医学课件--甲状腺素与抗甲状腺药.ppt

[应用]:常用：碘化钾、卢戈氏液（复方碘溶液） 　1、治疗单纯甲状腺肿：小剂量，补充T3/T4 合成原料；2、甲亢术前准备：术前两周加服，缓解症 　　状，减少手术并发症； 3、甲状腺危象治疗：抑制T3/T4大量释放。 [不良反应] 1、慢性碘中毒：口、眼刺激症； 　 急性碘中毒：血管神经性水肿，喉头水肿。 2、过量诱发甲亢和甲状腺功能紊乱。 3、碘化物可透过胎盘屏障，可进入乳汁， 　　而影响胎儿和婴儿。 三、放射性碘 [作用机制] １３１I po或iv后被甲状腺选择性摄取,　放出β射线(99%)和γ射线(1%)。β射线可破坏增生的腺体组织,　由于射程短(2mm),　故对周围正常组织无明显影响。 明显减少T3/T4的合成与释放。 [不良反应] 易致甲状腺功能低下； 　　 诱发肿瘤(20岁以下禁用)。 ［ 131I的应用］ 用于不宜手术、术后复发或对硫脲类无效/过敏的甲亢治疗。 　　 由于γ射线可被捕获，故131I也用于甲状腺功能的临床诊断。 四.β受体阻断药 通过阻断β受体而抑制心脏兴奋性，降低基础代谢率。同时可抑制T4在外周组织中脱碘转变为T3。 主要用于对其它疗法无效的甲亢或与硫脲类配伍应用。 　　 　！！！ * Levels of T4 (solid black curve), T3 (solid blue curve), and TSH (broken black curve) are normal early in the progression of hyperthyroidism (stage A). A stage B, where thyroid secretion has already increased, is presumed, but even an ultrasensitive TSH assay does not definitively demonstrate suppression. At stage C, a further excess of the thyroid hormones develops, which is sufficient to exacerbate cardiac symptoms. T4 may be within the upper-normal range and T3 minimally elevated, making diagnosis difficult. However, the TSH level is typically depressed at this point, and its measurement by the sensitive TSH assay can yield the diagnosis. In the absence of cardiac symptoms, hyperthyroidism is generally not det ected until both T4 and T3 are substantially above normal (stage D) and thyrotoxic symptoms are evident. * In some patients, a severe exacerbation of hyperthyroidism known as thyroid storm develops.57 The disorder is difficult to define precisely; as a result, incidence figures vary widely. The term should probably be restricted to a severe and prostrating illness characterized by fever, severe tachycardia, extreme sweating, and pronounced restlessness, leading ultimately, if unchecked, to dehydration and shock. Thyroid storm is rarely the initial manifestation of hyperthyroidism, although it may be the event that brings the patient to seek medi