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Thyroid gland

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Title: Thyroid Hormone Author: Admin Last modified by: Aong Created Date: 7/1/2010 3:32:07 AM Document presentation format ... – PowerPoint PPT presentation

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Title: Thyroid gland


1
Thyroid gland
  • (???????????)

????????? ?????????????? ???.(??????????????)
?.??????? ???.(????????????????) ?.????? ???
086-7239982 korat2551_at_gmail.com
2
???????????????????????
  • ???????????????????????
  • ?????????
  • ????????????????,??????????????????
  • (?????????????????????????????????????????????????
    )

3
????????????????????????
  • ????????????
  • ???????????????? ??????????????? ( T3 , T4 )
  • ?????????????????? ????????????????
    ????????????????
  • ??????????????????? ????????? ?????????
    ???????????
  • ??????????????? ??????????????? ( T3 , T4 )
  • ???????????? ???????????????? ??????
    ???????????????????????????????????????? nail bed
    ????? palmar erythema

4
  • ??????
  • ???????????????? ??????????????? ( T3 , T4 )
  • ??? ????????? ??????????? ????????
    ??????
  • ??????????????? ??????????????? ( T3 , T4 )
  • ?????????????? ???????????????????????????
    ??????????? ????????????????

5
  • ?????????????????
  • ???????????????? ??????????????? ( T3 , T4 )
  • ???????????? ????????????????????????????? 1
    ???????? ???????????? ???????????????????
  • ??????????????? ??????????????? ( T3 , T4 )
  • ????????????????????????? ??????????????????????
    ??????? 1 ????????????? ????????????????
    ???????????????
  • pulse pressure ??????????????? ????????????

6
  • ????????????
  • ???????????????? ??????????????? ( T3 , T4 )
  • ?????????? ????????? ??????? ?????????
  • ??????????????? ??????????????? ( T3 , T4 )
    ??????????
  • ????????? ??????? ??????????????? ????????

7
  • ?????????????
  • ???????????????? ??????????????? ( T3 , T4 )
  • ?????????????????????? ???????? ????????????
    ????????
  • (????????????????????????????????????????????
    ?????)
  • ??????????????? ??????????????? ( T3 , T4 )
  • ??????????????????????? ??? ????????????????(olig
    omenorrhea) ???????????????????(amenorrhea)
    ????????????????????

8
???????????????????????????????????
  • 1. Monoiodotyrosine(MIT) ---gt Diiodotyrosine
    (DIT)
  • 2DIT ---gt Thyroxine(T4) ----gt FT4
    (???????)
  • 2. Triiodothyronine (T3) ---gt FT3(???????),
    rT3(??????????)
  • 3. Calcitonin, Cathecolamine
  • 4. Thyroid stimulating hormone (TSH) ???????
    pituitary
  • 5. Thyroid releasing hormone (TRH) ???
    Hypothalamus
  • Thyroid binding globulin (TBG),Thyroid binding
    pre-albumin(TBPA,Transthyretin), Albumin (???)

???? ????????????????
9
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11
????Thyroglobulin ???????tyrosine?
??????????Couple Rx?
2 I
MIT
2DIT
????????
DIT
T4
T3
(T4 )
(DIT)
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13
???????????????????????
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15
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????????????(serum)????????????????????????????
  • 1. T4
  • 2. T3
  • 3. FT4
  • 4. FT3
  • 5. TSH
  • 6. TBG (??????????????????????)
  • TRH stimulating test (?? Non-sens.)
  • Thyroglobulin Ab (?? Auto-Ab)
  • Microsomal Ab (?? Auto-Ab)

???????????? ???????? TSH ???????????????????????
?????????????( T3,T4,FT4,FT3 )
24
?????????????????????????? Thyroid Function Test
??????? ????????
??????? ????? T4
Serum thyroxine 4.6 -
12.0 ug/dl FT4 Free thyroxine
0.7 1.9 ng/dl FT4F Free thyroxine
fraction 0.03- 0.005 THBR
Thyroid hormone binding ratio 0.9 1.1
- FT4I Free Thyroxine index 4
11 - T3 Serum
Triiodothyronine 80 - 180 ng/ml
( 0.5 -
2.0 ug/dl ) FT3 Free Triiodothyronine 1
230 619 pg/d FT3I Free T3
Index 80 180 -
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??????????????
29
????????????????????????????????
30
???????????????????????
31
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32
???????????????
  • ????????? ??????????????
  • ???.(??????????????) ?.???????
  • ???.(????????????????) ??.????? ?.?????
  • ??? 086-7239982

