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Hyperthyreose

Hyperthyroidism

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Zusammenfassung

Die häufigsten Ursachen einer Hyperthyreose sind autonome Adenome und der M. Basedow, deutlich seltener liegt eine Hashimoto-Thyreoiditis zugrunde. Bei Schilddrüsenautonomie bzw. beim M. Basedow handelt es sich um Bildungshyperthyreosen, wohingegen die Hashimoto-Thyreoiditis eine Freisetzungshyperthyreose darstellt. Die medikamentöse Therapie richtet sich nach der Genese der Erkrankung. Bei Autonomien und beim M. Basedow werden Thyreostatika und ggf. β-Blocker eingesetzt. Bezüglich der ablativen Therapie ist häufig eine Radiojodtherapie einer Operation vorzuziehen. Die Therapie der Hashimoto-Thyreoiditis erfolgt rein symptomatisch mit β-Blockern bzw. Kortikosteroiden. Eine besondere Herausforderung stellt die Hyperthyreose in der Schwangerschaft dar. Im ersten Trimenon wird Propylthiouracil eingesetzt, wohingegen im zweiten und dritten Trimenon Thyreostatika vom Thionamidtyp verabreicht werden. Ziel ist es, das freie Thyroxin im oberen Normbereich zu halten.

Abstract

Thyrotoxicosis is mainly caused by autonomous adenomas of the thyroid gland and by Graves’ disease. A less frequent cause for thyrotoxicosis is Hashimoto’s thyroiditis. Thyrotoxicosis in autonomous adenomas and Graves’ disease is caused by an increased thyroid hormone production whereas hyperthyroidism in Hashimoto’s thyroiditis results from destruction of the thyroid gland. Drug therapy depends on the cause of the disease. Autonomous adenomas and Graves’ disease are treated with methimazole and potentially with β-blockers. Regarding thyroid ablative therapy, radioiodine is mostly preferred compared to thyroidectomy. Drug therapy of Hashimoto’s thyroiditis is purely symptomatic using β-blockers and rarely corticosteroids. Hyperthyroidism in pregnancy is a major issue and pregnant women in the first trimester are treated with propylthiouracil (PTU) whereas women in the second and third trimesters are treated with methimazole. The aim is to maintain the serum fT4 levels within the upper normal range.

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Danksagung

Ich bedanke mich bei Herrn PD Dr. Hubertus Hautzel, stellvertretender Direktor der Nuklearmedizinischen Klinik des Universitätsklinikums Düsseldorf (Standort Jülich), für die kritische Durchsicht und Korrektur insbesondere des nuklearmedizinischen Teils sowie für die Bereitstellung der szintigraphischen Abbildungen.

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  1. Funktionsbereich Endokrinologie, Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Schott

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Schott, M. Hyperthyreose. Internist 54, 315–327 (2013). https://doi.org/10.1007/s00108-012-3196-1

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  • DOI: https://doi.org/10.1007/s00108-012-3196-1

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