甲亢和甲状腺结节的诊治PPT课件.ppt

甲亢和甲状腺结节 The term “thyrotoxicosis”（甲状腺毒症） refers to a clinical state that results from inappropriately high thyroid hormone action in tissues generally due to inappropriately high tissue thyroid hormone levels The term “hyperthyroidism” （甲亢）is a form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid ATA /AACE. Guidelines 2011 Thyrotoxicosis associated with a normal or elevated radioiodine uptake (RAIU) over the neck Thyrotoxicosis associated with a near-absent RAIU over the neck ATA /AACE. Guidelines 2011 Causes of thyrotoxicosis Graves disease (GD) TA TMNG Trophoblastic disease TSH-producing pituitary adenomas Resistance to thyroid hormone ATA /AACE. Guidelines 2011 Thyrotoxicosis associated with a normal or elevated RAIU Painless (silent) thyroiditis Amiodarone-induced thyroiditis Subacute thyroiditis Iatrogenic thyrotoxicosis Factitious ingestion of thyroid hormone Struma ovarii Acute thyroiditis Extensive metastases from follicular thyroid cancer ATA /AACE. Guidelines 2011 Thyrotoxicosis associated with a near-absent RAIU 如果临床表现不能肯定是GD，测定RAIU 如果有结节，做甲状腺scan ATA /AACE. Guidelines 2011 An alternative way to diagnose GD is by measurement of TRAb The ratio of TT3 to TT4 can also be useful in assessing the etiology of thyrotoxicosis when scintigraphy is contraindicated: the ratio(ng/mcg) is usually 20 in GD and toxic nodular goiter, and 20 in painless or postpartum thyroiditis ATA /AACE. Guidelines 2011 TRAb测定作为备选 如不能测定RAIU，可测定TT3/TT4(ng/g) ：GD和毒性结节性甲状腺肿通常 20 ；甲状腺炎所致甲亢通常 20 所有有症状的病人都应给予阻滞剂 ATA /AACE. Guidelines 2011 明显的Graves病可采用以下任一种方法治疗：131I治疗；抗甲状腺药物；甲状腺手术 ATA /AACE. Guidelines 2011 近期不准备怀孕的妇女 因伴发疾病致手术风险较大者 有甲状腺手术史者 无甲状腺很大需要手术的证据 不适合ATD治疗者 ATA /AACE. Guidelines 2011 支持131I治疗的因素 有较大缓解可能（如甲亢较轻，甲状腺较小，TRAb阴性或滴度较低）的患者 因年老或伴发疾病致手术风险较大者 余寿未长者 不遵从放射防护者 曾经手术治疗者 无甲状腺很大需要手术的证据 中至重度活动性Graves眼病者 ATA /AACE. Guidelines 2011 支持抗甲状腺药物(ATD)的因素 有压迫症状者 甲状腺大于80g RAIU相对较低 疑似甲状腺癌 大的无功能或低功能结节 共存的甲旁亢 计划在4-6月内怀孕的妇女，尤其是TRAb很高者 ATA /