Hyperthyroidism face

Introduction Facial muscles are thin, eyeballs are prominent, eyes are shining with a frightened expression, eye cracks are enlarged and less blinking, and performances accompanied by anxiety, irritability and irritability are common in patients with exophthalmia hyperthyroidism. Expressed as a horrified face, it is very horrified by the small sounds of the outside world, and the eyeballs are protruding, similar to the goldfish eyes; excited, irritated and irritable. This is a typical manifestation of hyperthyroidism.

Cause

Common in patients with exophthalmia hyperthyroidism.

Predisposing factors:

The induction of hyperthyroidism is closely related to autoimmune, genetic and environmental factors, among which autoimmune factors are the most important. Unfortunately, the development of thyroid autoimmunity and the development process have not been known so far, so it is difficult to find a preventive method.

Genetic factors are also important, but the genetic background and genetic approach have not been elucidated, so it is difficult to prevent them genetically.

Environmental factors mainly include various factors that induce the onset of hyperthyroidism, such as trauma, mental stimulation, infection, etc. Although the induction of many hyperthyroidism is mainly related to autoimmunity and genetic factors, it is closely related to environmental factors. If you encounter predisposing factors, you will not develop the disease. It can be seen that the onset of some hyperthyroidism patients may be prevented under the condition of avoiding the predisposing factors.

(1) Infection: such as a cold, tonsillitis, pneumonia, etc.

(2) Trauma: such as car accidents, trauma, etc.

(3) Mental stimulation: such as mental stress, anxiety and so on.

(4) Excessive fatigue: such as overwork.

(5) Pregnancy: Hyperthyroidism may be induced or aggravated in early pregnancy.

(6) Excessive iodine intake: such as eating seaweed and other seafood.

(7) Certain drugs: such as amiodarone.

an examination

Related inspection

Basal gastric secretion, basal metabolism, erythrocyte acetylcholinesterase, facial expression, cerebrospinal fluid, cyclic guanosine

Expressed as a horrified face, it is very horrified by the small sounds of the outside world; the eyeballs are protruding, similar to the goldfish eyes, excited, irritated and irritable. This is a typical manifestation of hyperthyroidism.

1, serum free thyroxine (FT4) and free triiodothyronine (FT3) FT3, FT4 is the active part of circulating blood thyroid hormone, it is not affected by changes in blood TBG, directly respond to thyroid function status. It has been widely used in clinical practice in recent years, and its sensitivity and specificity are significantly higher than total T3 (TT3), total T4 ((TT4), normal value FT4 9-25 pmol/L; FT33-9 pmol/L (RIA), each experiment There are certain differences in room standards.

2, serum thyroxine (TT4), is the most basic screening index for judging thyroid function, more than 99.95% of serum T4 and protein binding, of which 80% -90% combined with globulin called thyroxine-binding globulin (TBG) TT4 refers to the total amount of T4 binding to protein, which is affected by the amount of binding protein and binding force such as TBG; TBG is also affected by factors such as pregnancy, estrogen and viral hepatitis, and is affected by androgen and low protein blood. Symptoms (severe liver disease, nephrotic syndrome), prednisone and other effects decreased. Care must be taken when analyzing.

3, serum total triiodothyronine (TT3) serum T3 and protein binding more than 99.5%, also affected by TBG, TT3 concentration changes often parallel with TT4 changes, but the early recurrence of hyperthyroidism, TT3 rise It is often very fast, about 4 times normal, TT4 rises slowly, only 2.5 times normal, so TT3 is a sensitive indicator for the diagnosis of the disease; for the beginning of the disease, the efficacy of the treatment and the recurrence of the recurrence It is more sensitive, especially for the diagnosis of T3 hyperthyroidism to obtain specific indicators. It should be noted that the elderly patients with apathetic hyperthyroidism or chronic disease TT3 may not be high.

4, serum anti-T3 (revrseT3, rT3) rT3 no biological activity, is the degradation product of T4 in peripheral tissues, its blood concentration changes with T4, T3 maintain a certain proportion, especially consistent with T4 changes, can also be used to understand the thyroid Functional indicators, some of the early stage of the disease or early relapse only rT3 increased as a more sensitive indicator. In severe malnutrition or certain systemic disease states, rT3 is significantly elevated, while TT3 is significantly reduced, which is an important indicator for the diagnosis of low T3 syndrome.

