内分泌内科 甲亢.ppt

甲状腺机能亢进症Hyperthyroidism;;Regulation of Thyroid Hormones;甲状腺毒症(thyrotoxicosis)的常见原因 甲状腺功能亢进症： ⒈弥漫性毒性甲状腺肿（Graves病 diffuse toxic goiter） ⒉桥本甲状腺毒症(Hashitoxicosis) ⒊新生儿甲状腺功能亢进症 ⒋多结节性毒性甲状腺肿(Toxic multiple nodular goiter) ⒌甲状腺自主高功能腺瘤(Plummer disease) ⒍滤泡状甲状腺癌 ⒎碘致甲状腺功能亢进症（IHH） ⒏HCG相关性甲状腺功能亢进症（绒毛膜癌、葡萄胎等） ⒐垂体TSH瘤或增生致甲状腺功能亢进症 ;非甲状腺功能亢进类型 ⒈亚急性肉芽肿性甲状腺炎（亚急性甲状腺炎） ⒉亚急性淋巴细胞性甲状腺炎（无痛性甲状腺炎） ⒊慢性淋巴细胞性甲状腺炎（桥本甲状腺炎、萎缩性 甲状腺炎） ⒋产后甲状腺炎（PPT） ⒌外源甲状腺激素替代 ⒍异位甲状腺激素产生（卵巢甲状腺肿等）;Graves 病;Figure 7-15 Possible sequence and clinical outcome in AITD, indicating the interrelation of envirenmental and genetic factors, and dependence of the clinical picture on the type of immune response. ;临床表现;甲状腺毒症;Figure 10-7. Plummers nail changes, showing thinning of the nail and marked posterior erosion of the hyponychium. ;Thyroid acropachy;甲状腺肿大;;眼征;;;Palpebral edema;Conjuntival injection and chemosis;Paralysis of upward Gaze on the right;Figure 12-3. End stage in severe involvement of extraocular muscles in ophthalmopathy;a. Extraocular muscle from a patient with Graves disease and infiltrative ophthalmopathy. The lymphocytic infiltration and fibrosis are characteristic findings. ;Graves病眼征的分级标准（ 美国甲状腺学会ATA ) 级别 眼部表现 0 无症状和体征 无症状，体征有上睑挛缩、 Stellwag征、von Graefe征等 2 有症状和体征，软组织受累 3 突眼（﹥18mm) 眼外肌受累 角膜受累 视力丧失（视神经受累） ;甲状腺危象;甲亢性心脏病;Figure 10-9. Congestive heart failure induced in an otherwise healthy young woman (a), which receded (b), and returned to normal (c), during and after therapy. ;淡漠型甲亢 T3 或T4型甲亢 亚临床型甲亢 妊娠期甲亢 胫前黏液性水肿 甲状腺功能正常型Graves眼病;胫前粘液性水肿;Figure 12-7. (a) Massive infiltrative , localized myxedema in a female patient with Graves disease and progressive exophthalmos. The lesions have become confluent over the lower extremities. (b) In the same patient, localized myxedema, involving the phalanges, is evident. ;;实验室及其他检查;影响TBG的因素;;Figure 6-8. The effect of serum TSH assay sensitivity on the discrimination of euth