HYPOTHYROIDISM亚临床甲状腺功能减退症ppt课件.pptVIP

胆道疾病病人护理化工企业本质安全理论实践及方法内科护理学呼吸系统总论概论脾胃病常见症状及治疗经验偏瘫截瘫康复训练手册偏执性精神障碍品管圈实践 胆道疾病病人护理化工企业本质安全理论实践及方法内科护理学呼吸系统总论概论脾胃病常见症状及治疗经验偏瘫截瘫康复训练手册偏执性精神障碍品管圈实践 SUBCLINICAL HYPOTHYROIDISM Alex Gonzalez MD, FACP Alex Gonzalez MD, FACP Dayan, C. M. et. al. N Engl J Med 1996;335:99-107 Age-Specific Rates for the Development of Hypothyroidism and Hyperthyroidism in Women Causes of hypothyroidism Autoimmune thyroiditis (Hashimoto’s) Atrophic Goitrous Radioactive iodine Rx for Graves’. Thyroid surgery Neck irradiation Drugs Hypothyroidism in the elderly Symptoms of hypothyroidism are similar to symptoms due to aging. 78 y.o. fell at home and fractured a hip. He was very slow to recover after anesthesia. TSH: 86 uU/L (n: 0.4- 5) Primary HypothyroidismRecommended screening: A. Thyroid Assoc.: Screen every 5 years after age 35 A.A. of Fam. Physicians/ A.A.of Clinical Endocrinologists: Periodic screening of asymptomatic women over 60. No screening for men. US Preventive Services Task Force: No screening recommended Thyroid function studies Serum TSH. 0.4- 5.0 mU/L Total T4. 5-11 mcg/dL, Free T4 0.8-1.8 ng/dL Total T3. 95-170 ng/dL, Free T3 2.0-4.4 pg/mL Total rT3 30-50 ng/dL aTPO and antithyroglobulin antibodies Thyroglobulin TSH receptor antibody (TSI) Thyroid Ultrasound Radioactive uptake/Scan Biopsy Thyroid function screen TSH (0.4- 5.0 mU/L) Screening for thyroid disease Normal TSH = normal thyroid function Low TSH = Hyperthyroidism. High TSH = Primary Hypothyroidism When the TSH is abnormal, follow with a serum Free T4 for confirmation. Diagnosis of Primary Hypothyroididsm Elevated TSH Low Free T4 68 y.o. woman with fatigue, somnolence and cognitive decline.Radioactive Iodine for Graves’ disease 20 years ago T