桥本甲状腺炎培训课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,桥本甲状腺炎,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,桥本甲状腺炎,*,*,一、疾病定义与概述,二、临床诊断,三、治疗措施,四、中医认识,五、最新进展,内容提要,1,桥本甲状腺炎,10/2/2024,内容提要1桥本甲状腺炎10/3/2022,Hashimotosdisease:,A progressive disease of the thyroid gland characterized by the presence of antibodies directed against the thyroid and by infiltration of the thyroid gland by lymphocytes(white blood cells activated by the immune system).Hashimoto disease is the most common cause of hypothyroidism in North America and Europe.In Hashimoto disease,the thyroid gland is usually enlarged(goiter)and has a decreased ability to make thyroid hormones.Hashimoto disease predominantly affects women,and it can be inherited.Also known as autoimmune thyroiditis and Hashimoto thyroiditis,.,Definition,：,http:/ thyroiditis,，,HT,桥本氏病,Hashimotos disease,HD,慢性淋巴细胞性甲状腺炎,Chronic lymphocytic thyroiditis,Dr.Hakaru Hashimoto,3,桥本甲状腺炎,10/2/2024,桥本氏甲状腺炎概述：自身免疫性甲状腺炎之一Dr.Hakar,甲状腺炎概述：,指甲状腺组织发生变性、渗出、坏死、增生等炎性病理改变而导致的一系列临床病症,4,桥本甲状腺炎,10/2/2024,甲状腺炎概述：指甲状腺组织发生变性、渗出、坏死、增生等炎性病,桥本甲状腺炎,Hashimoto thyroiditis,萎缩性甲状腺炎,atrophic thyroiditis,无痛性甲状腺炎,painless thyroiditis,产后甲状腺炎,postpartum thyroiditis,自身免疫性甲状腺炎,autoimmune thyroiditis,AITD,自身免疫性甲状腺炎：,5,桥本甲状腺炎,10/2/2024,桥本甲状腺炎萎缩性甲状腺炎无痛性甲状腺炎产后甲状腺炎自身免疫,桥本甲状腺炎,Hashimoto thyroiditis,萎缩性甲状腺炎,atrophic thyroiditis,慢性淋巴细胞性甲状腺炎,chronic lymphocytic thyroiditis,无痛性甲状腺炎,painless thyroiditis,产后甲状腺炎,postpartum thyroiditis,自身免疫性甲状腺炎,autoimmune thyroiditis,AITD,自身免疫性甲状腺炎：,6,桥本甲状腺炎,10/2/2024,桥本甲状腺炎萎缩性甲状腺炎慢性淋巴细胞性甲状腺炎无痛性甲状腺,流行病学：,占甲状腺疾病的,20-25%,饮食富碘地区引发甲状腺肿性甲状腺功能减退的最常见原因,引发儿童非地方性甲状腺肿的最主要病因,多发于,30-50,岁中年女性，发病率，男：女为,1:10,流行率：,0.4-1.5%,（中国）,发病率：,0.15%,（美国）,0-0.5%,（中国）,近,30,年来发病率持续增高,Teng W,Shan Z,Teng X,et al.Effect of iodine intake on thyroid diseases in China.,N Engl J Med.2006,354(26):2783-93.,7,桥本甲状腺炎,10/2/2024,流行病学：Teng W,Shan Z,Teng X,e,病因与发病机制：,遗传因素：,目前肯定的遗传易感基因包括人类白细胞抗原（,HLA),和细胞毒性,T,淋巴细胞相关抗原,-4(CTLA-4),环境因素：,高碘、硒缺乏、感染、应用胺碘酮、,IFN-,治疗,锂盐,吸烟等,自身免疫因素,TgAb,TPO-Ab,TSB-Ab,Fas,，,ADCC,（,抗体依赖性细胞介导的细胞毒,作用）,8,桥本甲状腺炎,10/2/2024,病因与发病机制：遗传因素：TgAb,TPO-Ab,TSB-A,TSH-R,TRAb,TSH,TSAb,TSBAb,T G I,HCG,T3,T4,TSH,受体配体,TSBAb,桥本甲状腺炎,TSH,受体与甲状腺功能：,病理作用,生理效应,9,桥本甲状腺炎,10/2/2024,TSH-RTRAbTSHTSAbTSBAbT G IHCGT,Normal thyroid,gland,TSB-Ab,End-stage,Hashimoto,thyroiditis,*-Hypothyroidism,*initially:goiter inflammation,TSAb,Graves disease,vvv,Hyperthyroidism,Normal thyroid,gland,TSH,Autoimmune Thyroid Disease,（,AITD,）,10,桥本甲状腺炎,10/2/2024,Normal thyroidTSB-AbEnd-stageT,TPO,TPO-Ab,+,细胞毒 作用,NK,细胞,ADCC,TPO-Ab,损伤甲状腺滤泡,11,桥本甲状腺炎,10/2/2024,TPOTPO-Ab+细胞毒 作用NK细胞ADCCTPO-Ab,肉眼,甲状腺弥漫性对称性肿大，稍呈结节状，质较韧，,60g,200g,左右，被膜轻度增厚，与周围组织无粘连，切面呈分叶状，色灰白灰黄。