临床医学李益明甲减课件_1

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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-thyroidaxisOverviewClinicalsyndromeSlowingdownofmetabolismSlowingofgrowthandmentalretardationininfantsandchildrenGeneralizedslowingdownoforganismDepositionofglycosaminoglycansinskinandmuscleReversiblewithther

2、apyEtiologyandClassifcationPrimary(thyroidfailure)Hashimoto’sthyroiditisIodidedeficiencyorexcessiveRadioactiveiodinetherapyforGDSubtotalthyroidectomySubacutethyroiditisSecondary:pituitarydeficitTertiary:hypothalamicdysfunctionPeripheralresistancetothyroidhormonePath

3、ogenesisAffectseachtissueAccumulationofglycosaminoglycans(hyaluronicacid)NottoexcessivesynthesisButdecreaseddestrutionIncreasedcapillarypermeabilityInterstitialedemaSkinHeartmuscleStriatedmuscleClinicalFeaturesAdultsSymptomsEasyfatigabilityColdnessWeightgainConstipa

4、tionMenstrualirregularitiesSignsCool,rough,dryskinPuffyfaceandhandsHoarseandhuskyvoiceSlowreflexesYellowishcolorskinClinicalFeaturesCardiovascularsignsImpairedmyocardiumcontractionBradycardiaDiminishedcardiacoutputECG:lowvoltageofQRS,P,TwavesPericardialeffusionCoron

5、aryarterydiseaseCardiacangina(Replacementtherapyaggravate)ClinicalFeaturesPulmonaryfunctionShallow,slowrespirationRespiratoryfailureIntestinalperistalsisMarkedlyslowedConstipationRenalfunctionDecreasedglomerularfiltrationClinicalFeaturesAnemiaImpairedhemoglobinsynth

6、esisMenorrhagiaandAbsorptionofironFolatedeficiencyPerniciousanemiaNuromuscularsystemMuscleweaknessSlowreflexesCentralnervoussystemsymptomsInabilitytoconcentrateAnovulatorycyclesandinfertilityDepressedSymptomsofhypothyroidismSymptoms%ofcasesWeakness99Dryskin97Coarse

7、skin97Lethargy91Slowspeech91Edemaofeyelids90Sensationofcold89Decreaseedsweeting89Coldskin83Thicktongue82Edemaofface79Coarsenessofhair76Pallorofskin67Memoryimpairment66SymptomsofhypothyroidismSymptoms%ofcasesConstipation61Gaininweight59Lossofhair57Palloroflips57Dyspn

8、ea55Peripheraledema55Hoarsenessoraphonia52Anorexia45Nervousness35Menorrhagia32Palpitation31Deafness30Precordialpain25MyxedemacomaFrequentl