李益明-甲减.pptVIP

甲状腺功能减退Hypothyroidism 复旦大学医学院内分泌科 李 益 明 Hypothalamic-pituitary-thyroid axis Overview Clinical syndrome Slowing down of metabolism Slowing of growth and mental retardation in infants and children Generalized slowing down of organism Deposition of glycosaminoglycans in skin and muscle Reversible with therapy Etiology and Classifcation Primary(thyroid failure) Hashimoto’s thyroiditis Iodide deficiency or excessive Radioactive iodine therapy for GD Subtotal thyroidectomy Subacute thyroiditis Secondary: pituitary deficit Tertiary: hypothalamic dysfunction Peripheral resistance to thyroid hormone Pathogenesis Affects each tissue Accumulation of glycosaminoglycans (hyaluronic acid) Not to excessive synthesis But decreased destrution Increased capillary permeability Interstitial edema Skin Heart muscle Striated muscle Clinical Features Adults Symptoms Easy fatigability Coldness Weight gain Constipation Menstrual irregularities Signs Cool, rough, dry skin Puffy face and hands Hoarse and husky voice Slow reflexes Yellowish color skin Clinical Features Cardiovascular signs Impaired myocardium contraction Bradycardia Diminished cardiac output ECG: low voltage of QRS, P, T waves Pericardial effusion Coronary artery disease Cardiac angina(Replacement therapy aggravate ) Clinical Features Pulmonary function Shallow, slow respiration Respiratory failure Intestinal peristalsis Markedly slowed Constipation Renal function Decreased glomerular filtration Clinical Features Anemia Impaired hemoglobin synthesis Menorrhagia and Absorption of iron? Folate deficiency Pernicious anemia Nuromuscular system Muscle weakness Slow reflexes Central nervous system symptoms Inability to concentrate Anovulatory cycles and infertility Depressed Symptoms of hypothyroidism Symptoms % of cases Weakness 99 Dry skin 97 Coarse skin 97