桥本 甲状腺炎.pptxVIP

桥本氏甲状腺炎; 一、疾病定义与概述 二、临床诊断 三、治疗措施 四、中医认识 五、最新进展 ; Hashimoto’s?disease: A progressive disease of the thyroid gland characterized by the presence of antibodies directed against the thyroid and by infiltration of the thyroid gland by lymphocytes (white blood cells activated by the immune system). Hashimoto disease is the most common cause of hypothyroidism in North America and Europe. In Hashimoto disease, the thyroid gland is usually enlarged (goiter) and has a decreased ability to make thyroid hormones. Hashimoto disease predominantly affects women, and it can be inherited. Also known as autoimmune thyroiditis and Hashimoto thyroiditis. ;桥本氏甲状腺炎概述：;甲状腺炎概述：;桥本甲状腺炎 Hashimoto thyroiditis ;桥本甲状腺炎 Hashimoto thyroiditis ;流行病学：;病因与发病机制：;;;TPO;[肉眼] 甲状腺弥漫性对称性肿大，稍呈结节状，质较韧，60g～200g左右，被膜轻度增厚，与周围组织无粘连，切面呈分叶状，色灰白灰黄。 [光镜] 实质组织破坏、萎缩，大量淋巴细胞及不等量的嗜酸性粒细胞浸润、淋巴滤泡形成、纤维组织增生，有时可出现多核巨细。;典型活检病理 特征：;Diagnose; 甲减伴甲状 腺萎缩;临床表现：;enlarged thyroid Weight gain fatigue paleness or puffiness of the face joint and muscle pain constipation inability to get warm ;甲状腺功能：20%甲减，5%甲亢，余可正常 自身抗体： Tpo-Ab， TgAb 甲状腺超声：甲状腺肿大呈弥漫性病变，回声减低、不均 核素扫描：不作为诊断常规 FNAB（细针穿刺抽吸活检）：滤泡细胞嗜酸性变特征性改变, 背景较多淋巴细胞 备注：2012年《甲状腺结节和分化型甲状腺癌诊治指南 》：凡直径1cm 的甲状腺结节，若无特殊，均可考虑FNAB检查。;甲状腺超声：;甲状腺核素扫描：;a solitary cold nodule in a 34-year-old woman who com-plained of a palpable right-sided neck mass of 5 months duration. At physical examination, the nodule felt very firm. Thyroid function parameters were all in the normal range, and the 24-hour RAIU was 22%. Photomicrograph (original magnification,×150; H-E stain)demonstrates Hashimoto thyroiditis 34岁，女性，主诉右颈部明显肿 块5个月。体检触及坚硬结节。 甲状腺功能???标均在正常范围内， 24小时RAIU为22％。 组织活检示：桥本甲状腺炎 ;Treatment;治疗要点;限碘　限制碘摄入量在安全范围(尿碘100～200μg/L) 阻止 甲状腺自身免疫破坏进展 随诊观察　(1)甲状腺功能正常者; (2)合并亚临床甲减， TSH10mU/L者 甲状腺激素替代治疗 (1)合并加减; (2)合并亚临床加减， TSH≥10mU/L者 甲状腺激素替代治疗通常予L-T4 50～100μg/ d ,逐步增至