1、甲状腺功能减退症（甲减）讲授目的和要求讲授目的和要求2甲状腺功能减退症（甲减）3甲状腺功能减退症（甲减）4甲状腺功能减退症（甲减）5甲状腺功能减退症（甲减）6甲状腺功能减退症（甲减）7甲状腺功能减退症（甲减）8甲状腺功能减退症（甲减）9甲状腺功能减退症（甲减）10甲状腺功能减退症（甲减）病情轻的早期病人可以没有特异症状畏寒、乏力、体重增加、手足肿胀感、嗜睡、记忆力 减退、少汗、关节疼痛、便秘、女性月经紊乱，或者月经过多、不孕11甲状腺功能减退症（甲减）12甲状腺功能减退症（甲减）13甲状腺功能减退症（甲减）Figure 9-3.(A)The classic torpid facies of s
2、evere myxedema in a man.The face appears puffy,and the eyelids are edematous.The skin is thickened and dry.(B)The facies in pituitary myxedema is often characterized by skin of normal thickness,covered by fine wrinkles.Puffiness is usually less than in primary myxedema.The eyelids are often edematou
3、s.The palpebral fissure may be narrwowed because of blepharoptosis,due to diminished tone of the sympathetic nervous fibers to Mllers levator palpebral superious muscle and is the opposite of the lid retraction seen in thyrotoxicosis.The modest measurable exophthalmos seen in some patients with myxe
4、dema is presumably related to accumulation of the same mucous edema in the orbit as is seen elsewhere.It is not progressive and carries no threat to vision,as in the ophthalmopathy of Graves disease.The tongue is usually large,occasionally to the point of clumsiness.Sometimes a patient will complain
5、 of this problem.Sometimes it is smooth,as in pernicious anemia(of course,pernicious anemia may coexist).Patients do not usually complain of soreness of the tongue,as they may in pernicious anemia.When anemia is marked,the tongue may be pale,but more often it is red,in contrast to the pallid face.14
6、甲状腺功能减退症（甲减）Figure 15-12.Ten year old female with severe 1 hypothyroidism due to primary myxedema before(A)and after(B)treatment.Presenting complaint was poor growth.Note the dull facies,relative obesity and immature bod proportions prior to treatment.At age 10 years she had not lost a single decidu
7、ous tooth.After treatment was initiated(indicated by the arrow in Panel C),she lost 6 teeth in 10 months and had striking catch up growth.Bone age was 5 years at a chronologic age of 10 years.TSH receptor blocking antibodies were negative.15甲状腺功能减退症（甲减）16甲状腺功能减退症（甲减）17甲状腺功能减退症（甲减）18甲状腺功能减退症（甲减）19甲状腺
8、功能减退症（甲减）1.临床表现临床表现2.实验室检查实验室检查 20甲状腺功能减退症（甲减）21甲状腺功能减退症（甲减）22甲状腺功能减退症（甲减）23甲状腺功能减退症（甲减）24甲状腺功能减退症（甲减）25甲状腺功能减退症（甲减）26甲状腺功能减退症（甲减）27甲状腺功能减退症（甲减）28甲状腺功能减退症（甲减）29甲状腺功能减退症（甲减）30甲状腺功能减退症（甲减）31甲状腺功能减退症（甲减）32甲状腺功能减退症（甲减）33甲状腺功能减退症（甲减）(一一)昏迷，嗜睡，有如处于冬眠状态昏迷，嗜睡，有如处于冬眠状态(二二)低体温低体温：粘液性水肿的标志和特点：粘液性水肿的标志和特点(三三)呼吸
9、功能抑制，呼吸浅慢，呈低换气状态，氧分压低，呼吸功能抑制，呼吸浅慢，呈低换气状态，氧分压低，二氧化碳分压高，呼吸性酸中毒二氧化碳分压高，呼吸性酸中毒(四四)心率缓慢，常有心包或其他浆膜腔积液，心率缓慢，常有心包或其他浆膜腔积液，(五五)血压低血压低严重者四肢肌肉松弛，反射减弱或消失，休克、昏迷，可伴发严重者四肢肌肉松弛，反射减弱或消失，休克、昏迷，可伴发心、肾功能衰竭，常威胁生命。心、肾功能衰竭，常威胁生命。五低：低反应、低体温、五低：低反应、低体温、低通气功能、低心率、低血压低通气功能、低心率、低血压34甲状腺功能减退症（甲减）1、补充甲状腺激素补充甲状腺激素：首选 L-T3针：静注针：静注
10、10g，Q4h 或L-T4针：首剂针：首剂300-500ug iv，后，后50ug iv qd 或用片剂（鼻饲）：或用片剂（鼻饲）：左旋甲状腺素片：首剂左旋甲状腺素片：首剂100-200ug，后，后50ug qd2、糖皮质激素、糖皮质激素 氢化可的松：氢化可的松：200mg300mg qd35甲状腺功能减退症（甲减）3、一般疗法及支持治疗、一般疗法及支持治疗n保温：增加被褥或调节室温保温：增加被褥或调节室温n供氧：积极改善呼吸状况，保证呼吸道通畅，必要供氧：积极改善呼吸状况，保证呼吸道通畅，必要时作气管切开时作气管切开n控制液体出入量，如不发热，每日控制液体出入量，如不发热，每日5001000
11、ml已已足够足够，葡萄糖，葡萄糖n禁用镇静剂和麻醉药禁用镇静剂和麻醉药 4、防治感染，去除诱因、防治感染，去除诱因36甲状腺功能减退症（甲减）37甲状腺功能减退症（甲减）38甲状腺功能减退症（甲减）39甲状腺功能减退症（甲减）40甲状腺功能减退症（甲减）41甲状腺功能减退症（甲减）42甲状腺功能减退症（甲减）43甲状腺功能减退症（甲减）44甲状腺功能减退症（甲减）45甲状腺功能减退症（甲减）46甲状腺功能减退症（甲减）47甲状腺功能减退症（甲减）48甲状腺功能减退症（甲减）49甲状腺功能减退症（甲减）50甲状腺功能减退症（甲减）51甲状腺功能减退症（甲减）53甲状腺功能减退症（甲减）54甲状腺功能减退症（甲减）55甲状腺功能减退症（甲减）56甲状腺功能减退症（甲减）57甲状腺功能减退症（甲减）58甲状腺功能减退症（甲减）59甲状腺功能减退症（甲减）60甲状腺功能减退症（甲减）61甲状腺功能减退症（甲减）62甲状腺功能减退症（甲减）63甲状腺功能减退症（甲减）64甲状腺功能减退症（甲减）65甲状腺功能减退症（甲减）66甲状腺功能减退症（甲减）
