甲状腺本科生实习讲课课件.ppt

1、甲状腺疾病（The disease of the thyroid）Thyroid?VIP endocrineglandgland?喉结下23cm，3、4 tracheal cartilage前?H型，棕红色，2030g?左右两叶+峡部?叶宽2cm，高45cm；峡宽、高2cm?吞咽时ThyroidThyroid?50150ug I/d?腺体I总量：8000ug?调节：?自身调节*Woffchaikoff效应*KIT3、T4Thyroid?Thyroxine：?促进人体发育?促进protein、carbohydrate、fat分解?增强组织氧耗?T310%?T4 90%Simple goiter?

2、Etiology：Iodine-defciency 相对/绝对Thyroxine 合成/分泌障碍Hyperiodine?Endemic?Diffuse?Nodular Simple goiter?Clinical feature：?BMR?thyroid enlargement +nodule?dyspnea/dysphagia?secondary hyperthyroidism/malignant transformation Simple goiter?Diagnosis：?Medical history：?PE?131I/99mTc?BUS?FNASimple goiter?Therap

3、y：?Iodine-defciency/pregnancy：kelp（土壤缺碘！）?Diffuse（20y）：?甲状腺素片：3060mgBid 36m?优甲乐：50100ug Qd 50ug/34w 36m?Operation：Simple goiter?Operation：?压迫症状：?胸骨后：substernal goiter?巨大：?Secondary hyperthyroidism?Malignant transformation？Hyperthyroidism?甲亢：?Primary：Graves病8590%突眼（+）?Secondary：突眼（）?Hyperfunctioning

4、thyroid adenoma：突眼（）Hyperthyroidism?Primary（exophthalmic goiter）：2040y?突眼是一种自免疾病?球后纤维、脂肪增生，?淋巴细胞浸润、亲水性粘多糖?透明质酸沉积?伴发：型DM，肌无力，RAPrimary hyperthyroidism?Etiology：?Autoimmune disease：HLA-DRS Ag（滤泡壁细胞膜TSHR）：*LATS、TSI、LATS-P、HTS、TR-AbPrimary hyperthyroidism?Clinical feature：?Diffuse?irritable、hand tremor、

5、hidrosis、bulimia、emaciation、rapid pulsePrimary hyperthyroidism?Diagnosis1：?BMR：（PR+PP）111?N：10%?Mild：2030%?Moderate：3060%?Severe：60%Primary hyperthyroidism?Diagnosis2：?thyroid iodine uptake：131I?2h：25%?24h：50%+峰值提前?和程度无关！Primary hyperthyroidism?Diagnosis3：?Five of the thyroid function：T3、T4、fT3、fT4、

6、TSHPrimary hyperthyroidism?Therapy：?131I：2mm，78%，易甲低?Pharmacotherapy：5060%（P）、33%（S）?Operation：cure rate 95%Primary hyperthyroidism?Operation：subtotal thyroidectomy?Indication?Secondary、Hyperfunctioning thyroid adenoma?Moderate?较大、压迫、胸骨后?补救?妊娠早、中期Primary hyperthyroidism?Operation：?Preoperotive prepa

7、ration：?Examination：Neck radiography、laryngoscopy、BMR、Ca+?Rapid heart rate：心得安 10mg Tid?Drug：?Antithyroid drugs 24m +Iodine 2w（Lugols solution）?心得安：P不著者，哮喘禁用Primary hyperthyroidism?Operation：?全麻?superior laryngeal nerve?recurrent laryngeal nerve?parathyroid glandsPrimary hyperthyroidism?Operation：?P

8、ost-operative care：?床旁备气切包?切口压冰袋切口压冰袋?voice?drainagePrimary hyperthyroidism?Surical complications：?Dyspnea、asphyxia：48h?Recurrent/superior laryngeal nerve injury：?Parathyroid glands injury：48h?Thyroid crisis：1236h?Hypothyroidism：550%?Recurrence：15%tetanyThyroiditis?Subacute thyroiditis（De Quervain）：

9、?infection of the upper respiratory tract：前驱期有肌痛 12w?v破坏滤泡+巨细胞性肉芽肿?甲状腺痛及压痛，向下颌及耳部放散?3040y?T，ESR?BMR，131I?激素+甲状腺素Thyroiditis?Chronic lymphocytic thyoiditis（Hashimotos）：?Autoimmune disease+hypothyroidism?淋巴cell浸润、滤泡?包膜内病变，无粘连、压迫?腺体质硬，平滑，椎体叶大?BMR，131I?甲状腺素Thyroid adenoma?Pathological type：follicular/pa

10、pillary capsule?Clinical feature：单发、包膜?Differential diagnosis：?Therapy（甲亢20%，恶变10%）：?单纯（楔形）切除?大部切除Thyroid carcinoma?Pathological type：FNA?Papillary：70%40y（儿童100%）?Follicular：15%50y 包膜不完整?Anaplastic：510%60y 小细胞/巨细胞型?Medullary：C细胞CT 15%家族史?Clinical feature：?Clinical stages：45y分化型Thyroid carcinoma?Therapy：甲状腺+颈部淋巴结?Low-risk group：腺叶+峡部?High-risk group：患侧全+对侧次全?预防性颈淋巴结清扫：不推荐?内分泌：甲状腺素?131I：术后?Radiotherapy：anaplastic Thyroid nodule?4%?Medical history：?PE：?ECT：热结节恶变率4%，温结节9%?BUS：实性结节20%，囊性23%，囊实性12%?FNA：6次，注意假阴性！