甲亢新进展精要课件.ppt

妊娠期甲亢的治疗 妊娠期： 监测甲状腺功能 *有主张使用FT4作为指标，因为孕妇血清FT4水平与脐带血的FT4水平显著相关 *FT3指标缺乏这种相关 *开始治疗的前2个月，TSH水平不能作为监测指标 *TSH水平达到正常是甲亢得到有效控制的指标，此时ATD应当减量或者停药 产后：ATD与哺乳 *哺乳期治疗甲亢，PTU应当作为首选，MMI的乳汁透过率较PTU高。 *从目前搜集到的文献报告：哺乳期间使用PTU 300毫克/天或MMI 20毫克/天对胎儿甲状腺功能没有明显影响。 *应当监测婴儿的甲状腺功能。 Follicles: the Functional Units of the Thyroid Gland. The follicles are the functional, secretory units of the thyroid gland.1 Follicular cells produce thick, proteinaceous colloid1,2 that fills the lumen.2,3 Colloid is composed primarily of thyroglobulin (Tg).4 Thyroglobulin is a high-molecular weight glycoprotein that facilitates the assembly of thyroid hormones within the thyroid follicular lumen.1 The amino acid tyrosine, which is incorporated within the molecular structure of Tg,1 becomes iodinated.2 Iodine is bound to tyrosyl residues in Tg at the apical surface of the follicle cells to form, in turn, monoiodotyrosine (MIT) and diiodotyrosine (DIT).1 MIT and DIT combine to form the 2 biologically active thyroid hormones, thyroxine (T4) and triiodothyronine (T3).1 In addition to providing the matrix for thyroid hormone synthesis,5 the Tg molecule also stores a large supply of iodine and thyroid hormone for secretion at a steady rate or on demand.5 References Braverman LE, Utiger RD, eds. The Thyroid: A Fundamental and Clinical Text. 8th ed. Philadelphia, Pa: Lippincott, Williams Wilkins; 2000:488. Fauci AS, et al, eds. Harrisons Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:2012. 3. DeGroot LJ, Larson PR, Hennemann G: The Thyroid and Its Diseases. Chapter 1: Phylogeny, ontogeny, anatomy, and metabolic regulation of the thyroid, revised 01 August 2002 by Dumont JE, Corvilain B, and Maenhaut C. (Presented online at ). Accessed June 6, 2003. 4. Hardman JG, Limbird LE, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 9th ed. McGraw Hill, New York; 1996:1385 5. Medeiros-Neto G, et al. Endocr Rev. 1993;14:165-183. * 最后一方面，我们看一下赛治的用药方式方面的优势。以往的血液药代动力学研究