33
Thyroid gland disease
  • Goiter ??????????????????????? ??. gt 40 g
    ????????????????????? ?????? Simple
    goiter,Multinodular goiter
  • Euthyroid ?????????????? ??????????
    ??.???????????
  • Hyperthyroidism ?????????????????????
    ?????????? ??.??????????? ?????? Graves
    dz,Thyroiditis, Thyrotoxicosis, ???
  • Hypothyroidism ??????????????????????
    ?????????? ??.??????????? ??????
    Cretinism,Myxedema

34
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35
Hyperthyroidism
  • Hyperthyroidism ??? ??????????????????????????????
    (thyrotoxicosis) ???????????????????? T3,T4
    ?????????????????????????????????
  • ???????????????????????,??????????????????,???????
    ?????????,????????????,??????,?????????????,??????
    ????(???????????????? ??????????????
    ???????????????),?????????,?????????????????,?????
    ??(fine tremor),?????????????????,????????????????
    ??,????????

36
Graves dz.
  • ???????????????????? Autoantibody????IgG??????????
  • ????????? Basedows dz,exophthalmic goiter, toxic
    g.,primary hyperthyroidism,1o hyperplasia,
    diffuse hyperplasia
  • ?? 3 ????(?????????) ??? 1.Hyperthyroidism ???
    diffuse hyperplasia 2.?????(Exophthalmos)
    3.dermopathy ?????????????????????????????????????
    ????????????????????????????????

37
Graves dz.
  • ???????? gt ??? ????? 61 ??? 101
  • ????????????? ???????? 20-40 ??
  • ?????????????????? HLA-DR3,HLA-B8,HLA-Dw3
  • ????????? Thyroglobulin Ab gt microsomal Ab
  • ?????????? Ab ????????????????????? medial
    rectus,superior rectus ????????? Graves
    opthalmopathy ?????????????? Go Antibody ?????
    lymphocyte infiltration ??? mucopolysacch.???????
    ??????????????????????????????????
    ??????????????????????????(Exopthalmos)

38
Graves dz.
  • ??????????????????????????????????????????????????
    ?? ????? infiltrate ????????? lymphocyte
    ???????????????? mucopolysaccharide
    ??????????????????????????????????????????????????
    ?????????????? pretibial myxedema
  • ???????????????????????? TSH receptor
    ?????????????? follicular cell ???????????????????
    ?????? TSH ???????????????????? ?????????????
    ???????????????????????????????????????????
    ??????????? thyroid-stimulating
    immunoglobulin(TSI) ????????????T3,T4 ???????
    ??????? thyroid growth -stimulating
    immunoglubulin(TGI) ?????????????????????????????

39
?????
40
Hyperthyroidism diagnosis
41
Thyroiditis
  • ??????????????????????????????????????????????????
    ????????
  • acute thyroiditis ????????????????????????????????
    ?
  • Subacute thyroiditis ??????????????gt??? (31)
    ????????????????????????????????????
    ??????????????????? ?????????? ESR ?????????
    ????????????? Hyperthyroid ????????? hypothyroid
    ????????????????? Euthyroid
  • Lymphocytic thyroiditis ??????????????????????????
    ??????? 0-6 ????? ???????????????????
    ?????????gt??? 21

42
Thyroiditis
  • Hashimotos thyroiditis ??????????????????????????
    cytotoxic T cell ????? follicular cell
    ????????????????? ???????????? Hyper- ????????
    Hypo- ??????????????????? 30-50 ??
    ?????????????????? 101 ??????
    ????????????????????,HLA-DR5, Autoimmune dz.????
    SLE,RA,SS,pernicious anemia ???????? microsomal
    Ab gt thyroglobulin Ab
  • Riedels thyroiditis ?????????????????????????????
    ?????????????????????? ??????????????????????????
    ??????????????????????? ?????????? recurrent
    laryngeal nerve,50????????????????? Hypo-

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44
Euthyroid
  • Euthyroid    ???  ??????????????????????????????
      ???????????????  ???????????(goiter)  
    ??????????????????????????????????   
    ??????????????????????????????????????????????  
      ???????????????????????????  ????  ???????????
    (simple goiter)
  • ????????????????????? ??????????????????
    ?????????????????????? ?????????????????????????
    ???????????????? ???????????????
    ???????????????????? ????????????????????????
    ??????????????????????? ??????????????????????
    ???????????????????????????????????????????
    ?????????