5. TSH immunoradiometric assay (sTSH IRMA) The sTSH level in the normal blood circulation is 0.4-3.0 or 0.6-4.0 IU/ml. Using IRMA technology to detect the lower limit of normal level, the minimum detection value of this method is generally 0.03IU/ml, which has high sensitivity, so it is also called sTSH ("sensitive" TSH). Widely used in the diagnosis and treatment monitoring of hyperthyroidism and hypothyroidism.

6, thyroid hormone releasing hormone (TRH) stimulation test hyperthyroidism serum T4, T3 increased, feedback inhibition of TSH, so TSH is not excited by TRH, such as intravenous TSH200G TSH increased, can rule out the disease; such as TSH does not increase (no Reaction) supports the diagnosis of hyperthyroidism. It should be noted that the increase of TSH can also be seen in Graves' ophthalmopathy with normal thyroid function, pituitary lesions and insufficient secretion of TSH. The side effects of this test are few, and it is safer for patients with coronary heart disease or hyperthyroidism than T3 inhibition test.

7, thyroid 131I rate of this method for the diagnosis of hyperthyroidism with a rate of 90%, iodine-deficient goiter can also be elevated, but generally no peak forward, can be used for T3 inhibition test identification, this method can not reflect the severity of the disease and Changes in the condition of the treatment, but can be used to identify hyperthyroidism of different causes, such as low 131I rate may be thyroiditis with hyperthyroidism, iodothyroid or exogenous hormone caused by hyperthyroidism. It should be noted that this law is affected by a variety of foods and iodine-containing drugs, including traditional Chinese medicines, such as anti-thyroid contraceptives, which should be stopped for more than 1-2 months before the measurement, and disabled during pregnancy and lactation. . Normal value: measured by Geiger counter tube, the values of 3 and 24 h were 5%-25% and 20%-45%, respectively, and the peak appeared at 24h. Hyperthyroidism: 3h>25%, 24h>45%: and the peak shifts forward.

8, triiodothyronine inhibition test referred to as T3 inhibition test. Used to identify goiter with a 131I rate increase caused by hyperthyroidism or simple goiter. Methods: First, take the basic 131I rate, oral, T320g, 3 times a day for 6 days (or oral dry thyroid tablets 60mg, 3 times a day, even for 8d, then take 131I rate. Compare the two results, normal The rate of 131I in patients with simple goiter is more than 50%, and the rate of 131I in patients with hyperthyroidism can not be suppressed. The rate of 131I is less than 50%. This method is forbidden for those with coronary heart disease or hyperthyroidism, so as not to induce arrhythmia or angina. .

9, thyroid stimulating antibody (TSAb) determination of GD patients with blood TSAb positive detection rate of up to 80% -95%, the disease not only has early diagnostic significance, it is also valuable for judging disease activity, whether it is recurring, but also as An important indicator of treatment discontinuation.

Differential diagnosis

Differential diagnosis of hyperthyroidism:

1, acute face: face flushing, happy and uneasy, expression pain, is an acute fever, such as lobar pneumonia, malaria and other performance.

2, bitter smile face: tetanus is caused by the toxins of Clostridium tetani to the nervous system syndrome. Patients with local or systemic muscles or tonic spasm, often affected by facial and neck muscles, closed jaws and "smiley face".

3, scarlet hot face: the face of the person, not only the "stage" of the seven emotions, but also the "window" reflecting the diseases in the body. Therefore, it is an important and simple method to detect diseases in the early stage. Scarlet hot face: facial congestion and redness, the skin color around the nose and mouth is obviously pale.

4, chronic face: face gray or pale, face stunned, gaze. Common in chronic wasting diseases, such as cirrhosis, malignant tumors, severe tuberculosis.

5, measles face: two eyes are red and afraid of light, increased secretions in the eyes, nasal obstruction, accompanied by fever and cough.

6, anemia face: pale and dull, eyelids, lips and tongue light, expression tired and weak.

7, dementia face: head large neck short, small eye cracks, wide nose, flat nose, hypertrophy of the nose, thick tongue and often stretch out of the mouth, common in patients with small patients.

8, typhoid face: apathy, slow response, showing no desire. Mostly, the face of patients with high fever and fever, such as typhoid fever, encephalitis, and meningitis.

9, cachexia quality face: face is extremely thin, pale complexion, skin elasticity is poor, more common in patients with chronic wasting diseases, such as tuberculosis, advanced cancer and so on.

10, scarlet hot face: facial congestion and redness, the skin around the nose and mouth is obviously pale.

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