临床医学李益明甲减课件

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1、甲状腺功能减退Hypothyroidism复旦大学医学院内分泌科李益明Hypothalamic-pituitary-thyroidaxisOverviewClinicalsyndromeSlowingdownofmetabolismSlowingofgrowthandmentalretardationininfantsandchildrenGeneralizedslowingdownoforganismDepositionofglycosaminoglycansinskinandmuscleReversiblewiththerapyEtiologyandClassifcationPr

2、imary(thyroidfailure)Hashimoto’sthyroiditisIodidedeficiencyorexcessiveRadioactiveiodinetherapyforGDSubtotalthyroidectomySubacutethyroiditisSecondary:pituitarydeficitTertiary:hypothalamicdysfunctionPeripheralresistancetothyroidhormonePathogenesisAffectseachtissueAccumulationofglycosaminoglycans(

3、hyaluronicacid)NottoexcessivesynthesisButdecreaseddestrutionIncreasedcapillarypermeabilityInterstitialedemaSkinHeartmuscleStriatedmuscleClinicalFeaturesAdultsSymptomsEasyfatigabilityColdnessWeightgainConstipationMenstrualirregularitiesSignsCool,rough,dryskinPuffyfaceandhandsHoarseandhuskyvoiceS

4、lowreflexesYellowishcolorskinClinicalFeaturesCardiovascularsignsImpairedmyocardiumcontractionBradycardiaDiminishedcardiacoutputECG:lowvoltageofQRS,P,TwavesPericardialeffusionCoronaryarterydiseaseCardiacangina(Replacementtherapyaggravate)ClinicalFeaturesPulmonaryfunctionShallow,slowrespirationRe

5、spiratoryfailureIntestinalperistalsisMarkedlyslowedConstipationRenalfunctionDecreasedglomerularfiltrationClinicalFeaturesAnemiaImpairedhemoglobinsynthesisMenorrhagiaandAbsorptionofironFolatedeficiencyPerniciousanemiaNuromuscularsystemMuscleweaknessSlowreflexesCentralnervoussystemsymptomsInabil

6、itytoconcentrateAnovulatorycyclesandinfertilityDepressedSymptomsofhypothyroidismSymptoms%ofcasesWeakness99Dryskin97Coarseskin97Lethargy91Slowspeech91Edemaofeyelids90Sensationofcold89Decreaseedsweeting89Coldskin83Thicktongue82Edemaofface79Coarsenessofhair76Pallorofskin67Memoryimpairment66Symptom

7、sofhypothyroidismSymptoms%ofcasesConstipation61Gaininweight59Lossofhair57Palloroflips57Dyspnea55Peripheraledema55Hoarsenessoraphonia52Anorexia45Nervousness35Menorrhagia32Palpitation31Deafness30Precordialpain25MyxedemacomaFrequentl