李益明－甲减.ppt

甲状腺功能减退Hypothyroidism
复旦大学医学院内分泌科
李益明
Hypothalamic-pituitary-thyroid axis
Overview
Clinical syndrome
Slowing down of metabolism
Slowing of growth and mental retardation in infants and children
Generalized slowing down anism
Deposition of glycosaminoglycans in skin and muscle
Reversible with therapy
Etiology and Classifcation
Primary(thyroid failure)
Hashimoto’s thyroiditis
Iodide deficiency or excessive
Radioactive iodine therapy for GD
Subtotal thyroidectomy
Subacute thyroiditis
Secondary: pituitary deficit
Tertiary: hypothalamic dysfunction
Peripheral resistance to thyroid hormone
Pathogenesis
Affects each tissue
Accumulation of glycosaminoglycans (hyaluronic acid)
Not to excessive synthesis
But decreased destrution
Increased capillary permeability
Interstitial edema
Skin
Heart muscle
Striated muscle
Clinical Features
Adults
Symptoms
Easy fatigability
Coldness
Weight gain
Constipation
Menstrual irregularities
Signs
Cool, rough, dry skin
Puffy face and hands
Hoarse and husky voice
Slow reflexes
Yellowish color skin
Clinical Features
Cardiovascular signs
Impaired myocardium contraction
Bradycardia
Diminished cardiac output
ECG: low voltage of QRS, P, T waves
Pericardial effusion
Coronary artery disease
Cardiac angina(Replacement therapy aggravate )
Clinical Features
Pulmonary function
Shallow, slow respiration
Respiratory failure
Intestinal peristalsis
Markedly slowed
Constipation
Renal function
Decreased glomerular filtration