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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 tyreoiditen kan inflammationsdämpande läkemedel behövas.
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  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet