甲减课件2014本科概要1.pptxVIP

甲状腺功能减退症（甲减）; 掌握甲状腺功能减退症的临床表现和治疗方法 熟悉甲状腺性甲减最常见的病因—慢性淋巴细胞性甲状腺炎的病因、发病机制、临床表现和诊断要点 了解甲状腺功能减退症的分类和常见病因;一、定 义;二、甲减的分类-根据起病年龄分类;根据病变部位分类 ;根据病因分类;根据甲状腺功能减低的程度分类 ; 甲状腺性甲减的主要病因 自身免疫损伤：各种自身免疫性甲状腺炎如桥本甲状腺炎、 甲状腺破坏：手术、放射碘治疗 碘过量 抗甲状腺药物 ;中枢性甲减的病因 ;周围性甲减的病因 ;病史询问：手术放射治疗及既往甲状腺疾病史 发病隐匿，病程较长，可缺乏特异症状和体征 以代谢率减低和交感神经兴奋性下降为主要表现 ; 典型病人 1、粘液性水肿面容： 可有表情呆滞、面色苍白、颜面和/或眼睑浮肿、唇厚舌大、常有齿痕，声音嘶哑，头发干燥，稀疏，脆细 2、皮肤 干燥、粗糙、脱皮屑、皮肤温度低、浮肿，指甲生长缓慢，厚 脆，表面常有裂纹。腋毛和阴毛稀疏脱落 3、精神神经系统 反应迟钝，嗜睡，理解力和记忆力减退，腱反射变化具有特征性 4、肌肉和关节 肌肉松弛无力，常感肌肉关节疼痛、僵硬。受冷后加重。发育期间骨龄常延迟。; 典型病人 5、心血管系统 心动过缓，心音低弱，心输出量减低，心包积液 6. 血液系统：贫血 7. 消化系统 食欲↓、腹胀、便秘 8. 内分泌系统： 女性月经过多，久病闭经，少数病人出现泌乳，继发垂体增大 9. 粘液性水肿昏迷 严重全身疾病,甲状腺激素替代治疗中断, 寒冷,手术, 麻痹,镇静药等可诱发。嗜睡,低体温, 呼吸徐缓,心动 过缓,血压下降,肌肉松弛,甚至昏迷,休克等;Figure 9-3. (A) The classic torpid facies of severe myxedema in a man. The face appears puffy, and the eyelids are edematous. The skin is thickened and dry. (B) The facies in pituitary myxedema is often characterized by skin of normal thickness, covered by fine wrinkles. Puffiness is usually less than in primary myxedema. The eyelids are often edematous. The palpebral fissure may be narrwowed because of blepharoptosis, due to diminished tone of the sympathetic nervous fibers to Müllers levator palpebral superious muscle and is the opposite of the lid retraction seen in thyrotoxicosis. The modest measurable exophthalmos seen in some patients with myxedema is presumably related to accumulation of the same mucous edema in the orbit as is seen elsewhere. It is not progressive and carries no threat to vision, as in the ophthalmopathy of Graves disease. The tongue is usually large, occasionally to the point of clumsiness. Sometimes a patient will complain of this problem. Sometimes it is smooth, as in pernicious anemia (of course, pernicious anemia may coexist). Patients do not usually complain of soreness of the tongue, as they may in pernicious anemia. When