Adolescent hyperthyroidism

Introduction Hyperthyroidism is a common autoimmune disease in the endocrine system, referred to as hyperthyroidism. The cause of hyperthyroidism has not yet been fully understood. The known factor is that the thyroid gland secretes excessive thyroid hormone, causing hypermetabolism, nervous and mental excitement, and the process of oxidation in the body is accelerated to form an autoimmune disease. Hyperthyroidism has a long course of disease and is prone to recurrence. Traditional treatments use yin and yang, reduce qi and phlegm, and replenish qi and nourish yin to control the disease. It has the effect of relieving symptoms and improving the recovery.

Cause

Hyperthyroidism, commonly known as "hyperthyroidism", is a disease in which thyroid function is excessively active. Hyperthyroidism is also known as Graves' disease or toxic diffuse goiter.

It is an autoimmune disease, and its clinical manifestations are not limited to the thyroid gland, but a multi-system syndrome, including: high metabolic syndrome, diffuse goiter, eye signs, skin lesions and thyroid extremity.

Most patients have both high metabolic syndrome and goiter. In addition to the thyroid, invasive endocrine exophthalmos can be present alone without hypermetabolic disease.

Hyperthyroidism (hyperthyroidism) refers to thyrotoxicosis caused by the disease of the thyroid itself. The cause is mainly diffuse toxic goiter (Graves disease), multinodular gonads and thyroid autonomic function. Adenoma (Plummer disease).

According to the causes of hyperthyroidism, it can be divided into three categories: primary, secondary and high-function adenoma.

1 Primary hyperthyroidism is the most common, which means hypercapnia, accompanied by hyperfunction. The patient is between 20 and 40 years old. The gland enlargement is diffuse, bilaterally symmetrical, often accompanied by eyeball protrusion, so it is also called "exophthalmetic goiter."

2 secondary hyperthyroidism is less common, such as hyperthyroidism secondary to nodular goiter; patients have nodular goiter for many years, and later symptoms of hyperactivity. The age of onset is more than 40 years old. The gland is nodular and swollen, with multiple asymmetry on both sides, no eyeballs protruding, and prone to myocardial damage.

3 high-functioning adenoma, rare, a single spontaneous autonomic nodule in the thyroid, thyroid tissue around the nodule atrophy changes. The patient has no eyeballs protruding.

an examination

Related inspection

Basal metabolism serum total thyroxine (TT4) total triiodothyronine (TT3) urinary cyclic guanosine urinary protein

Mainly rely on typical clinical manifestations, sometimes combined with some special tests. The special inspection methods commonly used for hyperthyroidism are as follows:

1. The basal metabolic rate can be determined based on pulse pressure and pulse rate, or measured using a basic metabolic stringer. The latter is more reliable, but the former is simple. The commonly used calculation formula is: basal metabolic rate = (pulse rate + pulse pressure) - 111. The basal metabolic rate is measured at a completely quiet, fasting time. The normal value is ±10%; the increase to +20% - 30% is mild hyperthyroidism / 30% - 60% is moderate, and more than 60% is severe.

2. Determination of 131 iodine rate in thyroid gland The amount of 131 taken in normal thyroid within 24 hours is 30% to 40% of the total body. If the amount of 131 iodine in the thyroid gland exceeds 25% of the total human body within 2 hours, or exceeds 50% of the total body volume within 14 hours, and the 131 iodine peak appears in advance, the hyperthyroidism can be diagnosed.

3. Determination of T3 and T4 in serum In the case of hyperthyroidism, serum T3 can be about 4 times higher than normal, and T4 is only 2 times half of normal. Therefore, T3 determination has high sensitivity to the diagnosis of hyperthyroidism.

Differential diagnosis

1, simple goiter: goiter, but no hyperthyroidism, all kinds of thyroid function tests are within the normal range.

2, neurosis: mental neurosis is similar to hyperthyroidism, but there is no hyperthyroidism of hyperthyroidism, appetite is not hyperthyroidism, the hands are flat and tremor, the pulse rate is normal without goiter and eye signs, thyroid function test is normal.

3, other causes of hyperthyroidism: such as pituitary hyperthyroidism, autoimmune thyroiditis, subacute thyroiditis, heterologous TSH hyperthyroidism, etc., can be identified by the corresponding special examination.

4, other: weight loss, low heat must be identified with tuberculosis, cancer. Diarrhea must be differentiated from chronic colitis. Arrhythmia must be differentiated from rheumatic heart disease, myocarditis, and coronary heart disease. Unilateral exophthalmos must be differentiated from tumors in the orbit.

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