45
Hypothyroidism
  • ?????????????????????????????? ???????????????????
    ?? ????????????????????????????
  • ????????????????? Hyperthyroidism ????????????
    ?????????,????????,??????,??????(?????????),??????
    ?????????,??????????,?????????????,??????
    ???????????????????????????????,??????????????????
    ?????????????, ??????????????? (???????),???????,?
    ? reflex ??? ???????????????????????????????
    ???????? myxedema ????????????????????????????????
    ????????????????????????? ????????????????????????
    ?? ??????????????????? ??????? ???? ????
    ???????? Cretinism
  • ?????? ?????????????????????????
    ??????????????????????????????????????????????????
    ????

46
Cretinism
  • ??? ???? Hypothyroidism ?????????????????? ?????
    13000 17000 ?????????????????????,6??????????
    ??
  • ????????????????????????????????????????,
    ?????????????????
  • ????????????????????? ?????? ????????????????????,
    ????????????????,???????????????????????
    colloid,???? hypopituitarism
  • ??????????????? ?????????????????? ?????????
    ???????? dyshormonogenetic goiter
    ?????????????????????????
  • ?????????????? ??????????????????????? ???????
    ???,?????????????????,??????????????,reflex
    ???,??????,???????,???????? ???????????????????,??
    ?????????????,?????????,?????????????, ??????
    Mongoloid,??????? ????????????????????,???????

47
???????
????????? ??????? ???????
48
Myxedema
  • ??? ???? Hypothyroidism ????????????????????
    ???????? ??????????????? ?????????????????
    ????????????????????????
  • ???????????????? ?????? ??????(?????????)
    ???????????????,??????????,?????????????,??????
    ???????????????????????????????,??????????????????
    ?????????????,???????????????,???????,?? reflex
    ??? ???????????????????????????????
  • ?????????????? post-partum pituitary necrosis
    (Sheehans syndrome)

49
thyroid hormone ????????????
50
????? thyroid hormone ????????????????
???????????????????????? myxedma
?????????????????????????????????
???????????????????????? ????????????????????????
??????????? ?????? ???????????????????????
????????????????? ????????????????????????????
???????? ???????????????????????
???????????????????????????????? thyroxine ???
triiodothyronine ?????
51
Simple goiter
  • ??? ????????? ????????????????????????????????????
    ?? ???????? Simple goiter,diffuse nontoxic goiter
  • ?????????????? ??.lt300 g. ????????????????????????
    ? nodule ?????? ?????????????????????????????
    Euthyroid
  • ????????????? endemic g. ???? sporadic g.
  • ?????????????????????????????????????????????
    ???????????????????????????????????? ???????????
    ??????????????????? (???? lt 2B)
  • ?????????????? Simple G.? Multinodular G.?Toxic
    multinodular goiter

52
  • ??????????????
  • ?????????????????????????????????????
    ?????????????????????????????????????????????
    ???????????????? endemic goiter
    ???????????????????????????????????????????????
    ????????????????????? thyroxine ???
    triiodothyronine ??? ?????????????????????????????
    ??????????????????????? TSH ???????????
    ??????????????????????????????????????????????????
    ??????????????????? (??????????????????????????)

53
????????
54
Multinodular goiter
  • ??? ????????????????????????????????????
    ??????????????????? nodule ???????????????????????
    ?????????????????????????????????? ?????????
    ????????????????????????????????????????????
    ???????????? ???colloid ????????????????????
  • ??????????????????????????????????
    ??????????????????????????????????? thyroxine
    ???? ??????????????????? TSH ??????? ????????????
    follicular cell ??????????????????????????? TSH
    ????????????? ????????? nodule ??????????????
  • ????????????????????????? ?????? ???
    ??????????????????

