妊娠期甲状腺疾病的规培讲课.pptVIP

妊娠期甲状腺功能减退症 产科 隋霜 甲状腺激素的生理作用 对于全身器官有广泛的影响 The Thyroid Increased LDL cholesterol2 Elevatedtriglycerides2 The Liver The Intestines Constipation4 Decreased GI motility4 Decreased fertility6 Menstrual abnormalities6 The Reproductive System Depression1 Decreased concentration1 General lack of interest1 Impaired fetal intellectual development7 The Brain Decreased function5 Fluid retention and edema5 The Kidneys Decreased heart rate3 Increased blood pressure3 Decreased cardiac output3 Diastolic dysfunction3 The Heart 1. Nemeroff CB. Clinical significance of psychoneuroendocrinology in psychiatry: focus on the thyroid and adrenal. J Clin Psychiatry. 1989;50(suppl):13-20. 2. Klausen IC, Nielsen FE, Hegedüs L, Gerdes LU, Charles P, Faergeman O.Treatment of hypothyroidism reduces low-density lipoproteins but not lipoprotein (a) Metabolism. 1992;41:911-914. 3. Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation. 1993;87:1435-1441. 4. Vassilopoulou-Sellin R, Sellin JH. The gastrointestinal tract and liver in hypothyroidism. In:Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid. 7th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996:816-820. 5. Moses AM, Scheinman SJ. The kidneys and electrolyte metabolism. In:Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid. 7th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996:812-815. 6. Emerson CH.Thyroid function and disease in the female. In: Gold JJ, Josimovich JB, eds. Gynecologic Endocrinology. 4th ed. New York, NY:Plenum Publishing Corp; 1987:109-133. 7. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;341:549-555. 甲状腺激素的生物学作用 一、对代谢的影响 1.产热效应：使组织耗氧量和产热量增加； 2.对蛋白质、糖、脂肪代谢影响：加速蛋白质和各种酶的生成、促进糖的吸收，增强糖原分解；促进脂肪氧化； 二、对生长与发育的影响：促进组织分化、生长与发育成熟 三、对神经系统的影响：影响神经系统的发育，兴奋交感神经系统； 四、其他:心血管系统、水和电解质 甲状腺功能的调节 肝脏 下丘脑 垂体 甲状腺 TRH T4 /T3 TBG 雌激素 卵巢 TSH 碘化物 结合 FT4 负反