hypothyroidism亚临床甲状腺功能减退症课件

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1、SUBCLINICALHYPOTHYROIDISMAlexGonzalezMD,FACPAlexGonzalezMD,FACPDayan,C.M.et.al.NEnglJMed1996;335:99-107Age-SpecificRatesfortheDevelopmentofHypothyroidismandHyperthyroidisminWomenCausesofhypothyroidismAutoimmunethyroiditis(Hashimoto’s)AtrophicGoitrousRadioactiveiodi

2、neRxforGraves’.ThyroidsurgeryNeckirradiationDrugsHypothyroidismintheelderlySymptomsofhypothyroidismaresimilartosymptomsduetoaging.78y.o.fellathomeandfracturedahip.Hewasveryslowtorecoverafteranesthesia.TSH:86uU/L(n:0.4-5)PrimaryHypothyroidismRecommendedscreening:A.T

3、hyroidAssoc.:Screenevery5yearsafterage35A.A.ofFam.Physicians/A.A.ofClinicalEndocrinologists:Periodicscreeningofasymptomaticwomenover60.Noscreeningformen.USPreventiveServicesTaskForce:NoscreeningrecommendedThyroidfunctionstudiesSerumTSH.0.4-5.0mU/LTotalT4.5-11mcg/dL

4、,FreeT40.8-1.8ng/dLTotalT3.95-170ng/dL,FreeT32.0-4.4pg/mLTotalrT330-50ng/dLaTPOandantithyroglobulinantibodiesThyroglobulinTSHreceptorantibody(TSI)ThyroidUltrasoundRadioactiveuptake/ScanBiopsyThyroidfunctionscreenTSH(0.4-5.0mU/L)ScreeningforthyroiddiseaseNormalTSH=n

5、ormalthyroidfunctionLowTSH=Hyperthyroidism.HighTSH=PrimaryHypothyroidismWhentheTSHisabnormal,followwithaserumFreeT4forconfirmation.DiagnosisofPrimaryHypothyroididsmElevatedTSHLowFreeT468y.o.womanwithfatigue,somnolenceandcognitivedecline.RadioactiveIodineforGraves’d

6、isease20yearsagoTSH:68mU/L(0.4-5)FreeT4:0.2(0.8-1.8ng/dL)Dx:PrimaryHypothyroidismSubclinicalhypothyroidismSerumTSHabovetheupperlimitofnormalNormalFreeT4SubclinicalhypothyroidismAfterthesixdecadetheprevalenceis>10%andequalinmenandwomen.80%haveaTSHbetween5and10mIU/LE

7、xample:85y.o.womanwholivesbyherself.Shehadrecentlylostherhusband.Shewastired,somnolentandforgetful.Nogoiter.TSHscreen:7.8mU/L(n:0.4-5)FreeT4:1.0ng/dL(n:0.8-1.8)Treatment?SubclinicalhypothyroidismShewasgiven50mcgofLevothyroxinedaily.SubclinicalhypothyroidismThepatie

8、ntwasadmitted6weekslaterwithseveredyspnea.ShewasonA.Fib.andcongestiveheartfailureSerumTSH<0.01mU/L(n:0.4-5)SerumfreeT4highat2.3ng/dL(0.8-1.8)Subc