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1、HyperthyroidismDepartmentofendocrinologyandmetabolismRenjiHospitalHyperthyroidismDefinition:Aclinicalsyndromeisbroughtaboutbythyroidhormoneoverproductionofvariouscauses.T4,T3-TBG------------FT4,FT3receptorTSHCNSinputTRHthyroidhypothalamuspituitaryTargettissueTargetcellFT4FT3TSHTHYROID

2、pituitaryClassificationofhyperthyroidismAbnormalthyroidstimulatorFT3,FT4AdenomaResistancetoT3,T4Greaves’deseaseTSITSHanalogHCGtumorTHYROIDClassificationofhyperthyroidismDiffusetoxicgoiterHyperfunctionadenomaToxicmultinodulargoiterToxicadenoma(Plummer’sdisease)CarcinomaSubacutethyroid

3、itisChronicthyroiditisFT3,FT4ExtrathyroidsourceofhormonetransientthyrotoxicosisDisorderofstorageThyroiddestructionIod-Basedow’sdiseaseExcessiodideGraves'diseaseThyroidhormoneoverproductionAutoImmune(TSI-TSH-RAb)mediatedGraves'diseaseFeaturedas:HyperthyroidismAutoimmunemediatedDiffusegoit

4、erExophthalmosPretibialmyexedemaHLA-DR3geneticfactorsInfectionEnvironmentalriskfactordefectinimmunoregulationwithfailureof“suppressor”Tlymocytphesfunction.allowing“helper”TlymocytphestostimulateBlymphocytestoproduceTSHreceptorantibodies(TRAb)Thyroid-stimulatingantibody(TSAb)Thyroid-stimu

5、latingblockingantibody(TSBAb)EtiologyAndPathogenesis-autoimmunediseasementalfactorsGraves'diseaseThyroidmanifestationsofGraves'diseasediffusetoxicgoiterExtrathyroidalmanifestationsofGraves'diseaseOphthalmopathyDermopathyBeimmunologicallymediatedactivationoffibroblastsintheextraocularmusc

6、lesandskin,withaccumulationofglycosaminoglycans,leadingtothetrappingofwaterandedema.Later,fibrosisbecomesprominentThefibroblastactivationiscausedbycytokinesderivedfromlocallyinfiltratingTcellsandmacrophages.ClinicalManifestationsHyperthyroidism-commontoanycauseofthyrotoxicosisAutoimmunem

7、ediated-specificforGraves'diseaseDiffusegoiterExophthalmosPretibialmyexedemaClinicalManifestationsTheclinicalpresentationdependsontheseverityofthyrotoxicosis,thedurationofthedisease,individualsusceptibilitytoexcessthyroidhormone,andtheageofthepatient.Symptomsofhypermetabo