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'''Other''' (not included in hyperthyroidism)
'''Other''' (not included in hyperthyroidism)


* [[Thyroiditis]] - can cause transient thyrotoxicosis due to the disruption of thyroid follicles by inflammation and the release of stored hormones into the blood. Hypothyroidism usually occurs afterwards. Eg: [[Hashimoto's thyroiditis]], subacute granulomatous thyroiditis, subacute lymphocytic thyroiditis
*[[Thyroiditis]] - can cause transient thyrotoxicosis due to the disruption of thyroid follicles by inflammation and the release of stored hormones into the blood. Hypothyroidism usually occurs afterwards. Eg: [[Hashimoto's thyroiditis]], subacute granulomatous thyroiditis, subacute lymphocytic thyroiditis


* [[Ovarian goiter]] - ovarian [[teratoma]], producing thyroid hormones
*[[Ovarian goiter]] - ovarian [[teratoma]], producing thyroid hormones


* Thyreotoxicosis factitia - overdose of thyroid hormones or preparations with iodine (contrast agents, [http://www.sukl.cz/modules/medication/search.php?data%5Bmaterial%5D=amiodaron#data-listing amiodaro]n)
*Thyreotoxicosis factitia - overdose of thyroid hormones or preparations with iodine (contrast agents, [http://www.sukl.cz/modules/medication/search.php?data%5Bmaterial%5D=amiodaron#data-listing amiodaro]n)


* Neonatal thyrotoxicosis can be caused by transplacental immunoglobulin (TSI) transmission from a mother with Graves' disease.
*Neonatal thyrotoxicosis can be caused by transplacental immunoglobulin (TSI) transmission from a mother with Graves' disease.


<br />
<br />
==Clinical picture==
==Clinical picture==
Je dán '''hypermetabolickým stavem a aktivací sympatiku'''.
J It is due to the '''hypermetabolic state and activation of the sympathetic nervous system'''


*teplá, překrvená kůže, nadměrné pocení, intolerance tepla
*warm, increased perfusion of the skin, excessive sweating, heat intolerance  
*hubnutí, urychlení růstu
*weight loss, accelerated growth
*hypermotilita GIT a průjem
*GIT hypermotility and diarrhea
*[[tachykardie]], [[palpitace]], systolická hypertenze, velká tlaková amplituda,
*[[tachycardia]], [[palpitations]], systolic hypertension, large pressure amplitude
*třes, zvýšená dráždivost
*tremor, increased irritability
*tyroidní [[myopatie]] - slabost proximálního svalstva končetin, až 50% nemocných
*thyroid myopathy - weakness of the proximal muscles of the limbs, up to 50% of patients 
*[[exoftalmus]] (zírající výraz očí) – způsoben zmnožením pojivové tkáně vlivem autoimunitní stimulation<ref name="KlinPed2012-187" />,
*exophthalmos (staring expression of the eyes) - caused by the increase of connective tissue due to autoimmune stimulation<ref name="KlinPed2012-187" />,
*difuzní [[struma]],
*diffuse [[goiter]]
*nervozita, motorický neklid, poruchy koncentrace, výkyvy nálad
*nervousness, motor restlessness, concentration disorders, mood swings
*Graefeho příznak: při pohledu dolů nesleduje víčko bulbus,
*[[Graefe's symptom]]: looking down does not follow the bulbus cap,
*[[Stellwagův příznak]]: snížená frekvence mrkání,
*[[Stellwag symptom]]: decreased blinking frequency,
*Moebiův příznak: oslabená konvergence bulbů.<ref name="muntau" />
*[[Moebi's sympto]]<nowiki/>m: weakened convergence of bulbs.<ref name="muntau" />


==Diagnostics==
==Diagnostics==


*zvýšený T<sub>3</sub> a fT<sub>4</sub> (volná forma tyroxinu, je biologicky aktivní a zodpovídá za tkáňové účinky hormonu),
*Increased T3 and fT4 (the free form of thyroxine, is biologically active and responsible for the tissue effects of the hormone),
*snížený TSH,
*reduced TSH,
*protilátky (proti TSH-receptorům (TRAK, TRAb, rTSH-ab), [[tyreoglobulin]]u, tyroidální peroxidáze),
*antibodies (against TSH-receptors (TRAK, TRAb, rTSH-ab), [[thyroglobulin]], thyroid peroxidase),
*snížená sérová hladina cholesterolu,
*low serum cholesterol
*UZ štítnice: stanovení objemu, diagnostika adenomu (+ scintigrafie),
*Ultrasound of the thyroid gland: volume determination, adenoma diagnosis (+ scintigraphy), 
*kostní věk.<ref name="muntau" />
*bone age.<ref name="muntau" />
 


===Diferencial diagnosis===
===Diferencial diagnosis===


*'''[[sepse]]'''
*[[Sepsis]]
*'''[[maligní hypertermie]]'''
*[[malignant hyperthermia]]
*reakce po [[krevní transfúze|transfúzi]]
*[[transfusion reaction]]
*[[adrenální krize]]
*[[adrenal crisis]]


==Treatment==
==Treatment==


#'''Iniciální''' (útočná):
#'''Inicial:'''
#*tyreostatika (blokují syntézu T<sub>3</sub> a T<sub>4</sub>) - '''{{HVLP|thiamazol}}''' (Thyrozol), '''carbimazol''' nebo '''propylthiouracil'''
#*thyrostatics (block T3 and T4 synthesis) '''- HVLP (Thyrozole), carbimazole''' or '''propylthiouraci'''
#*[[betablokátory]] (hyperkinetická cirkulace)
#*[[beta-blockers]] (hyperkinetic circulation)
#'''Definitivní''':
#'''Definitive''':
#*dlouhodobá léčba tyreostatiky
#*long-term treatment with thyrostatics
#*(sub)totální '''tyreoidektomie''' (po opakovaných recidivách po vysazeni tyreostatik)
#*(sub)total thyroidectomy (after repeated relapses after discontinuation of thyrostatics)
#*radioablace štítné žlázy radiojódem (při KI chirurgické léčby, preferovaná v USA)
#*radioiodulation of the thyroid gland by radioiodine ( surgical treatment preferred in the USA)


Po TTE (totální tyreoidektomii) či destrukci žlázy radioaktivním jódem pacient většinou postupně přechází do hypotyreózy s doživotní nutností substituční léčby '''levothyroxinem'''.
After TTE (total thyroidectomy) or destruction of the gland by radioactive iodine, the patient usually gradually switches to hypothyroidism with a lifelong need for '''levothyroxine''' replacement therapy.


==Neonatal hyperthyroidoism==
==Neonatal hyperthyroidoism==


*vzácná život ohrožující porucha,
*a rare life-threatening disorder
*etiologie: transplacentární přenos mateřských protilátek proti TSH receptoru (TRAb, rTSH-ab) při známé nebo nerozpoznané tyreotoxikóze matky Graves-Basedowova typu,
*etiology: transplacental transmission of maternal antibodies against the TSH receptor (TRAb, rTSH-ab) or unrecognized Graves-Basedow-type thyrotoxicosis,
*klinický obraz u plodu: intrauterinní růstová retardace, fetální tachykardie, urychlení kostního zrání, struma, exoftalmus,
*clinical picture in the fetus: intrauterine growth retardation, fetal tachycardia, acceleration of bone maturation, goiter, exophthalmos,
*klinický obraz u neléčeného novorozence: metabolický rozvrat, srdeční selhání,
*clinical picture in untreated newborn: metabolic disruption, heart failure, 
*terapie: konzervativní antithyreoidální léčba, postupné vysazení během 2–3 měsíců (mizí mateřské protilátky z cirkulace).<ref name="KlinPed2012-187">LEBL, J, J JANDA a P POHUNEK, et al. ''Klinická pediatrie. ''1. vydání. Galén, 2012. 698 s. s. 187. <nowiki>ISBN 978-80-7262-772-1</nowiki>.</ref>
*therapy: conservative antithyroid treatment, gradual discontinuation within 2-3 months (maternal antibodies disappear from the circulation).<ref name="KlinPed2012-187">LEBL, J, J JANDA a P POHUNEK, et al. ''Klinická pediatrie. ''1. vydání. Galén, 2012. 698 s. s. 187. <nowiki>ISBN 978-80-7262-772-1</nowiki>.</ref>
<noinclude>
<noinclude>
==Links==
==Links==

Revision as of 13:09, 8 December 2020

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Last update: Tuesday, 08 Dec 2020 at 1.09 pm.

Symptoms and signs of hyperthyroidism

Thyrotoxicosis is a condition in which tissues are exposed to high levels of circulating thyroid hormones. The most common cause of thyrotoxicosis is Hyperthyroidism[1], ie excessive thyroid function. Usually in practice, the two terms are often confused.