,光镜,实质组织破坏、萎缩，大量淋巴细胞及不等量的嗜酸性粒细胞浸润、淋巴滤泡形成、纤维组织增生，有时可出现多核巨细。,病理 特征：,12,桥本甲状腺炎,10/2/2024,肉眼病理 特征：12桥本甲状腺炎10/3/2022,典型活检病理 特征：,The specimen in Panel A shows,typical changes of Hashimotos,thyroiditis,including lymphoid,follicles with germinal centers(G),small lymphocytes and plasma,cells(P),thyroid follicles with,Hrthle-cell metaplasia(H),and,minimal colloid material(C).,G:,淋巴滤泡生发中心,P:,小淋巴细胞和浆细胞,H:,甲状腺滤泡与何氏细胞化生,C:,胶体物质,Pearce EN,Farwell AP,Braverman LE.Thyroiditis.N Engl J Med 2003;348:2646-2655,.,典型桥本氏甲状腺炎病变组织样本,(A),13,桥本甲状腺炎,10/2/2024,典型活检病理 特征：The specimen in Pane,Diagnose,14,桥本甲状腺炎,10/2/2024,Diagnose14桥本甲状腺炎10/3/2022,甲减伴甲状 腺萎缩,甲亢表现,甲状腺肿大,甲减表现,和或,和或,甲状腺功能,TPoAb,，,TgAb,甲状腺超声,或,ECT,临床诊断,HT,FNAB,确诊,HT,临床表现典型，抗体升高,临床表现不典型，抗体显著升高,临床诊断,AT,FNAB,确诊,AT,流程：,15,桥本甲状腺炎,10/2/2024,甲减伴甲状 腺萎缩甲亢表现甲状腺肿大甲减表现和或和或甲状腺,临床表现：,桥本氏病,初起,没有独特的症状和体征。,本病通常进展缓慢，数年,的,甲状腺损伤,，才会,导致血液中甲状腺激素水平,异常,。,随着病情的发展,及激素缺乏的严重程度加深，呈现,主要,是,甲状腺功能减退,的症状与体征。,甲状腺功能异常 图（左：甲减,/,右：甲亢）,16,桥本甲状腺炎,10/2/2024,临床表现：桥本氏病初起没有独特的症状和体征。甲状腺功能异常,enlarged thyroid,Weight gain,fatigue,paleness or puffiness of the face,joint and muscle pain,constipation,inability to get warm,joint and muscle pain,hair loss or thinning,brittle hair,irregular or heavy menstrual periods,depression,slowed heart rate,difficulty getting pregnant,Symptoms,：,http:/ thyroidjoint and musc,甲状腺功能：,20%,甲减，,5%,甲亢，余可正常,自身抗体：,Tpo-Ab,，,TgAb,甲状腺超声：甲状腺肿大呈弥漫性病变，回声减低、不均,核素扫描：不作为诊断常规,FNAB,（细针穿刺抽吸活检,）,：滤泡细胞嗜酸性变特征性改变,背景较多淋巴细胞,备注：,2012,年,甲状腺结节和分化型甲状腺癌诊治指南,：凡直径,1cm,的甲状腺结节，若无特殊，均可考虑,FNAB,检查。,实验室及其他检查：,18,桥本甲状腺炎,10/2/2024,甲状腺功能：20%甲减，5%甲亢，余可正常实验室及其他检查：,甲状腺超声：,桥本氏病患者甲状腺超声成像（右叶纵向）,19,桥本甲状腺炎,10/2/2024,甲状腺超声：桥本氏病患者甲状腺超声成像（右叶纵向）19桥本甲,甲状腺核素扫描：,Late-stage Hashimoto thyroiditis in a 59-year-old woman,Distant(left)and close-up(right)anterior images reveal nonuniform and relatively low thyroid activity compared with background activity.,20,桥本甲状腺炎,10/2/2024,甲状腺核素扫描：Late-sta,a solitary cold nodule in a 34-year-old woman,who com-plained of a palpable right-sided,neck mass of 5 months duration.At physical,examination,the nodule felt very,firm.Thyroid function parameters were all in,the normal range,and the 24-hour RAIU was,22%.,Photomicrograph(original magnification,150;,H-E stain)demonstrates Hashimoto thyroiditis,34岁,，女性,，,主诉,右颈部,明显肿,块,5,个月,。体检,触及坚硬结节,。,甲状腺功能指标均在正常范围内，,24小时RAIU为22。,组织活检示：桥本甲状腺炎,甲状腺活检：,21,桥本甲状腺炎,10/2/2024,a solitary cold nodule in a 34,Treatment,Solu