(精选)【医学课件课件】Graves′ orbitopathy教学课件.pptVIP

*;Case report: Graves’ Disease;P.E. : diaphoresis, cachexia, a resting HR 110 beats/min, and a diffusely enlarged, nontender thyroid gland; lid retraction, mild proptosis,and conjunctival injection. The pt had been aware of a mass growing in the anterior neck for the previous 6 years and recent hair loss, heat intolerance, and a resting tremor. Thyrotropin levels were suppressed, at 0.01 mIU/L (reference range, 0.49 to 4.67). Total levels of triiodothyronine and thyroxine were elevated, at 791 ng/dL (reference range, 79 to 149) and more than 24 μg/dL (reference range, 4.5 to 12), respectively. The results of an immunoassay for levels of unbound triiodothyronine and thyroxine were not available. Dx: Graves’ disease. Tx: propranolol and methimazole resulted in a substantial improvement in fatigue, tremulousness, and tachycardia within 1 week. She was thereafter lost to follow-up.;*;Graves orbitopathy (GO);藥物治療 ;手術治療 ;A wait-and-see strategy in which pts are monitored until symptoms worsen can be challenged. First, many pts with even mild GO have a substantial decrease in their quality of life, as assessed either by general health–related quality-of-life questionnaires or by a GO–specific quality-of-life questionnaire (GO-QOL). Second, in a natural-history study of mild GO, spontaneous improvement occurred in about 20% of pts, but eye disease remained static in 65% and progressed in 15%. Two agents that may potentially inhibit pathogenic mechanisms believed to be relevant in GO are selenium and pentoxifylline.;The goal of the study was to determine whether selenium or pentoxifylline, as compared with placebo, could affect the course of GO (either by enhancing improvement or preventing worsening) and could improve quality of life. The study lasted 1 year and consisted of a 6-month period of intervention followed by a 6-month period of follow-up. Selenium was given as selenium selenite orally in a dose of 100 μg twice daily, pentoxifylline (Trental, Sanofi Aventis)