复旦大学临床医学专业：《内科学》课程教学资源（课件讲义，双语版）甲状腺功能减退（李益明）

甲状腺功能减退 Hypothyroidism 复旦大学医学院内分泌科 李益明

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 Hypothalamus TRH Stimulation Inhibitior Free Hormone <-Bound Hormone Pituitary Thyroid T3.T4 Binding Proteins Thyroid

Hypothalamic-pituitary￾thyroid axis

HYPOTHALAMUS TRH Somatostatin HYPOFYZA TSH T T STITNA ZLAZA Na vsech urovnich navic dochazi ke konverzi T,na aktivnejsi T3, coz muze hrat roli ve zpetnovazebne kontrole

verview Clinical syndrome Slowing down of metabolism Slowing of growth and mental retardation in infants and children Generalized slowing down of organism Deposition of glycosaminoglycans in skin and muscle Reversible with therapy

Overview Clinical syndrome Slowing down of metabolism Slowing of growth and mental retardation in infants and children Generalized slowing down of organism Deposition of glycosaminoglycans in skin and muscle Reversible with therapy

Etiology and classifcation Primary(thyroid failure) t Hashimoto's thyroiditis t lodide deficiency or excessive Radioactive iodine therapy for gD Subtotal thyroidectomy t Subacute thyroiditis Secondary: pituitary deficit Tertiary: hypothalamic dysfunction Peripheral resistance to thyroid hormone

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) t Not to excessive synthesis t But decreased destrution Increased capillary permea bility Interstitial edema t Skin ◆ Heart muscle ◆ Striated muscle

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

Clinical Features

Adults Symptoms Easy fatigability Coldness Weight gain t Constipation Menstrual irregularities Signs ◆C0ol, rough, dry skin ◆ Puffy face and hands Hoarse and husky voice Slow reflexes t Yellowish color skin

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 t Bradycardia t Diminished cardiac output t ECG: low voltage of Qrs, P,t waves Pericardial effusion Coronary artery disease Cardiac angina(Replacement therapy aggravate

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 t Shallow, slow respiration ◆ Respiratory failure Intestinal peristalsis t Markedly slowed t Constipation Renal function Decreased glomerular filtration

Clinical Features Pulmonary function Shallow, slow respiration Respiratory failure Intestinal peristalsis Markedly slowed Constipation Renal function Decreased glomerular filtration