内分泌与代谢疾病

nontoxic goiter

Physiological function; Synthesis of thyroid hormones

Tests of thyroid function : Measurement of total serum thyroid hormone concentrations

Serum free T4 and T3 concentrations

Radioactive iodine uptake

Tests of thyroid regulation: Serum thyrotropin

Anatomic evaluation of the thyroid gland :The thyroid scan ,Thyroid ultrasound ,Needle biopsy Anti-thyroid antibodies : thyroid microsomal antibody (TMAb)

thyroglobulin antibodies (TgAb)

thyroid TSH receptor (TRAb’s

The roles of thyroid hormones

regulate tissue metabolism

central nervous system development

growth and bone maturation

Etiology and pathogenesis

endemic goiter：iodine deficiency

Sporadic goiter: diet ,drugs , heredity , immunity

Clinical manifestations: Simple thyroid gland intumescence，usually asymptomatic，sever

intumescence can cause press symptome

I: diameter<3cm II: diameter 3-5 cm III: diameter 5-7 cm

IV: diameter 7-9 cm V: diameter >9cm

Laboratory findings

T3、T4 、TSH normal

Radioactive iodine uptake increase, but the time of peak dose not move foreward

Thyroid globulin increase

Antibodies to thyroid are negative

Prevention and treatment

Endemic goiter prevention: iodine salt

Treatment : levothyroxine; Surgery

Hyperthyroidism

Definition: Syndrome that reflects the hypermetabolism resulting from excessive quantities of circulating thyroid hormones

GD: The most common form of thyrotoxicosis

clinical syndrome: hypermetabolism,diffuse enlargement of the thyroid gland exophthalmos,

pretibial myxedema

Etiology and pathogenesis

Autoimmune disorder: TRAb

Genetic inheritance

Others factors

Symptoms and signs

Hypermetabolic signs : moist warm skin; tachycardia or atrial fibrillation , even (rarely) heart

failure; fine resting finger tremors, hyperreflexia.

Goiter: most common, but on occasion absent, Symmetric diffusive enlargement, Move with swallow, Soft to moderate in consistency, Not pain, Commonly bruit or murmurs can

be heard and/or thrill can be felt

Eyes: 25%-50% with exophthalmos (eye forward protruding)

Mostly Simple

–proptosis<18mm

–Stare (Stellwag sign), “pop-eye”

–Upper lid retraction leads to widening of the palpebral fissure

–Lid lag (von Graefe sign), globe lag

–No wrinkle when look upward (Joffroy sign)

–Inward gaze or convergence is impaired (Mobius sign)

Infiltrative or malignant or graves’: Proptosis>18mm

Special manifestation: Thyrocardiac disorders(Arrhythmia,Cardiomegaly, dilation of the

chambers, Cardiac insufficiency/failure

Thyrotoxic Crisis

Pretibial Myxedema

Apathetic Graves’s disease

•Usually in senile person

•Without/mild goiter

•Slight or insidious thyrotoxicosis & often go unnoticed, therefore, prone to develop crisis •Most often present with anorexia, vomiting, diarrhea

•Sometimes to see the cardiologist for tachycardia or arrhythmia

•Easy to be suspected with malignancy because of weight loss

Isolated T3 or T4 Hyperthyroidism

•T3 hyperthyroidism

–Early stage of goiter, under antithyroid therapy or simple iodine deficient goiter –Mild thyrotoxicosis

–FT3 & T3↑, FT4 & T4→, TSH → /↓, RAIU →/ ↑

•T4 Hyperthyroidism

–GD with severe systemic disorders

–FT4 & T4 ↑, FT3 & T3 →/slight ↓ TSH → /↓, RAIU →/ ↑

Subclinical Hyperthyroidism

•T3 & T4 →, TSH↓

•Under TH treatment or during antithyroid treatment

•May lead to heart impairment or present with periodical paralysis or opthalmopathy. •Generally need not to be treated

Euthyroid Graves exophthalmos

•<5% Graves’ exophthalmos

•Unilateral or bilateral

•Mostly infiltrative

•Thyrotoxicosis develops usually in several months or years

•Most often have thyroid dysfunction, TSH↓ or suppressed TRH stimulation Thyrotoxic Periodic Paralysis