12诊断学头颈部英语.pptVIP

甲状腺滤泡细胞圆形围绕在蛋白质胶状体，甲状腺滤泡细胞膜上有TSH受体，滤泡细胞内有甲状腺球蛋白。 细胞膜上的TSH受体与TSH受体抗体结合后在甲状腺滤泡细胞内通过腺苷酸环化酶-cAMP的信号传导途径，刺激甲状腺球蛋白的生成及转移到细胞外。 活性碘使甲状腺球蛋白中的酪氨酸残基碘化，生成一碘酪氨酸（MIT）或二碘酪氨酸（DIT）残基。然后在过氧化物酶催化下，一分子DIT与一分子MIT缩合成一分子T3，两分子DIT缩合成一分子T4。含T3、T4的甲状腺球蛋白再摄取到甲状腺滤泡腔中贮存，并释放T3和T4。 * 焦急、焦虑、多汗、怕热、震颤、多动、心悸、消瘦、食欲增加、月经不稳 多动，兴奋 窦性心动过速 或 房性心律失常，房颤，心衰收缩期高血压，脉压差大温暖，湿润，柔、光滑的皮肤 - 温暖的握手过度出汗，掌红斑，甲脱离伸展双手细颤 大肌肉无力，腹泻，男性乳房发育症 * * * * * * * * Common Symptoms Nervousness [n?:v?sn?s] 焦急 Anxiety[???za??ti] 焦虑 Increased perspiration [?p?:sp??re??n] 多汗 4. Heat intolerance 怕热 5. Tremor[?trem?(r)] 震颤 6. Hyperactivity 多动 7. Palpitations [?p?lp??te??nz] 心悸 8. Weight loss despite increased appetite 消瘦食欲增加 9. Reduction in menstrual flow or oligo-menorrhea 月经不稳 Common Signs Hyperactivity, Hyper kinesis [k??ni:s?s] 多动/兴奋 Sinus tachycardia or atrial arrhythmia [?eitri?l ??riemi?], atrial fibrillation [?f?br?‘le???n], congestive heart failure [k?n’d?est?v] 窦性心动过速/房性心律失常/房颤/心衰 Systolic hypertension, wide pulse pressure 收缩期高血压/脉压差大 Warm, moist, soft and smooth skin- warm handshake 热潮湿 5. Excessive perspiration [?p?:sp??re??n] 多汗 6. Fine tremor of out stretched hands [st‘ret?t] 伸展细颤 Large muscle weakness, Diarrhea, Gynecomastia 肌肉无力/腹泻/男性乳房发育 Diagnosis Typical clinical presentation Markedly suppressed TSH (0.05 μIU/mL) Elevated FT4 and FT3 (Markedly in Graves) Thyroid antibodies – by Elisa – anti-TPO, TSI ECG to demonstrate cardiac manifestations Nuclear Scintigraphy to differentiate the causes www.drsarma.in Algorithm for Hyperthyroidism Measure TSH and FT4 ? TSH, ? FT4 Measure F