tachycardia (heart rate >140 beats/min)
Increased white blood cells and neutrophils (thyroid storm is a stress emergency)
thyrotoxicosis heart disease
Has three effects on the heart
Enhance cardiac beta receptor sensitivity to catecholamines
Directly acts on myocardial contractile protein → enhances myocardial inotropic effect
Secondary thyroid hormone leads to peripheral vasodilation → cardiac output compensation↑
Apathetic hyperthyroidism
More common in the elderly, with insidious onset (prone to thyroid storm)
Symptoms of hypermetabolism are not obvious, and bulging eyes are not obvious
Obvious weight loss/palpitations/apathy
laboratory tests
thyroid stimulating hormone TSH
The most sensitive indicator of thyroid function
Serum free thyroid hormone FT4/FT3
Main indicators for diagnosing clinical hyperthyroidism
The preferred examination for the diagnosis of hyperthyroidism: TSH decrease, FT3/FT4 increase
★Sensitivity TSH>FT3>FT4>TT4
Thyroid radionuclide scan
Mainly used for differential diagnosis of hyperthyroidism
Diagnostic Criteria for Autonomous Hyperfunctioning Thyroid Adenoma
★Blood T3T4 is not helpful in diagnosing hyperthyroidism
diagnosis
Diagnosis of hyperthyroidism
Hypermetabolic symptoms and signs
Increased serum thyroid hormone/lowered TSH
Graves' disease diagnosis
Diffuse thyroid enlargement
proptosis
Pretibial myxedema
Trab/TPoab positive
treat
radioactive iodine
Destroy thyroid tissue → reduce thyroid hormone production (iodine 131 is absorbed by the thyroid gland and releases reflection rays to destroy the tissue)
★It is radioactive and cannot be used for a long time.
★Selective destruction of thyroid tissue
Indications
Goiter greater than second degree (3rd degree)
Allergy to antithyroid drugs/relapse after treatment with antithyroid drugs
Hyperthyroidism combined with heart disease
Hyperthyroidism with leukopenia/liver and kidney damage
Adverse reactions
Hypothyroidism
subtopic
★Measure the iodine 131 intake rate before use
Antithyroid drugs ATD (thiosulfonamides)
Classification
Thioureas
imidazoles
mechanism
Inhibit thyroxine synthesis
★The mechanism of iodine is to inhibit the release of thyroxine ≠ iodine 131
Indications
Mild to moderate illness
Mild to moderate thyroid enlargement
Pregnant women/elderly people are not suitable for surgery
Adverse reactions
Most severe (agranulocytosis) (leukopenia)
Glucocorticoids
Can only be used in thyroid storm
No need for ordinary hyperthyroidism
Surgical treatment
Indications
Significant enlargement of the thyroid gland with symptoms of compression
Unable to insist on taking medicine
retrosternal goiter
Suspected thyroid cancer/malignant transformation
technique
Subtotal thyroidectomy after oral iodine solution
Contraindications
Combined with severe heart/liver and kidney disease
Miscarriage and malformation are prone to occur in 1st to 3rd/7th to 9th month of pregnancy
iodine agent
Compound sodium iodide solution (only used before surgery and in thyroid storm)
Beta blockers (propranolol)
Block the excitatory effects of thyroid hormone on the heart
Block the conversion of T4 to T3
Hypothyroidism
Overview
Hypokalemia or thyroid hormone resistance due to various causes
Pathological mechanism
Mucopolysaccharide accumulation in tissues and skin (myxedema)
Classification
primary hypothyroidism
Hypothyroidism caused by lesions of the thyroid gland itself
self-immune
thyroid surgery
Iodine 131 treatment
central hypothyroidism
Lesions of the hypothalamus and pituitary gland result in → decreased secretion of thyrotropin-releasing hormone (TRH)/thyroid-stimulating hormone (TSH)
thyroid hormone resistance syndrome
clinical manifestations
clinical manifestations
low metabolic rate
low sympathetic nervous system
Physical examination
dull expression
Facial eyelid edema
thick lips, big tongue
Thinning and dry hair
laboratory tests
Increased serum TSH (earliest test result) (earliest change)
TT4 and FT4 reduced
★T3/T4 cannot be used as an indicator (T4 is more sensitive than T3)
If it is hyperthyroidism (T3 is more sensitive than T4)