Interpretation of the 2022 edition of “guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China”

doi:10.16139/j.1007-9610.2023.06.05

Abstract

Abstract:

“Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China” (2022) (referred to as the “guidelines”) was officially published in August 2022 in the Chinese Journal of Endocrine Metabolism. These guidelines have been extensively updated from the 2007 version, with 15 sections covering the etiology, clinical manifestations, diagnosis, evaluation, and treatment of hyperthyroidism, as well as the management of specific types of thyrotoxicosis. The new version guidelines proposed 107 recommended opinions supported by stronger evidence, offering comprehensive and reliable guidance for clinical doctors and medical professionals dealing with thyrotoxicosis. This article aimed to extract the key points and recommended strategies from the guidelines to help clinical doctors better understand and apply the latest guiding principles.

Key words: Thyrotoxicosis, Hyperthyroidism, Thyroid crisis, Graves ophthalmopathy, Guide Interpretation

CLC Number:

XU Bojin, PENG Wenfang, HUANG Shan. Interpretation of the 2022 edition of “guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China”[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 512-519.

Figures/Tables 14

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References 16

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甲状腺毒症类别	甲状腺毒症病因
甲亢	弥漫性毒性甲状腺肿，即GD
	毒性多结节性甲状腺肿（toxic multinodular goiter, TMNG）
	毒性甲状腺腺瘤（toxic adenoma, TA）
	碘致甲亢
	自身免疫性新生儿甲亢
	家族性非自身免疫性甲亢
	散发性非自身免疫性甲亢
	功能性甲状腺癌转移
	分泌促甲状腺激素（thyroid stimulating hormone, TSH）的垂体腺瘤
	甲状腺激素抵抗（T₃受体β突变）
	人绒毛膜促性腺激素（human chorionic gonadotrophin, hCG）相关甲亢
	妊娠一过性甲状腺毒症（gestational transient thyrotoxicosis, GTT）
	妊娠滋养细胞肿瘤：葡萄胎、绒毛膜癌
	卵巢甲状腺肿
非甲亢	亚急性甲状腺炎
	桥本甲状腺炎
	无痛性甲状腺炎，产后甲状腺炎
	急性甲状腺炎
	人为甲状腺毒症

检查指标	应用建议
FT₃和FT₄	诊断甲状腺毒症的主要指标需注意生理（如年龄、妊娠、季节等）、病理、药物等因素的干扰
TSH	诊断甲状腺毒症最敏感的指标需排除影响TSH测定的相关因素需对TSH水平降低原因进行鉴别
TRAb	有助于甲状腺毒症的病因鉴别和GD的诊断
TPOAb和TgAb	用于甲状腺相关自身免疫病因诊断不能根据高滴度血清水平诊断GD
¹³¹I摄取率	辅助甲状腺毒症的病因鉴别
甲状腺静态显像	可用于甲状腺毒症病因鉴别，还有助于鉴别结节功能和发现异位甲状腺
甲状腺超声	鉴别甲状腺毒症病因的重要影像学手段

甲状腺毒症诊断	GD诊断
病史临床表现 FT₃、FT₄和TSH水平	必备条件	① 甲亢诊断成立
	必备条件	② 甲状腺弥漫性肿大，少数病例可无甲状腺肿大
	具备其一	③ 眼睑退缩和其他提示Graves眼病（Graves' orbitopathy, GO）的眼征
		④ 皮肤黏液性病变如胫前黏液性水肿或指端粗厚
		⑤ 第三代方法检测的TRAb阳性

指标类别		标准	分数
体温调节障碍	体温（℃）	37.2~37.7	5
		37.8~38.3	10
		38.4~38.8	15
		38.9~39.3	20
		39.4~39.9	25
		≥40	30
心血管系统	心动过速（次/min）	100~109	5
		110~119	10
		120~129	15
		130~139	20
		≥140	25
	心房颤动	无	0
	心房颤动	有	10
	充血性心力衰竭	无	0
		轻度	5
		中度	10
		重度	20
消化系统症状		无	0
		中度（腹泻/腹痛/恶心/呕吐）	10
		重度（黄疸）	20
中枢神经系统症状		无	0
		轻度（烦躁不安）	10
		中度（谵妄/精神错乱/昏睡）	20
		重度（癫痫/昏迷）	30
诱因状态		无	0
诱因状态		有	10
总分		≥45：甲状腺危象
		25~44：甲状腺危象前期
		<25：无甲状腺危象

药物	剂量	评价
丙硫氧嘧啶	200~400 mg/6~8 h，口服	抑制激素合成阻断外周T₄向T₃转换
甲巯咪唑	20~30 mg/6 h，口服	抑制新激素合成
普萘洛尔	60~80 mg/4~6 h，口服	建议对充血性心力衰竭病人进行有创血流动力学监测大剂量阻断外周T₄向T₃转化替代药物：艾司洛尔静脉输注
碘[卢戈碘液(Lugol碘液)]	4~8滴(20滴/mL， 8 mg碘/滴)/6~8 h，口服	ATD应用1 h后开始服用抑制新激素合成抑制甲状腺激素释放
氢化可的松	500~100 mg/6~8 h，静脉滴注	可能阻断外周T₄向T₃转换预防相对肾上腺功能不全替代药物：地塞米松
地塞米松	2 mg/6~8 h，静脉滴注	外周T₄向T₃转换预防相对肾上腺功能不全