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Hyperthyroidism needs to be accurately classified and treated, otherwise it will fall into the confusion of mistreatment!
Chronic lymphocytic thyroiditis is an autoimmune inflammation of the thyroid gland, first reported by Hashimoto (Hashimoto) of Kyushu University in Japan in 1912, so it is also known as "Hashimoto's thyroiditis" or "Hashimoto's disease", which is currently the most common clinical thyroid disease
.
Hashimoto's disease can have different symptoms at different clinical stages, and thyroid function can be reduced or increased, making patients less disturbed
.
Today, let's understand this disease together through a "misdiagnosis" case~
.
She was told she might have hyperthyroidism, so she immediately went to the hospital
.
The first doctor was Dr.
Xiao Wu, who listened to Xiao Ni's medical history, made a diagnosis of hyperthyroidism, and told Xiao Ni to do a thyroid function test to finally confirm the diagnosis, and at the same time decide the dosage
of anti-thyroid drugs according to the test results.
Unfortunately, the laboratory department happened to lack several thyroid antibody test kits, so these tests could not be done
temporarily.
Dr.
Xiao Wu thought that there was no big problem, as long as he could do the main A gong projects such as T3, T4, and TSH
.
The final laboratory results came out, showing that T3 and T4 levels were increased, confirming that hyperthyroidism did indeed exist
.
Dr.
Xiao Wu did not carefully classify hyperthyroidism, so he greatly administered intensive anti-thyroid therapy: methylthiimidazole (MMI) 30 mg, 1 dose
.
Xiao Ni took the drug for less than a week, and the symptoms such as palpitations, fatigue, and sweating did disappear, but she began to have dry skin, and sometimes felt afraid of cold.
.
.
So she went to Dr.
Wu for follow-up, but Dr.
Wu thought that the patient was only very sensitive to antithyroid drugs, and asked her to reduce the dose of methylthiimidazole to 20 mg and continue to take it.
.
.
.
After another half a month, Xiao Ni began to appear swollen and her cold symptoms worsened, so she came to the clinic
again.
Dr.
Wu reviewed the thyroid function, and the results showed that the levels of T3 and T4 decreased and the TSH level soared
.
Dr.
Wu thought that the patient was too sensitive to antithyroidism, and overkill was leading to hypothyroidism
.
Tell the patient to suspend antithyroid drugs and switch to L-thyroid tablets, and also tell the patient that it will be corrected soon
.
But Xiaoni treated for a long time, and the symptoms of hypothyroidism did not ease.
.
.
The director carefully questioned the medical history and physical examination, and finally diagnosed Hashimoto's disease, which led to permanent hypothyroidism due to incorrect treatment
.
Afterwards, the director talked to Xiao Wu: "As a specialist, it is necessary to accurately classify and treat hyperthyroidism, otherwise it will fall into the confusion of mistreatment and bring great harm
to patients.
" ”
Follow the director to explore "secretion"
The incidence of Hashimoto's disease is 0.
3%~10%, and in recent years, the incidence has gradually increased, and women are more likely to suffer from the disease
than men.
The cause of this disease is not completely clear, and it may be affected by genetics, individual hormone levels, external environment and other factors
.
Patients with Hashimoto's disease present with diffuse enlargement of the thyroid gland, significantly elevated serum thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) levels, and lymphocyte infiltration
of thyroid tissue.
For example, hypothyroidism occurs, accompanied by chills, hair loss, memory loss and other symptoms
.
The thyroid gland is in an abnormal state for a long time, resulting in hypothyroidism, a decrease in thyroid hormone levels, resulting in a decrease in glomerular filtration function, tubular transport function, cognitive dysfunction, reduced metabolic rate, elevated blood lipids, etc.
, and finally develop into chronic kidney disease, neurological diseases, cardiovascular diseases and other diseases
.
Patients not only have to bear the pain caused by the disease, but also the high cost
of treatment.
Therefore, it is necessary to find effective treatments for Hashimoto's disease to reduce the risk of
future adverse development.
Toll-like receptors (TLRs)/myeloid differentiation protein 88 (MyD88)/nuclear transcription factor κB (NF-κB) have been shown Signaling pathways are involved in inflammation, immune response activation and apoptosis, and are widely used in various diseases
such as inflammation, tumors, and immune-related.
