1, hypermetabolic group
Patients may show fear of heat and sweating, and the skin of palms, face, neck and armpits is ruddy and sweaty. There is often low fever, and in severe cases, high fever can occur. Patients often have tachycardia, palpitation and overeating, but lose weight, fatigue and weakness.
2, goiter
Many patients complain of goiter, which is diffuse symmetrical enlargement and soft mass, and moves up and down when swallowing. A few patients with goiter are asymmetrical or not obvious.
3. Eye sign
Have the following eye signs:
1, the palpebral fissure is widened, and blinking and staring are less;
2. Intraocular aggregation is difficult or poor;
3. When the eyes look down, the upper eyelid can't follow the eyeball because of retraction;
4. Eyes looking up, forehead skin can't have wrinkles.
4. Symptoms of nervous system
Patients with hyperthyroidism are neurotic, excitable, irritable and anxious, insomnia and nervous, talkative, sometimes upset, but occasionally indifferent and silent, depressed.
5. Symptoms of cardiovascular system
Because of hypermetabolism, increased heart rate, increased cardiac output, accelerated blood circulation and increased pulse pressure difference. Most patients report palpitation, chest tightness and shortness of breath, which are aggravated after exercise, and various premature beats and atrial fibrillation may occur.
6. Symptoms of digestive system
Hyperthyroidism is characterized by hyperthyroidism, but the weight is obviously reduced. The combination of the two often suggests the possibility of this disease or diabetes. The cause of diarrhea caused by this disease is that it is easy to get hungry after eating too much, plus excessive secretion of thyroxine, which excites gastrointestinal smooth muscle to accelerate peristalsis, causing indigestion and frequent defecation.
7, need to do the inspection
1, basal metabolic rate determination
Basal metabolic rate (BMR) is the level of energy consumption per unit time measured by human body in quiet rest and fasting state, usually taking oxygen consumption rate as an index. The determination of basal metabolic rate is of certain significance for auxiliary diagnosis of thyroid dysfunction and adjustment of therapeutic drug dosage.
2. Determination of seven products of one gong
The determination of seven A functions includes the determination of thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), free T3, free T4, anti-thyroglobulin antibody (TG antibody) and anti-thyroid peroxidase antibody (TPO antibody).
These seven tests reflect whether there is hyperthyroidism in the body, which is an important basis for clinical diagnosis of hyperthyroidism.
3.T3 inhibition test
T3 inhibition test is used to identify the increase of thyroid aspirate131Ⅰ. The inhibition rate of T3 inhibition test is 50% in normal people and simple goiter, and 50% in hyperthyroidism, or no inhibition, and malignant exophthalmos is not inhibited. Please note that it is not suitable for elderly patients with hyperthyroidism and coronary heart disease complicated with arrhythmia, because it will cause arrhythmia.
4, thyroid antibody examination
There are thyroglobulin antibody (TGA), thyroid microsomal antibody (TMA) and some other antibodies such as antinuclear antibody (ANA), anti-smooth muscle antibody (SMA), anti-mitochondrial antibody (AMA), anti-myocardial antibody (CMA) and anti-gastric parietal cell antibody (PCA). The positive rate of thyroid stimulating antibody (TSAb) or thyroid stimulating immunoglobulin (TSI) was the highest.
5, electrocardiogram examination
The electrocardiogram of patients with periodic paralysis of hyperthyroidism showed low potassium changes such as ST segment depression, low T wave and high U wave.
6. Thyroid ultrasound
Thyroid ultrasound can determine the size, shape, presence or absence of nodules, blood flow and so on. In hyperthyroidism, B-ultrasound showed goiter, rich blood flow and even "flame-like".
B-ultrasound is of great value for finding thyroid nodules that cannot be touched by hand diagnosis. Retrobulbar B-ultrasound can detect extraocular muscle hypertrophy early, which is helpful to diagnose Graves ophthalmopathy, judge the degree of lesion and observe its changes.
7. EMG.
Patients with hyperthyroidism complicated with myasthenia gravis may have the phenomenon of action potential attenuation. The potential is normal at the beginning of detection, and then the amplitude and frequency gradually decrease, suggesting that the neuromuscular junction is pathological. Patients with hyperthyroid myopathy can generally have myopathy type changes, such as the average action potential time limit is obviously shortened, and the action potential voltage and polyphase potential are increased.
8, muscle biopsy
The changes of muscle ultrastructure in patients with chronic hyperthyroidism myopathy by muscle biopsy are mainly due to the loss of normal morphology of mitochondria, the appearance of giant mitochondria, the expansion of transverse tubes and the accumulation of microtubules in muscle fibers.
9. Neostigmine test
Patients with hyperthyroidism complicated with myasthenia gravis can see that the symptoms of myasthenia gravis are obviously alleviated. Patients with hyperthyroidism and periodic paralysis did not respond to the test.