甲状腺素及抗甲状腺药.pdf

甲状腺素及抗甲状腺药 Weiwei Hu huww@zju.edu.cn Dept. Pharmacology, Medical School, Zhejiang University Pharmacology of thyroid hormones  1. 生长和发育 TH不足可致神经发育障碍、智力低下、身材矮小 （呆小症）, 成年可 致记忆减退、反应迟钝  2. 代谢 促进氧化、增加氧耗、提高基础代谢率、产热散热增多 甲减代谢降低，粘液性水肿，浆膜腔积液  3. 提高交感系统的敏感性 甲亢机体对交感神经和肾上腺髓质激素的敏感性增高  4. 心血管效应 （T3增加α基因表达，调节编码肌小节肌球蛋白） 甲亢心动过速、心脏肥大、外周阻力下降、脉压升高 甲减心动过缓、心排血减少、心包积液、外周阻力升高、脉压 降低、平均动脉压升高 Clinical uses of thyroid hormones  1. 甲状腺功能减退症 Cretinism(克汀, 呆小症): a situation induced by a insufficiency of thyroid hormone at birth and during minority (未成年)  execute growth, twined facial features, increased tongue and mental detainment Adult:  Myxedema(粘液性水肿)：真皮层粘多糖沉积  Fatigue, weakness, weight gain, cold intolerance  Coarse, dry hair, dry and rough pale skin, hair loss  Muscle cramps and frequent muscle aches  Constipation(便秘)  Depression, Memory loss  Abnormal menstrual cycles, decreased libido 左甲状腺素(Levothyroxine，L-T4)替代治疗  呆小症需尽早治疗  新生儿、老年、有心血管疾患者，从小剂量开始（因增加 心率和血压）  垂体功能低下者先用GCS，再用TH  粘液性水肿昏迷 （低体温、低血压、呼吸减弱、昏迷等): T3 (快而强，游离量多) 和GS (以防急性肾上腺皮质功能不 全) Clinical uses of thyroid hormones  2. 单纯性甲状腺肿 Supply iodide--iodide deficiency Thyroid hormones Surgery—nodule  3. Treat after thyroid cancer surgery to reduce TSH level to inhibit recurrence of cancer 抗甲状腺药 Hyperthyroidism ( 甲状腺功能亢进)  毒性弥漫性甲状腺肿(Graves Disease)常见  Graves Disease is caused by an abnormal immune system response that attacks the thyroid gland, and it causes too much production of thyroid hormones.  Antibodies serve as agonists to the TSH receptors on the