单纯性甲状腺肿simple_goiter精品课件

单纯性甲状腺肿Simple Goiter 定义：多种原因所致的甲状腺非炎 性，非肿瘤性肿大，甲功一般正常 。 分类：地方性(Endemic goiter ) 和散发行(sporadic goiter) 病因及发病机制 缺碘: 正常人碘需要量：200500微克/天 土壤，水中缺碘：地方性甲肿原因 NIS突变 甲状腺激素合成或分泌障碍 碘过多 致甲状腺肿物质 先天性甲状腺激素合成障碍 甲状腺激素需要量增加 甲状腺激素合成障碍 ，甲状腺激素分泌不 足 TSH分泌增加/ TSH的反 应性增强 单纯性甲状腺肿 ？TGI or cytokine 病理 增生，复原变化过度导致： 弥漫性甲状腺肿-胶样甲状腺肿 结节性甲状腺肿（增生性结节和胶质 储留性结节） 继发性改变： 分类：弥漫性，结节性和混合性 临床表现 甲状腺肿大及压迫症状 甲状腺功能障碍：大多正常，一般不导 致甲状腺功能障碍，在严重的缺碘地区 ，可出现地方性呆小病。在多发结节的 基础上，可出现自主性功能亢进。如地 方性甲状腺肿患者摄入碘过多，有时也 可诱发甲状腺功能亢进，称碘甲状腺功 能亢进症 实验室检查 T3、T4测定 T4常正常或偏低，T3正常或偏高。 TSH正常或偏高。 甲状腺摄I率测定 缺碘者甲状腺摄I率大多增高 ，但高峰不前移。 甲状腺扫描 单纯性甲状腺肿甲状腺扫描为弥漫性 增大，放射性分布均匀。结节性甲状腺肿可见有功能 或无功能结节 24小时尿碘含量下降。 诊断和鉴别诊断 慢性淋巴细胞性甲状腺炎。 甲状腺癌鉴别 GRAVES病 治疗 生理性甲状腺肿大如青春期、妊娠、哺乳期的甲 状腺轻度肿大，可多食含碘食物，观察甲状腺 肿大发展情况，暂不用药。但非生理性者，或 甲状腺肿大明显者可选用以下治疗： 一、甲状腺激素 甲状腺片60-180mg/d或优 甲乐100-200ug/d，先从小量开始，逐渐增加 剂量。疗程3-6个月。如有甲状腺结节，甲状 腺片可加至240mg/d，疗程6个月以上 二、手术治疗 单纯性甲状腺肿 一般不需手术治 疗，有以下情况者考虑手术治疗： 1、巨大甲状腺，给日常生活代来困难者； 2、有压迫症状者； 3、有结节、且结节和甲状腺癌不宜区别者。 有以上情况者可作甲状腺次全切除术，术后长 期服用甲状腺激素制剂 预防 缺碘引起的甲状腺肿可以预防，特别是 地方性甲状腺肿在我国早已开展了预防 。食盐加碘和碘油注射均是预防措施， 通过预防，我国的地方性甲状腺肿发病 率大大降低。 d+UGse0WIug2YJvh3ZLxj5!Myk6$OAm8&QBn9*RDpb)TEqc-UGse0WItf1XJvh3ZLxi4#Myk6$OAl7%PBn9*RDpa(SEqc-UGsd+VHtf1XJvh2YKwi4#Myk6!Nzl7%PBn9&QCoa(SEqc-TFrd+VHtf1WIug2YKwi4#Lxj5!Nzl7%OAm8&QCoa(SDpb)TFrd+VHse0WIug2YKvh3ZLxj5!Nzk6$OAm8&QCn9*RDpb)TFrc-UGse0WIug1XJvh3ZLxj4#Myk6$OAm8%PBn9*RDpb(SEqc-UGse0VHtf1XJvh3ZKwi4#Myk6$Nzl7%PBn9*RCoa(SEqc- UFrd+VHtf1XJug2YKwi4#Myj5!Nzl7%PBm8&QCoa(SEqb)TFrd+VHte0WIug2YKwi3ZLxj5!Nzl6$OAm8&QCoa*RDpb)TFrd+UGse0WIug2XJvh3ZLxj5!Myk6$OAm8&PBn9*RDpb)TEqc-UGpb(SEqc-UGse0VHtf1XJvh3ZKwi4#Myk6$Nzl7%PBn9*RCoa(SEqc-UFrd+VHtf1XJug2YKwi4#Mxj5!Nzl7%PBm8&QCoa(SEqb)TFrd+VHte0WIug2YKwi3ZLxj5!Nzl6$OAm8&QCoa*RDpb)TFrd+UGse0WIug2XJvh3ZLxj5!Myk6$OAm8&PBn9*RDpb)TEqc-UGse0WItf1XJvh3ZLwi4#Myk6$OAl7%PBn9*RDoa(SEqc- 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