课件：内分泌总论甲亢英文廖二元.ppt

F. Complications a. cardiopathy and heart failure thyrotoxicosis ,arrhythmia, heart enlargement and heart failure, and all disappeared after treatment b. Thyrotoxic crisis symptoms and signs exaggerated abruptly precipitating factors: infection, trauma, surgery radiation thyroiditis, DKA, parturtion Additional pictures: arrhythmias, pulmonary edema, congestive heart failure, restlessness, delirium, nausea, vomiting, abdominal pain, apathy, stupor, coma, hypotension, shock, etc. c. hypokalemic periodic paralysis more common in Asia abruptly paralysis with hypokalemia precipitated by dextrose, oral carbohydrate or vigorous exercise. attacks last 7-27 hrs. some companied by myasthenia gravis. A. Serum TH and TSH a. FT3 and FT4 b. TT3 and TT4 c. rT3 d. TSH B. TSH receptor antibodies Laboratory and Special Exams C. TRH stimulation test euthyroid Graves ophthalmopathy GD medication D. 131I uptake and T3 suppression test E. pathological exams A. Functional diagnosis GD suspected: (1)weight loss; (2)slight fever; (3)diarrhea; (4)tachycardia; (5)atrial fibrillation; (6)fatigue; (7)dysmenorrhea; (8)with difficult in control of DM, TB, heart failure, CHD, liver disease Diagnosis and Differential Diagnosis B. Types FT3 、FT4 , sTSH (uTSH) : hyperthyroidism FT3(orTT3) , FT4(TT4) normal, sTSH : T3 hyperthyroidism FT4(orTT4) , FT3 (TT3) normal, sTSH : T4 hyperthyroidism FT3 and FT4 (ab)normal, sTSH : subclinical hyperthyroidism C. Pathogenic diagnosis TRAb, TgAb, TPOAb, HCG, 131I uptake, TSH A. General management rest enough, energy and nutrients supplement, sedatives for restlessness and insomnia. B. Management of hyperthyroidism a. medical antithyroid agents: methylthiouracil (MTU) or propylthiouracil (PTU) 300~600mg/d methimazole (MM) or carbimazole (CMZ) 30~60mg/d Treatment b. dosage and course 1st stage (ca.6