Hopp til innhold
NHI.no
Annonse

Høyt stoffskifte, hypertyreose: Diagnosen

Innhold i artikkelen

Sykehistorien med de typiske symptomene gir ofte sterk mistanke om denne diagnosen. Ved legeundersøkelsen kan det påvises et lett struma og pasienten virker rastløs, snakker hurtig, huden er fuktig og varm, pulsen er rask, det foreligger en lett skjelving og noen har litt utstående øyne.

Annonse

Målinger av hormonet TSH sammen med fritt T4 (FT4) viser forhøyede verdier og vil i de fleste tilfeller bekrefte diagnosen. Påvisning av antistoffer i blodet bidrar til å fastslå årsaken til forhøyet stoffskifte. Funn av TRAS tyder på Graves sykdom. Funn av et annet antistoff, anti-TPO, er typisk for tyreoiditter, men forekommer også hos halvparten av pasientene med Graves sykdom.

Andre undersøkelser som kan være aktuelle, er scintigrafi. En undersøkelse der det sprøytes inn en liten mengde radioaktivt jod som samler seg opp i skjoldkjertelen. Scintigrafi gjør det mulig for legen å se hvor aktiv skjoldkjertelen er i produksjonen av stoffskiftehormoner, og for å avdekke eventuelle hormonproduserende knuter i kjertelen. Ved lavt eller normalt stoffskifte er scintigrafi uaktuelt.

Vil du vite mer

Vil du vite mer - Kurs om stoffskiftesykdommer

Dette dokumentet er basert på det profesjonelle dokumentet Hypertyreose . Referanselisten for dette dokumentet vises nedenfor

  1. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet 2016 Aug 27; 388(10047): 906–918. www.ncbi.nlm.nih.gov
  2. Pearce EN. Diagnosis and management of thyrotoxicosis. BMJ 2007; 332: 1369-73. PubMed
  3. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379:1142–54.
  4. Bjøro T, Holmen J, Krüger Ø, et al. Prevalens av hypotyreose og hypertyreose i Nord-Trøndelag. Tidsskr Nor Lægeforen 2002; 122: 1022-8. PubMed
  5. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99:923–31. PMID: 24423323 PubMed
  6. Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves’ disease. Autoimmun Rev. 2014;13:398–402. PMID: 24424182 PubMed
  7. 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; 26: 10. DOI: 10.1089/thy.2016.0229 DOI
  8. Schwartz F, Bergmann N, Zerahn B, Faber J. Incidence rate of symptomatic painless thyroiditis presenting with thyrotoxicosis in Denmark as evaluated by consecutive thyroid scintigraphies. Scand J Clin Lab Invest. 2013;73:240–44. PMID: 23438331 PubMed
  9. Mikkelsen KV, Andersen-Ranberg K, Hegedus L. Thyreoideadysfunktion hos ældre. Ugeskr Læger 2001; 163: 2770-3. PubMed
  10. Reid JR, Wheeler SF. Hyperthyroidism: Diagnosis and treatment. Am Fam Physician 2005; 72: 623-30. PubMed
  11. Vaidya B, Pearce SH. Diagnosis and management of thyrotoxicosis. BMJ. 2014;349:g5128. doi: 10.1136/bmj.g5128.
  12. Ross DS, Cooper DS, Mulder JE. Diagnosis of hyperthyroidism. UpToDate, last updated april 2013. UpToDate
  13. US Preventive Services Task Force. Screening for thyroid disease: Recommendation statement. Ann Intern Med 2004; 140:125-27. Helfand M. Screening for subclinical thyroid dysfunction in nonpregnant adults: A summary of the evidence for the US Preventive services task force. Ann Intern Med 2004; 140:128-41. Annals of Internal Medicine
  14. Bahn Chair RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21: 593. PubMed
  15. Norsk kvalitetsforbedring av laboratorieundersøkelser (Noklus). Anbefalte analyser ved utvalgte kliniske problemstillinger. Siden besøkt 28.09.2020. www.noklus.no
  16. Babovic A, Müller C, Bach-Gansmo C. Når er det indikasjon for thyreoideascintigrafi?. Tidsskr Nor Legeforen 2013.
  17. Burch HB, Burmann KD, Cooper DS. A 2011 survey of clinical practice patterns in the management of Graves' disease. J Clin Endocrinol Metab 2012; 97: 4549. pmid:23043191 PubMed
  18. Cooper DS. Antithyroid drugs. N Engl J Med 2005; 352: 905-17. New England Journal of Medicine
  19. Abraham P, Avenell A, McGeoch SC, Clark LF, Bevan JS. Antithyroid drug regimen for treating Graves' hyperthyroidism. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD003420. DOI: 10.1002/14651858.CD003420.pub4 DOI
  20. Nedrebo BG, Holm PA, Uhlving S, Sorheim JI, Skeie S, Eide GE, et al. Predictors of outcome and comparison of different drug regimens for the prevention of relapse in patients with Graves' disease. Eur J Endocrinol 2002; 147: 583-9. PubMed
  21. Woeber KA. Methimazole-induced hepatotoxicity. Endocr Pract 2002; 8: 222-4. PubMed
  22. Jansson S, Lie-Karlsen K, Stenqvist O, Korner U, Lundholm K, Tisell LE. Oxygen consumption in patients with hyperthyroidism before and after treatment with beta-blockade versus thyrostatic treatment: a prospective randomized study. Ann Surg 2001; 233: 60-4. PubMed
  23. Allahabadia A, Daykin J, Sheppard MC, Gough SC, Franklyn JA. Radioiodine treatment of hyperthyroidism-prognostic factors for outcome. J Clin Endocrinol Metab 2001; 86: 3611-7. PubMed
  24. Metso S, Jaatinen P, Huhtala H, Luukkaala T, Oksala H, Salmi J. Long-term follow-up study of radioiodine treatment of hyperthyroidism. Clin Endocrinol (Oxf) 2004; 61: 641-8. PubMed
  25. Holm LE, Lundell G, Dahlqvist I, Israelsson A. Cure rate after I therapy for hyperthyroidism. Acta Radiol Oncol 1981; 20: 161-6. PubMed
  26. Cooper DS. Antithyroid drugs in the management of patients with Graves' disease: An evidence-based approach to therapeutic controversies. J Clin Endocrinol Metab 2003; 88: 3474-81. PubMed
  27. Bogazzi F, Giovanetti C, Fessehatsion R, et al. Impact of lithium on efficacy of radioactive iodine therapy for Graves' disease: a cohort study on cure rate, time to cure, and frequency of increased serum thyroxine after antithyroid drug withdrawal. J Clin Endocrinol Metab 2010; 95: 201-8. PubMed
  28. Colaco SM, Si M, Reiff E, Clark OH. Hyperparathyroidism after radioactive iodine therapy. Am J Surg 2007; 194: 323-7. PubMed
  29. Ginsberg J. Diagnosis and management of Graves' disease. CMAJ 2003; 168: 575-85. Canadian Medical Association Journal
  30. Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res 2000; 90: 161-5. PubMed
  31. Alsanea O, Clark OH. Treatment of Graves' disease: the advantages of surgery. Endocrinol Metab Clin North Am 2000; 29: 321-37. PubMed
Annonse
Annonse