Etiopathogenesis

Hypertyreóza

  • Graves' disease - the most common cause of hyperthyroidism; antibodies against receptors for TSH (TRAK);[2]
  • Hyperfunctional goiter
  • Hyperfunctional thyroid adenoma - very rare
  • Pituitary adenoma secreting TSH - very rare
  • Increased secretion of hCG - hCG and TSH are glycoprotein hormones and are partly similar, so at higher concentrations there may be cross-reactivity with TSH receptors, eg pregnancy (mostly at the end of the 1st trimester), hCG-producing mole hydatidosis, testicular tumor


Other (not included in hyperthyroidism)

  • Thyroiditis - can cause transient thyrotoxicosis due to the disruption of thyroid follicles by inflammation and the release of stored hormones into the blood. Hypothyroidism usually occurs afterwards. Eg: Hashimoto's thyroiditis, subacute granulomatous thyroiditis, subacute lymphocytic thyroiditis
  • Thyreotoxicosis factitia - overdose of thyroid hormones or preparations with iodine (contrast agents, amiodaron)
  • Neonatal thyrotoxicosis can be caused by transplacental immunoglobulin (TSI) transmission from a mother with Graves' disease.


Clinical picture

J It is due to the hypermetabolic state and activation of the sympathetic nervous system

  • warm, increased perfusion of the skin, excessive sweating, heat intolerance
  • weight loss, accelerated growth
  • GIT hypermotility and diarrhea
  • tachycardia, palpitations, systolic hypertension, large pressure amplitude
  • tremor, increased irritability
  • thyroid myopathy - weakness of the proximal muscles of the limbs, up to 50% of patients 
  • exophthalmos (staring expression of the eyes) - caused by the increase of connective tissue due to autoimmune stimulation[3],
  • diffuse goiter
  • nervousness, motor restlessness, concentration disorders, mood swings
  • Graefe's symptom: looking down does not follow the bulbus cap,
  • Stellwag symptom: decreased blinking frequency,
  • Moebi's symptom: weakened convergence of bulbs.[2]

Diagnostics

  • Increased T3 and fT4 (the free form of thyroxine, is biologically active and responsible for the tissue effects of the hormone),
  • reduced TSH,
  • antibodies (against TSH-receptors (TRAK, TRAb, rTSH-ab), thyroglobulin, thyroid peroxidase),
  • low serum cholesterol
  • Ultrasound of the thyroid gland: volume determination, adenoma diagnosis (+ scintigraphy), 
  • bone age.[2]

Diferencial diagnosis

Treatment

  1. Inicial:
    • thyrostatics (block T3 and T4 synthesis) - HVLP (Thyrozole), carbimazole or propylthiouraci
    • beta-blockers (hyperkinetic circulation)
  2. Definitive:
    • long-term treatment with thyrostatics
    • (sub)total thyroidectomy (after repeated relapses after discontinuation of thyrostatics)
    • radioiodulation of the thyroid gland by radioiodine ( surgical treatment preferred in the USA)

After TTE (total thyroidectomy) or destruction of the gland by radioactive iodine, the patient usually gradually switches to hypothyroidism with a lifelong need for levothyroxine replacement therapy.

Neonatal hyperthyroidoism

  • a rare life-threatening disorder
  • etiology: transplacental transmission of maternal antibodies against the TSH receptor (TRAb, rTSH-ab) or unrecognized Graves-Basedow-type thyrotoxicosis,
  • clinical picture in the fetus: intrauterine growth retardation, fetal tachycardia, acceleration of bone maturation, goiter, exophthalmos,
  • clinical picture in untreated newborn: metabolic disruption, heart failure, 
  • therapy: conservative antithyroid treatment, gradual discontinuation within 2-3 months (maternal antibodies disappear from the circulation).[3]

Links

Related articles

External links

Reference

  1. ↑ HOLUB, V. Tyreotoxikóza. Postgraduální medicína [online]. 2003, roč. -, vol. -, s. -, dostupné také z <https://zdravi.euro.cz/clanek/postgradualni-medicina/tyreotoxikoza-153007>. 
  2. ↑ Jump up to: a b c MUNTAU, Ania Carolina. Pediatrie. 4. vydání. Praha : Grada, 2009. s. 77-78. ISBN 978-80-247-2525-3
  3. ↑ Jump up to: a b LEBL, J, J JANDA a P POHUNEK, et al. Klinická pediatrie. 1. vydání. Galén, 2012. 698 s. s. 187. ISBN 978-80-7262-772-1.

Used literature

  • HAVRÁNEK, Jiří: Tyreotoxická krize.
  • KUMAR, Vinay. Robbins basic pathology. 8. vydání. Philadelphia : Saunders/Elsevier, 2007. ISBN 978-0-8089-2366-4.
  • PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2010-05-19]. <https://langenbeck.webs.com/>.
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