西安交通大学医学院内分泌系统疾病课件 Thyrotoxicosis.pptVIP

Thyrotoxicosis Zhang jin-an (张进安） Endocrinology Department; Center for Clinical Research, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University Thyrotoxicosis Thyrotoxicosis: occurs when tissues are exposed to excess amounts of thyroid hormone, resulting in specific metabolic changes and pathophysiologic alterations in organ function ----Thyrotoxicosis describes the clinical syndrome Hyperthyroidism: denotes increased formation and release of thyroid hormone from the thyroid gland ---Thyroid gland function is high Causes of Thyrotoxicosis Primary hyperthyroidism??Graves disease??Toxic multinodular goiter??Toxic adenoma??Functioning thyroid carcinoma metastases??Activating mutation of the TSH receptor??Struma ovarii (ovarian leratoma)??Drugs: iodine excess Thyrotoxicosis without hyperthyroidism??Subacute thyroiditis??Silent thyroiditis??Ingestion of excess thyroid hormone (thyrotoxicosis factitia) or thyroid tissue(hamburger toxicosis)Secondary hyperthyroidism??TSH-secreting pituitary adenoma??Thyroid hormone resistance syndrome: occasional patients may have features of thyrotoxicosis??Chorionic gonadotropin-secreting tumors a ?? Graves’ Disease (GD) 1. Basedow’s or Parry’s disease an organic autoimmune disorder, hyperthyroidism, diffuse goiter, exophthalmos, dermopathy 2. accounts for 60 to 80% of thyrotoxicosis 3. 2% of women but is one-tenth as frequent in men 4. typically occurs between 20 and 50 years of age Etiology and pathogenesis 1. Genetic factors (1) familial predisposition: (2) HLA: HLA-B8, HLA-B35, HLA-B46. 2. Autoimmunity (1) TRAbs: TSI,TSAb,TSBAb (2) TPOAb in 80% patient (3) The ratio of Ts/Th decreased (4) Class II molecules expressed in thyroid cell (5) Retro-orbital fibroblasts express a TSH receptor like protein 3. Environmental factor str