甲状腺疾病2.1讲解材料.pptVIP

甲状腺疾病;;甲状腺神经（迷走神经）;甲状腺生理功能;A;;Fig. 2-2. The iodide cycle. Ingested iodide is trapped in the thyroid, oxidized, and bound to tyrosine to form iodotyrosines in TG; coupling of iodotyrosyl residues forms T4 and T3. Hormone secreted by the gland is transported in serum. Some T4 is deiodinated to T3. The hormone exerts its metabolic effect on the cell and is ultimately deiodinated; the iodide is reused or excreted in the kidney. A second cycle goes on inside the thyroid gland, with deiodination of iodotyrosines generating iodide, some of which is reused without leaving the thyroid.;下丘脑TRH 垂体前叶TSH 甲状腺 T4/T3 血 液 T4/T3 ;;分 类;单纯性甲状腺肿 simple goiter;缺碘 甲状腺素合成不足 TSH分泌增加 甲状腺肿大（代偿性） ? 扩张的滤泡均匀散布在甲状腺各部 弥漫性 endemic goiter ? 扩张的滤泡集成大小不等结节 结节性 nodular goiter;临 床 表 现;预 防;治 疗 原 则;甲状腺功能亢进 HYPERTHYROIDISM;病因 未完全明了;;临床表现;Common symptoms and signs of hyperthyroidism Palpitations 心悸 Heat intolerance 畏热 Nervousness 紧张不安 Insomnia 失眠 Breathlessness 呼吸困难 Increased bowel movements 肠蠕动增加 Light or absent menstrual periods 月经紊乱 Fatigue 疲乏 Fast heart rate 心率加快 Trembling hands 手颤 Weight loss 体重减轻 Muscle weakness 肌肉无力 Warm moist skin 皮肤潮湿 Hair loss 脱发 Staring gaze 凝视;Classic severe Graves‘ ophthalmopathy demonstrating a widened palpebral fissure, 眼裂加宽periorbital edema,眶周水肿 proptosis, chemosis, and conjunctival injection. 眼球突出，结膜充血、水肿;Graves disease patient： exophthalmos vitiligo;特殊检查;特殊检查;治疗;外科治疗;★手术适应症;手术禁忌症;术前检查;★药物准备(术前准备);★碘准备 Lugol’s solution ;碘准备 Lugol’s solution ;碘准备 Lugol’s solution;碘准备 Lugol’s solution;心得安准备;心得安准备;手术原则 1;手术原则 2;术后观察及护理;★手术并发症;手术并发症;手术并发症;手术并发症;手术并发症;手术并发症 ?甲状腺危象（少见）;降低血中甲状腺素水平 抑制释放 Lugol液 3~5ml口服，以后每小时2ml 10%碘化钠10ml+10%GS 500ml 静点， 24小时可给20~30ml 抑制合成 甲基硫氧嘧啶 200mg Tid 首剂600mg 他巴唑 20mg q6h 首剂 60mg ; 降低周围组