桥本甲状腺炎临床医师继续教育讲座1

1、会计学1桥本甲状腺炎临床医师继续教育讲座桥本甲状腺炎临床医师继续教育讲座1急性甲状腺炎慢性甲状腺炎n 细菌性n 病毒性n 慢性淋巴细胞性甲状腺炎 桥本甲状腺炎（HT） 慢性萎缩性甲状腺炎(atrophic thyroiditis)(atrophic thyroiditis) n 慢浸纤性(Riedel Thyroiditis) n 产后甲状腺炎(postpartum thyroiditis)亚急性甲状腺炎n 亚急性肉芽肿性甲状腺炎（亚甲炎，de Quervein thyrioditis)n 亚急性淋巴细胞性甲状腺炎（无痛性甲状腺炎painless，寂静性-silent）其他甲状腺炎 放射、药物

2、放射、药物(胺碘酮，干扰素胺碘酮，干扰素-a)、外伤、结、外伤、结核、梅毒、真菌、布氏杆菌、寄生虫、结节病、核、梅毒、真菌、布氏杆菌、寄生虫、结节病、淀粉样变等淀粉样变等桥本甲状腺炎（Hashmoto Thyroiditis）Dr. Hakaru Hashimoto (1881-1934). Japanese surgeon.1912年首次报告4例患者什么是桥本甲状腺炎？桥本甲状腺炎Hashimoto thyroiditis 萎缩性甲状腺炎atrophic thyroiditis 无痛性甲状腺炎painless thyroiditis 产后甲状腺炎postpartum thyroiditis

3、自身免疫性甲状腺炎autoimmune thyroiditis AITD桥本甲状腺炎Hashimoto thyroiditis 萎缩性甲状腺炎atrophic thyroiditis 慢性淋巴细胞性甲状腺炎chronic lymphocytic thyroiditis 无痛性甲状腺炎painless thyroiditis 产后甲状腺炎postpartum thyroiditis 自身免疫性甲状腺炎autoimmune thyroiditis AITDTeng W, Shan Z, Teng X, et al.Effect of iodine intake on thyroid disease

4、s in China. N Engl J Med. 2006, 354(26):2783-93.Teng W, Shan Z, Teng X, et al.Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006, 354(26):2783-93.TSH-RTRAbTSHTSAbTSBAbT G IHCGT3,T4生理效应TSH受体配体病理作用TSBAb桥本甲状腺炎Normal thyroidglandTSB-AbEnd-stageHashimotothyroiditis* - Hypothyroidism

5、* initially: goiter w/ inflammationTSAbGraves diseasevvvHyperthyroidismAUTOIMMUNE THYROID DISEASE(AITD)Normal thyroidglandTSHTPOTPO-Ab+细胞毒作用NK细胞ADCC细胞凋亡与HTTPOAb TPO特异性T细胞淋巴因子(？)Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med 2003;348:2646-2655. 甲状腺功能减退甲状腺功能亢进Identical male twins with

6、Hashimotos thyroiditis were photographed at age 12. At age 8, they had the same height and appearance. During the intervening 4 years, small goiters developed and the growth of the twin on the right almost stopped. Biopsy indicated Hashimotos thyroiditis in each twins thyroid. Pathology of Hashimoto

7、s thyroiditis. In this typical view of severe Hashimotos thyroiditis, the normal thyroid follicles are small and greatly reduced in number, and with the hematoxylin and eosin stain are seen to be eosinophilic. There is marked fibrosis. The dominant feature is a profuse mononuclear lymphocytic infilt

8、rate and lymphoid germinal center formation. Image Description: A dense infiltrate of plasma cells and lymphocytes with germinal center formation is seen in this thyroid. Cells of the individual colloid follicles often display abundant pink granular cytoplasm, which is referred to as oncocytic chang

9、e, in this setting. These cells are referred to as Hurthle cells or oncocytes - these are metaplastic. Fluorescent thyroid scan in thyroiditis. The normal thyroid scan (left) allows identification of a thyroid with normal stable (127I) stores throughout both lobes. A marked reduction in 127I content

10、 is apparent throughout the entire gland involved with Hashimotos thyroiditis (right). 甲亢表现甲状腺肿大甲减表现和或和或甲状腺功能TPoAb，TgAb甲状腺超声或ECT临床诊断HTFNAB确诊HT临床表现典型，抗体升高临床表现不典型，抗体显著升高甲减伴甲状腺萎缩临床诊断ATFNAB确诊ATPearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med 2003;348:2646-2655. 特征HTPL产后甲状腺炎PL散发性甲状腺炎亚甲炎化脓性R

11、iedel年龄高峰3050Child-bearing age30402060儿童，20403060性别（F：M）9:12:15:11:14:1病因自免自免自免NO感染NO病理L,LC,FL,FL,F巨噬细胞,肉芽肿脓肿形成致密纤维组织甲状腺功能HypoHyper,HypoHyper,HypoHyper,HypoNormalNormalTPO-Ab增高增高增高Normal Normal 可升高ESRNormal NormalNormal增高增高Normal TRIU不定5%5%5%Normal Normal或降低正常甲状腺桥本病亚急性甲状腺炎单纯甲状腺肿JAMA 2004 Jan 14;291(

12、2):228-38. 刘晓云, 刘超, 覃又文, 等. 慢性淋巴细胞性甲状腺炎的局部免疫调节治疗J. 江苏医药, 2007, 33(2):124-126刘晓云, 段宇, 刘超. 桥本甲状腺炎免疫治疗的研究进展J. 医学综述,2006,12(6):344-346谢谢参与再见http:/ 主任医师 门诊时间：周二上午、周三下午、周四上午http:/ Hakaru Hashimoto (1881-1934). Japanese surgeon.1912年首次报告4例患者TSH-RTRAbTSHTSAbTSBAbT G IHCGT3,T4生理效应TSH受体配体病理作用TSBAb桥本甲状腺炎Identical male twins with Hashimotos thyroiditis were photographed at age 12. At age 8, they had the same hei