Cooper David S
Division of Endocrinology, Sinai Hospital of Baltimore, Johns Hopkins University School of Medicine, MD 21215-5271, USA.
Lancet. 2003 Aug 9;362(9382):459-68. doi: 10.1016/S0140-6736(03)14073-1.
Hyperthyroidism is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormone. The most common cause of this syndrome is Graves' disease, followed by toxic multinodular goitre, and solitary hyperfunctioning nodules. Autoimmune postpartum and subacute thyroiditis, tumours that secrete thyrotropin, and drug-induced thyroid dysfunction, are also important causes. The diagnosis of hyperthyroidism is generally straightforward, with raised serum thyroid hormones and suppressed serum thyrotropin in almost all cases. Appropriate treatment of hyperthyroidism relies on identification of the underlying cause. Antithyroid drugs, radioactive iodine, and surgery are the traditional treatments for the three common forms of hyperthyroidism. Beta-adrenergic blocking agents are used in most patients for symptomatic relief, and might be the only treatment needed for thyroiditis, which is transient. The more unusual causes of hyperthyroidism, including struma ovarii, thyrotropin-secreting tumours, choriocarcinoma, and amiodarone-induced thyrotoxicosis are, more often than not, a challenge to diagnose and treat.
甲状腺功能亢进是一种病理综合征,在此综合征中,组织暴露于过量循环甲状腺激素。该综合征最常见的病因是格雷夫斯病,其次是毒性多结节性甲状腺肿和单个高功能结节。自身免疫性产后甲状腺炎和亚急性甲状腺炎、分泌促甲状腺激素的肿瘤以及药物性甲状腺功能障碍,也是重要病因。甲状腺功能亢进的诊断通常很简单,几乎在所有病例中血清甲状腺激素升高且血清促甲状腺激素受到抑制。甲状腺功能亢进的恰当治疗依赖于确定潜在病因。抗甲状腺药物、放射性碘和手术是三种常见类型甲状腺功能亢进的传统治疗方法。大多数患者使用β-肾上腺素能阻滞剂来缓解症状,对于短暂性的甲状腺炎而言,这可能是唯一需要的治疗方法。甲状腺功能亢进较不常见的病因,包括卵巢甲状腺肿、分泌促甲状腺激素的肿瘤、绒毛膜癌以及胺碘酮所致甲状腺毒症,往往在诊断和治疗方面具有挑战性。