甲状腺肿英文.ppt

Thephysiologicalfunctionsofthyroidgland Synthesize reserveandsecretethyroxine3 5 3 5 tetraiodothyronine T43 5 3 triiodothyronine T3 Synthesisofthyroidhormones ConcentratesiodineOrganification iodineoxidationanditsincorporationintotyrosinetoformmonoiodotyrosine MIT anddiiodotyrosine DIT Coupling T4andT3arisefromthecouplingofeither2DITresiduesor1MITand1DITresidue requiresthyroidperoxidase CirculatingT4andT3 Thyroidhormonesexistintwoforms freeandproteinboundthefreehormoneconcentrationdeterminesthethyroidstatusirrespectiveofthetotalplasmaconcentrationthetotalhormoneisdeterminedbythyroxine bindingglobin TGB andalbumin Thethyroidcellhasabilitytoconcentrateiodine therefore thestationofthyroidglandcanbejudgedbycheckingiodineuptakeThyroidperoxidaseplaysanimportantroleinthecourseoforganificationandcoupling Compoundsthatinhibitedtheactivityofthyroidperoxidasecanbeusedinthetreatmentofpatientswithhyperthyroidism Significance IncreasedTBG1 Pregnancy2 Treatmentwithsupraphysiologicamountsofestrogens 雌激素类includingoralcontraceptives 口服避孕药3 InsomepatientswithcirrhosisoracutehepatitisDecreasedTBG1 Proteinmalnutrition hepaticfailure chronicillness2 Nephroticsyndrome3 Duringtreatmentwithandrogenicsteroids雄激素orpharmacologic药理学dosesofglucocorticoids thyroxine bindingglobin TGB Testsofthyroidfunction MeasurementoftotalserumthyroidhormoneconcentrationsSerumfreeT4andT3concentrationsRadioactiveiodineuptake hypothalamus pituitary Thyroidgland TRH TSH T3T4 SmalldoseiodoineLargedoseiodine 甲状腺激素分泌的调节 Serumthyrotropin Testsofthyroidregulation Anatomicevaluationofthethyroidgland ThethyroidscanThyroidultrasoundNeedlebiopsy Othertestsspecificallyrelatedtothyroidfunctionordisease Anti thyroidantibodiesthyroidmicrosomalantibody TMAb thyroglobulinantibodies TgAb thyroidTSHreceptor TRAb s Therolesofthyroidhormonesregulatetissuemetabolismcentralnervoussystemdevelopmentgrowthandbonematuration Goiter Epithelialcellsbenignhyperplasia noninflammationandnontumorNontoxicgoiter simplegoiter euthyroid甲状腺机能正常的Classification endemicsporadiccompensatoryToxicgoiter hyperthyroidism Diagnosisthyroidglandintumescence肿大 diffuseor andnodular thefunctionofthyroidglandnormal antibodiesagainstoneselfarenegativeDifferentialdiagnosisAutoimmunethyroiditis antibodiesarepositive如桥本氏炎Thyroidcancer Etiologyandpathogenesis Thyroidglandintumescence T3T4tendtonormal endemicgoiter iodinedeficiency Iodinedeficiency THinsufficience TSH Etiologyandpathogenesis Sporadicgoiter1 dietiodineSubstancesleadingthyroidglandintumescence2 drugs3 heredity4 immunity 阻止碘吸收及抑制甲状腺素分泌的物质如水中的钙和氟 硼 硅等卷心菜 甘蓝 芹菜中含有硫氰酸盐或有机氯酸盐 能够妨碍碘向甲状腺集聚 磺胺类药 硫脲类药 锂 钴等能抑制碘离子的浓集或碘离子有机化 照影剂 含碘药物等 甲状腺激素合成障碍 检测出一种自身抗体 甲状腺生长免疫球蛋白 可刺激甲状腺增生肿大 Clinicalmanifestations Simplethyroidglandintumescence usuallyasymptomatic severintumescencecancausepresssymptomeI diameter9cm Laboratoryfindings T3 T4 TSHnormalRadioactiveiodineuptakeincrease butthetimeofpeakdosenotmoveforewardThyroidglobulinincreaseAntibodiestothyroidarenegative Diagnosisanddifferentialdiagnosis Diagnosisthyroidglandintumescence diffus