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Tyreotoxikos (hypertyreos)

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Definition:
Tillstånd med ökad mängd cirkulerande fria tyreoideahormoner. Tyreotoxikoserna delas in i hypertyreos med ökad produktion av hormon och tyreoiditer då lagren av hormon töms. Båda leder till förhöjda hormonnivåer i blodet. Vanligaste orsaken är autoimmun stimulering av sköldkörteln (Graves sjukdom).
Förekomst:
Prevalens är 0,5– 0,8 % i Europa.
Symtom:
Vanligaste symtomen är avmagring, trötthet, värmeintolerans och hjärtklappning.
Kliniska fynd:
Kliniska fynd kan vara rastlös patient med takykardi, förmaksflimmer, livliga reflexer, förstorad sköldkörtel och exoftalmus.
Diagnostik:
Diagnosen bekräftas av lågt TSH och högt FT4.
Behandling:
Betablockerare kan verka symtomlindrande vid tyreotoxikos. Vid hypertyreos minskas hormonproduktionen genom tyreostatikabehandling, radioaktivt jod eller tyreoidektomi. Vid tyreoiditer är den höga ämnesomsättningen övergående och man får avvakta spontan normalisering. Vid den virusorsakade tyroiditen kan inflammationsdämpande läkemedel behövas.
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  • Helena Filipsson Nyström, med dr och specialist i internmedicin, Institutionen för Medicin, Sahlgrenska akademin, Göteborgs universitet
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet