《桥本甲状腺炎》PPT课件.ppt

TheultrasonicdiagnosisofHashimotothyroiditis Tutor ZhengMinSpeaker WangLing IntroductionClinicalmanifestationsUltrasoundperformanceDifferentialdiagnosisSummary Hashimotothyroiditisalsocalledchroniclymphocyticthyroiditis JapanesescholarsHashimotoreportedfirstlyaccordingtothehistologicfeatures thatisthemostcommononeofautoimmunethyroiddiseases HTdiseaseslowly clinicalmanifestationisnotverytypical Andthecourseofalong pathologicalchangesandthyroidfunctionstateperformanceisdifferent sotheultrasonographyfindingsiscomplex Introduction From80 to90 patientsmainlymanifestedasthyroiddiffuseenlargementofasymmetry thyroidtexturetoughsuchasrubbersample withthesurroundingtissuewithoutadhesion Thelatecourseismorenodularoratrophy Earlymayhavehyperthyroidismperformance Latehypothyroidism Maybeduetothyroidatrophyperformanceformyxedema impotentandsoon Clinicalmanifestation Ultrasonographiccharacteristics thyroiddiffuseenlargementofasymmetry isthmusisobvious Theinternalechoreduction unevendistribution Thevisiblethinwire likeorcoarsenetwork likestrongecho Twodimensionalultrasonography LocalHTisrelativelyrare thatisaspecialtype earlymanifest Suchaseffectivelyandtimelytreatment prognosisandoutcomeisbetterUltrasonographyisonesideorbothsidelobeofthyroidownsingleormultipleunevenandhypoechoiczone boundaryclear formowerules like pattern spaceoccupyinglesioneffectisnotobvious EchoUnevennesstype Normalthyroidvolumeorbiger multipleuneven Increasingcoarseorfinewiresamplestrongecho Patchtype Normalthyroidvolumeorbiger diffuseddistributionsheethypoecho Diffusetype Thyroidvolumeincrease Essenceisdiffusetypeechoreduce Nodulestype Thyroidvolumeincrease diffusedistributionrangingfromthesizeofthehigh loworequalecho Classification 回声不均型 甲状腺球蛋白抗体 TGA 阳性 T3 T4 TSH正常 斑片型 弥漫型 结节型 Ultrasonicfoundtrachealsideswollenlymphnodes Isautoimmunethyroiddiseasemorespecificultrasoniconeofthesigns manifest Thyroidisthmusfront bilateralleafunderroundorovalechoic morphologicalrules partoftheskinmedullaboundaryclear earlyperiod essenceBloodflowsignalrich Eventheinfernosign PSVrise Prompthyperthyroidismornormal Withtheprogressofthedisease Therichbloodflowsignificantlylowerlevel PSVdroppedevenlowerthannormal Prompttypothyroidism laterperiod Bloodflowsignalsignificantlyreduced velocityobviouslyreduced PromptThyroidfunctionsignificantlyimpaired CDFI HTflowsignalmostsignificantlyincreased firesyndrome Thesignsmayoccurearlyhyperthyroidism stage alsobefoundinthelate hypothyroidism stage ThisnoteshouldnoticethyroidPSV andcombinethyroidfunctiontests SubacutethyroiditisNodulargoiterHyperthyroidism Differentialdiagnosis Thyroidprofileisnormalorincreased seeninsheethypoechoicarea moreirregular rearechoslightlyenhanced theisthmusisnoobviousthickening CDFI bloodflowisrichsurroundinghypoechoicarea butinternalflowsignalsisfewerornoSignal Subacutethyroiditis Theformerincreasemainlyaboutthesizeofthyroid thelatterincreasemainlyanteroposteriordiameter Isthmusthickening aninternalnetworkoracord likeechogenic Hyperthyroidism 甲亢 桥本 Twodimensionalultrasonography Thyroidsolitaryormultiplenodules Varyinsize Echodiversification CDFI Bloodflowsignaloccurringinbetweennodule butNodulesintheperipheralandintranodularbloodflowsignalless Nodulargoiter HTultrasonographyhascertaincharacteristics inthediagnosisanddifferentialdiagnosisofclinicalsignificance Inviewofthelongcourseofdisease comorbidity withcomplicatedclinicalmanifestations itssonographicappearancesarealsodifferent stillneededtobecombinedwithclin