Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- intolerância ao calor
- sudorese
- perda de peso
- palpitações
- tremor
- bócio difuso
- orbitopatia
Outros fatores diagnósticos
- irritabilidade
- sopro cardíaco
- pele úmida e aveludada
- queda de cabelos
- fraqueza muscular
- sopro tireoidiano
- onicólise
- vitiligo
- mixedema pré-tibial
- acropaquia
- irregularidade menstrual
- disfunção sexual
Fatores de risco
- história familiar de doença tireoidiana autoimune
- sexo feminino
- tabagismo
- ingestão elevada de iodo
- terapia com lítio
- agente biológico e terapias com citocina
- radiação
- radioterapia com iodo para bócio nodular benigno
- estresse
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- hormônio estimulante da tireoide (TSH)
- T4 sérico livre ou total
- T3 total ou livre sérico
- anticorpos antirreceptor de hormônio estimulante da tireoide (TSH [TRAb])
Investigações a serem consideradas
- cálculo da razão T3/T4 ou T3L/T4L total
- captação de iodo radioativo ou tecnécio-99
- cintilografia da tireoide
- anticorpos antitireoperoxidase (TPOAb)
- ultrassonografia da tireoide
- tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM) da órbita
- biópsia de pele
Algoritmo de tratamento
tempestade tireoidiana
doença de Graves subclínica
adultos sintomáticos não lactantes e não gestantes
gestantes
crianças
Colaboradores
Autores
Salman Razvi, MD
Consultant Endocrinologist and Senior Lecturer
Translational and Clinical Research Institute, Queen Elizabeth Hospital, Gateshead
Newcastle University
Newcastle upon Tyne
UK
Раскрытие информации
SR has received speaker fees from Merck, IBSA, and Abbott Pharmaceuticals Ltd., all makers of levothyroxine. In addition, SR is in receipt of funding for an investigator-initiated trial from Merck to study the role of thyroid hormones in heart failure.
Выражение благодарностей
Dr Salman Razvi would like to gratefully acknowledge Dr Petros Perros, Dr Douglas S. Ross, Dr George Hennemann, and Dr Vahab Fatourechi, previous contributors to this topic.
Раскрытие информации
PP, DSR, GH, and VF are authors of references cited in this topic.
Рецензенты
Elizabeth N. Pearce, MD
Associate Professor of Medicine
Boston University Medical Center
Boston
MA
Раскрытие информации
ENP is a consultant for Scientific Consulting Company GmbH and a management council member for the Iodine Global Network.
Kristien Boelaert, MD, PhD, FRCP
Reader in Endocrinology
Institute of Metabolism and Systems Research
College of Medical and Dental Sciences
University of Birmingham
Birmingham
UK
Раскрытие информации
KB declares that she has no competing interests.
Paul Carroll, MD, FRCP
Clinical Lead for Endocrinology
Chair of Thyroid MDM
Guy’s and St Thomas’ NHS Trust
London
UK
Раскрытие информации
PC declares that he has no competing interests.
David Cooper, MD
Division Head
Endocrinology
Sinai Hospital of Baltimore
Baltimore
MD
Раскрытие информации
DC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018 Jul 25;7(4):167-86.Полный текст Аннотация
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.Полный текст Аннотация
National Institute for Health and Care Excellence. Thyroid disease: assessment and management. Oct 2023 [internet publication].Полный текст
Mooij CF, Cheetham TD, Verburg FA, et al. 2022 European Thyroid Association guideline for the management of pediatric Graves' disease. Eur Thyroid J. 2022 Jan 1;11(1):e210073.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Bócio nodular tóxico
- Tireoidite indolor e pós-parto
- Hipertireoidismo gestacional
Больше ОтличияРекомендации
- Thyroid disease in pregnancy
- Practice parameter for treatment of benign and malignant thyroid disease with I-131 sodium iodide
Больше РекомендацииЛифлеты для пациента
Doença de Graves
Больше Лифлеты для пациента
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