甲亢讲课09033 ppt课件.ppt

CT scan of a 58-year-old woman with profound visual loss from optic neuropathy in association with Graves ophthalmopathy (GO) shows massive enlargement of all extraocular muscles and apical compression of the optic nerves. (Top) Axial view. (Bottom) Coronal view. How would you feel with muscles this big? GO normal 浸润性突眼 治疗 一般治疗：高枕卧位 限制钠盐及使用利尿剂 保护眼睛-戴有色眼镜 眼药（人工泪液） 睡眼时可用眼罩或盐水纱布 戒烟 浸润性突眼 治疗 突眼明显，有明显充血、复视及眼外肌水肿等可采用以下措施治疗 糖皮质激素：强的松 40-80mg/d， 2-4周，然后逐渐减量，总疗程3-12个月，重症患者甲强龙 500-1000mg 静滴 隔日1次，连用3次 免疫抑制剂治疗副作用 糖代谢紊乱 血压增高 体重增加 骨质疏松（股骨头坏死） Graves眼病的球后放疗 放射治疗的指征： 进行性发展的严重浸润性突眼 糖皮质激素治疗失败 视神经受累 眼眶减压术的辅助治疗 放射治疗的方法 直线加速器 总照射量 2000 rad，分10次在 2周内完成 球后放疗的疗效 治疗后6周左右，症状开始改善 3-6月后达最大疗效，作用可持续1年 2/3的患者可获得明显改善 不能改善眼睑症状和球后脂肪突出 无眼肌增生肥大的突眼和病程较长的眼肌麻痹无效 Graves眼病的眶部减压治疗 眶部减压治疗的指征 严重眼球突出伴疼痛或角膜溃疡 威胁视力而糖皮质激素治疗失败 复视患者需用眼外肌手术纠正者 眶部减压术式 经上颌窦切除眼眶底部和两侧壁 上颌窦炎为禁忌症。 眶部减压治疗的疗效和缺点 能迅速缓解症状，突眼度可减少 5-8 mm 患者在术后能迅速撤用激素，眶部症状无加剧 术后复视率可高达 50% 鼻泪管阻塞 姑息性治疗 甲状腺相关性眼病的其他治疗 其他免疫抑制剂：环磷酰胺、硫唑嘌呤、环孢A 血浆置换疗法 甲状腺全切以去除全部抗原 Octreotide * * Time course of destructive thyroiditis. TSH, thyroid-stimulating hormone; T3, triiodothyroxine; T4, thyroxine. * Thyroid-stimulating-hormone-secreting pituitary adenoma. These are usually large tumors, as in this case with lateral and small suprasellar extensions. * * * A large multinodular goiter with a dominant nodule in the right lobe. * * Asian, 20 mm; black, 22 mm. Increase in proptosis of 3–4 mm is mild involvement; 5–7 mm, moderate involvement; and over 8 mm, severe involvement. * Patient with mild ophthalmopathy of Graves disease. Left: Before radioactive iodine therapy. Note white sclera visible above and below the iris as well as mild periorbital edema. Right: After radioactive iodine therapy. Marked improvement is noted * * Mechanism of optic nerve compression in thyroid-associated ophthalmopat