甲减幻灯片ppt课件.pptVIP

甲状腺功能减退; 甲状腺功能减退症（hypothyroidism，简称甲减）是由各种原因导致的低甲状腺激素血症或甲状腺激素抵抗而引起的全身性低代谢综合征。 病理特征：粘多糖在组织和皮肤堆积，表现为粘液性水肿（myxedema）。 ;患病率;根据甲减起病时年龄分为三类;根据病变部位分为四类 ;病 因 ;幼年型甲减 成年型甲减 根据病变部位进一步分为四大类： 原发性甲减 继发性甲减 三发性甲减 周围性甲减 ;原发性甲减 自身免疫损伤 甲状腺破坏 碘过量 药物抑制 甲状腺激素合成障碍 病因不明，又称特发性，可能与甲状腺自身免疫损伤有关 ; 继发性甲减 由垂体疾病使促甲状腺激素（TSH）分泌减少引起。 三发性甲减 由下丘脑疾病使TRH分泌减少，导致垂体TSH分泌减少所致。 ; 周围性甲减 少见，多为家族遗传性疾病，由于血中存在甲状腺激素结合抗体，或甲状腺激素受体数目减少以及受体对甲状腺素不敏感，使甲状腺激素不能发挥正常的生物效应。 ; 甲减临床表现 血清TT4 或FT4 必备的实验室指标 TSH 最敏感的指标 ; 临床上可无明显甲减表现 血清FT3或TT3正常 对于甲状腺性甲减，仅表现为TSH的升高 ;临床表现;呆小症;幼年型甲减;成人型甲减;成人型甲减;;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 anemia is marked, the tongue may be pale, but more often it is red, in contrast to the pallid face. ;实验室化验和检查 ;生化检查和其他检查 ; 生化检查： 胆固醇明显升高，甲状腺性甲减常大于7.8mmol/L(300mg/dl)，而继发性甲减胆固醇正常或降低。 增高：血清甘油三酯，