Look at the picture to explore "secretion": clinical manifestations are diverse
The clinical manifestations of Hashimoto's disease are diverse and can be summarized as follows:
■1.
Early clinical stage
In the early stage of the disease, it may be asymptomatic, or only see goiter, diffuse, lobulated or nodular enlargement, tough and hard, and no adhesions
to surrounding tissues.
There may be pharyngeal discomfort or mild dysphagia, sometimes neck pressure, and occasionally local pain and tenderness
.
■ 2.
Transient hyperthyroidism phase
When the disease progresses, due to our decreased immune function or disorder, the thyroid gland is attacked by autoantibodies, resulting in the destruction of thyroid follicular cells, and excessive release of thyroxine into the blood circulation causing transient hyperthyroidism
.
Typical symptoms
of palpitation, hand tremors, diarrhea, sweating, irritability, and insomnia are typical.
The hyperthyroid phase generally lasts only a few months, and many people may pass this short stage
without realizing it.
In recent years, domestic literature studies have shown that high-frequency ultrasound differential diagnosis of Hashimoto's thyroiditis and hyperthyroidism has clinical practical value, so as to avoid blind anti-thyroid treatment
of Hashimoto's thyroiditis.
■ 3.
Stable period
.
Although the thyroid gland continues to suffer damage at this stage, it can still maintain normal function
.
During this time, the patient may not have any clinical symptoms
.
■4.
Permanent hypothyroidism
occurs when thyroid tissue cells are destroyed and eventually unable to maintain normal function.
Patients may present with hypothyroid symptoms such as fatigue, lethargy, edema, constipation, and weight gain.
And this stage is very likely to last a lifetime
.
When Hashimoto's hyperthyroidism symptoms are particularly pronounced, such as severe hand tremors and palpitations, β-blockers (propranolol) can be used, and antithyroid drugs
are generally not advocated.
Hashimoto's disease is a common chronic autoimmune disease whose cause is not fully understood
.
The serum levels of thyroglobulin antibodies and thyroid peroxidase antibodies in this disease are significantly increased
.
Long-term thyroid abnormalities can lead to hypothyroidism, so if effective indicators are used to determine the severity of Hashimoto's disease, early intervention can be carried out to improve outcomes
.
(Note: The characters in the text are pseudonyms) References: [1] edited by Li Changqi, Jiang Shuwen and Dong Jinglin
.
New progress in the diagnosis and treatment of hyperthyroidism[M]Heilongjiang Science and Technology Press.
Harbin 1996 First Edition 188; —208.
[2] Chinese Medical Association, Chinese Medical Association Clinical Pharmacy Branch, Journal of Chinese Medical Association, etc.
Guidelines for rational drug use at the primary level of hyperthyroidism[J].
Chinese Journal of General Practitioners,2021,20(5):515-519.
) [3] ZHANG Xingping.
Changes and significance of serum thyroid peroxidase antibody expression in patients with Hashimoto's thyroiditisMedical diet therapy and health[J]2022,24:179-181[4]WANG Hong,JIANG Chao,SHAO Yingxin.
Research progress in the diagnosis and treatment of Hashimoto's thyroiditis[J].
Heilongjiang Medical Journal,2015,35(3):230-232.
) [5] Qin Shaojie: Clinical application of high-frequency ultrasound differential diagnosis of Hashimoto's thyroiditis and hyperthyroidism[J] China Medical Engineering, 2021, 11:40-42 [6] Baskin, H.
J.
, Cobin, R.
H.
, Duick, D.
S.
, Gharib, H.
, Guttler, R.
B.
, Kaplan, M.
M.
, Segal, R.
L.
, & American Association of Clinical Endocrinologists (2002).
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism.
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 8(6), 457–469.
The theme of UN Diabetes Day 2022 is "Education for Tomorrow" to help healthcare professionals and people living with diabetes access quality diabetes education
.
This time, the "Medical Endocrinology Channel" once again cooperated with the Department of Endocrinology of the Southern Theater General Hospital to bring you a series of popular science content!
Wonderful articles and video content will be launched one after another today~
Where to watch more endocrine cases? Come to the "doctor's station" and take a look 👇
