甲状腺功能减退症（甲减） 课件

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1、甲状腺功能减退症(甲减)Hypothyroidism中山大学附属第一医院内分泌科肖海鹏甲减的定义多种原因引起的甲状腺激素合成,分泌或生物学效应不足所致。以低代谢率，粘多糖在组织和皮肤堆积为特征，严重者表现为粘液性水肿（Myxedema）及粘液性水肿性昏迷。甲减的分类根据病变部位分类原发性甲减(甲状腺性)继发性甲减（垂体性）三发性甲减(下丘脑性)受体性甲减（外周性）甲减的分类据病因分类药物性甲减[3]I治疗后甲减手术后甲减特发性甲减甲减的分型呆小病（克丁病Cretinism）幼年型甲减成年型甲减Figure15-11.(Leftpanel)Infantwithsevere,untrea

2、tedcongenitalhypothyroidismdiagnosedpriortotheadventofnewbornscreening.(Rightpanel)Infantwithcongenitalhypothyroidismidentifiedthroughnewbornscreening.Notethestrikingdifferenceintheseverityoftheclinicalfeatures.Figure15-12.Tenyearoldfemalewithsevere1°hypothyroidismduetoprimarymyxedemabefore(A)a

3、ndafter(B)treatment.Presentingcomplaintwaspoorgrowth.Notethedullfacies,relativeobesityandimmaturebodproportionspriortotreatment.Atage10yearsshehadnotlostasingledeciduoustooth.Aftertreatmentwasinitiated(indicatedbythearrowinPanelC),shelost6teethin10monthsandhadstrikingcatchupgrowth.Boneagewas5ye

4、arsatachronologicageof10years.TSHreceptorblockingantibodieswerenegative.临床表现一般表现：疲劳、畏寒怕冷、出汗减少、皮肤干燥、萎黄虚肿、面容虚浮、声音嘶哑、毛发稀少干枯精神神经：乏力淡漠、少言嗜睡、反应迟钝心血管症状：心率减慢、心肌病、心包积液消化症状：纳差、便秘、腹胀其他症状：贫血、性欲减退、月经过多、泌乳Figure9-3.(A)Theclassictorpidfaciesofseveremyxedemainaman.Thefaceappearspuffy,andtheeyelidsareedematous.

5、Theskinisthickenedanddry.(B)Thefaciesinpituitarymyxedemaisoftencharacterizedbyskinofnormalthickness,coveredbyfinewrinkles.Puffinessisusuallylessthaninprimarymyxedema.Theeyelidsareoftenedematous.Thepalpebralfissuremaybenarrwowedbecauseofblepharoptosis,duetodiminishedtoneofthesympatheticnervousfi

6、berstoMüller'slevatorpalpebralsuperiousmuscleandistheoppositeofthelidretractionseeninthyrotoxicosis.Themodestmeasurableexophthalmosseeninsomepatientswithmyxedemaispresumablyrelatedtoaccumulationofthesamemucousedemaintheorbitasisseenelsewhere.Itisnotprogressiveandcarriesnothreattovision,asintheo

7、phthalmopathyofGraves'disease.Thetongueisusuallylarge,occasionallytothepointofclumsiness.Sometimesapatientwillcomplainofthisproblem.Sometimesitissmooth,asinperniciousanemia(ofcourse,perniciousanemiamaycoexist).Patientsdonotusually