慢性淋巴细胞性甲状腺炎医学课件.ppt

1、1Dr.Hakaru Hashimoto 桥本甲状腺炎 Hashimotos thyroiditis 萎缩性甲状腺炎atrophic thyroiditis 慢性淋巴细胞性甲状腺炎chronic autoimmune thyroiditis 无痛性甲状腺炎painless thyroiditis 产后甲状腺炎postpartum thyroiditis 自身免疫性甲状腺炎自身免疫性甲状腺炎autoimmune thyroiditis Teng W,Shan Z,Teng X,et al.Effect of iodine intake on thyroid diseases in China.N

2、 Engl J Med.2006,354(26):2783-93.Teng W,Shan Z,Teng X,et al.Effect of iodine intake on thyroid diseases in China.N Engl J Med.2006,354(26):2783-93.The specimen in Panel A shows typical changes of Hashimotos thyroiditis,including lymphoid follicles with germinal centers(G),small lymphocytes and plasm

3、a cells(P),thyroid follicles with Hrthle-cell metaplasia(H),and minimal colloid material(C).Pearce EN,Farwell AP,Braverman LE.Thyroiditis.N Engl J Med 2003;348:2646-2655.G:生发中心生发中心P :浆细胞浆细胞 小淋巴细胞小淋巴细胞C:胶质物胶质物H:H-c 化生化生Hrthle-cell:许特尔细胞许特尔细胞,大大嗜酸细胞嗜酸细胞MYEXEDEMA:成人粘液性水肿成人粘液性水肿GRETINISM:呆小症呆小症;甲亢甲亢桥本脑病

4、桥本脑病Identical male twins with Hashimotos thyroiditis were photographed at age 12.At age 8,they had the same height and appearance.During the intervening 4 years,small goiters developed and the growth of the twin on the right almost stopped.Biopsy indicated Hashimotos thyroiditis in each twins thyroi

5、d.水肿，可累及脑干及皮层，从而出现局灶性神经功能缺失或昏迷等临床病症，并可随激素的应用而迅速缓解。甲状腺超声甲状腺超声Pathology of Hashimotos thyroiditis.In this typical view of severe Hashimotos thyroiditis,the normal thyroid follicles are small and greatly reduced in number,and with the hematoxylin and eosin stain are seen to be eosinophilic.There is mar

6、ked fibrosis.The dominant feature is a profuse mononuclear lymphocytic infiltrate and lymphoid germinal center formation.FNAB&BiopsyFNAB&Biopsy慢性炎症包括淋巴细胞和浆细胞慢性炎症包括淋巴细胞和浆细胞Image Description:A dense infiltrate of plasma cells and lymphocytes with germinal center formation is seen in this thyroid.Cells

7、 of the individual colloid follicles often display abundant pink granular cytoplasm,which is referred to as oncocytic change,in this setting.These cells are referred to as Hurthle cells or oncocytes-these are metaplastic.(Oncocytes：嗜酸瘤细胞：嗜酸瘤细胞)FNAB&BiopsyFluorescent thyroid scan in thyroiditis.The n

8、ormal thyroid scan(left)allows identification of a thyroid with normal stable(127I)stores throughout both lobes.A marked reduction in 127I content is apparent throughout the entire gland involved with Hashimotos thyroiditis(right).Diagnosis of Hashimotos thyroiditis(chronic thyroiditis)t *甲亢表现甲状腺肿大甲

9、减表现和或和或甲状腺功能TPoAb，TgAb甲状腺超声或ECT临床诊断临床诊断HTFNAB-细针抽吸活组织检查细针抽吸活组织检查确诊确诊HT临床表现典型，抗体升高临床表现不典型，抗体显著升高甲减伴甲状腺萎缩临床诊断ATFNAB确诊ATHashimotos thyroiditis等慢性淋巴细胞性甲状腺炎的诊断流程等慢性淋巴细胞性甲状腺炎的诊断流程Pearce EN,Farwell AP,Braverman LE.Thyroiditis.N Engl J Med 2003;348:2646-2655.化脓性JAMA 2004 Jan 14;291(2):228-38TPOAb水平恢复正常Brain L.Hashimotos disease and en-cephalopathy.Lancet 1966 Sep 3;2(7462):512-4Fig.2 MRI one day after admission:axial FLAIR images show widespread hyperintense signals over the left temporal and both parieto-occipital lobes in the subcortical white matter谢谢 ！