55
Multinodular goiter
  • ??????????????? ????? ??????
  • ????????????????? ??????????????? 10 25 ??
  • ??? ?.??? ?.???? ????? 18 ??? ??? 1000 ??
  • ?????? nodular goiter,nodular colloid
    goiter,endemic goiter, nontoxic multinodular
    goiter,adenomatous goiter
  • ?????????? ?????? ????? ????????????????????
    ????????? ????????????????????? goitrogen ??????
    ????? Ca, ????? F, thiocyanate,perchlorate,thiocar
    bamide

56
Toxic multinodular goiter
  • Toxic multinodular goiter,Plummers dz
  • ??? ????????????????????? multinodular goiter
    ????? gt 10 ?? ????????????????????????????????????
    ???????????? ??????????????????????????? Negative
    feedback ?????????????? Hyperthyroid ????
    ????????????????????????? ?????? ????????????
    ???????? atrial fibrillation ????????????????
    dermopathy ?????????? graves dz ????????? T3,
    T4 ????????????????
  • ????????????????? hyperthyroid ???????????????????
    ????????????????????????????? Jod-Basedow
    phenomenon

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?????????????????????
??????????????????????
??????????????????????
60
Congenital Hypothyroidism
61
Euthyroid sick syndrome
  • Nonthyroidal illness syndrome (NTIs)
    ????????????????????? ????????????????????????????
    ??????????? ???? ???????? ??????
    ???????????????????????????????
    ??????????????????????????????
  • ??????????? ????? T4 ????????????,????? T3,TBG
    ???,???????? rT3 ???????????? ????????????????????
    ????? Hypothyroid ???????????????????????????
    Euthyroid (???????)
  • ???? Euthyroid ??????????????????????????
    ???????????????????????????????????????
    ?????????????????????????????????
    ?????????????????????????????????????????????

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Thyroid storm (-crisis)
1
  • Thyroid crisis ?????????????????????????????????
    ??????????????????????????????????????????????????
    ?????(decompensation) ?????????????(???????????
    ?????? ??????????????????? 80-90) ?????????????
    Graves disease ??????????????? ???? toxic
    multinodular goiter ???? toxic adenoma
  • ??????????????? thyroid storm ????????????????????
    ????????????????????? Guideline ??? Burch, et al.
    1993 ???????????????????????????????
    ?????????????????????????? Hyperthyroidism

64
Thyroid storm (-crisis)
2
  • ???????????????? Free form ????????????
    ?????????????????????????? ???????????????????????
    ????????? radioactive iodine ??????????
    ??????????????????????????????????????????
  • ????? TBP(???????? transthyretin)
    ?????????????????? NTIs ?????? inhibitor???????TBP
    ????????????? free form ???????
  • ????????????????????????????? ????????????????????
    ???????????????????????? cathecholamine
    ??????????????????????? Propanolol
    ????????????????????? ???????????????????????????
    ?????????? ????? ????????????? ????? ??? ??????

65
Thyroid storm (-crisis)
3
  • ???????????????????????????(Hyperthermia)?????????
    ????? cutaneous vasodilation ????????????????
    39-40?C ??????? excessive diaphoresis
  • ????????????????? ????? sys.??? ??? dias. ???
    ?????????????????????????????????
    ??????????????????????????????????????????????????
    ???? ?????????????????????????????????????????????
    ???? ?????????????????????? ???????????? ???????
    ??????????
  • ?????????????????????????? ??????????????????????
    ???? ?????? ????????????????????????????????
    rhabdomyolysis, cerebral venous thrombosis,
    multiple organ dysfunction syndrome (MODS)

66
Thyroid storm (-crisis)
4
  • ??????????????????????? thyroid storm ?????
    ??????
  • Infections,Other acute medical illness, Acute
    emotional stress,Acute psychosis, Non-thyroid
    surgery, Parturition,Trauma,
  • Post radioiodine therapy,Post thyroidectomy ,
    After high dose iodine administration , Iodinated
    radiologic contrast agent , Discontinuation of
    anti-thyroid drugs , Vigorous palpation of
    thyroid gland

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??????????????? Thyroid storm
70
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71
???? ???????????????
  • Goiter ??????????????????? Simple goiter
    ????????????????? Multinodular goiter
    ??????????????????????Toxic multinodular goiter
  • Euthyroid ?????????????? ??????????
    ??.???????????
  • Hyperthyroidism ????????????????????? Graves
    dz?????,Thyroiditis???????, Thyrotoxicosis???????
  • Hypothyroidism ?????????????????????? ??????
    Cretinism ????????,Myxedema ??????
  • Thyroid storm ????????????? Hyperthyroidism
  • NTIs ????????????????????? Hypothyroidism
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