慢性淋巴細(xì)胞性甲狀腺炎課件

《中國甲狀腺疾病診治指南》中華醫(yī)學(xué)會(huì)內(nèi)分洶學(xué)分會(huì)《中國甲狀腺疾病診治指南》1慢性淋巴細(xì)胞性甲狀腺炎(Chroniclymphocyticthyroiditis)慢性淋巴細(xì)胞性甲狀腺炎2內(nèi)容概述流行病學(xué)病因和發(fā)病機(jī)制病理臨床表現(xiàn)實(shí)驗(yàn)室檢查和輔助檢查診斷與鑒別診斷治療預(yù)后中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治內(nèi)容3內(nèi)容概述流行病學(xué)病因和發(fā)病機(jī)制病理臨床表現(xiàn)實(shí)驗(yàn)室檢查和輔助檢查診斷與鑒別診斷治療預(yù)后中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治內(nèi)容4中華然學(xué)會(huì)育項(xiàng)目Dr,Hakaruhashimoto甲狀疾病臨床規(guī)化診治中華然學(xué)會(huì)育項(xiàng)目5概述日本學(xué)者Hashimoto于1912年首先報(bào)道■橋本病Hashimoto'sdisease(HT■慢性淋巴細(xì)胞性甲狀腺炎Chroniclymphocyticthyroiditis(CLT自身免疫性甲狀腺炎(AT)Chronicautoimmunethyroiditis中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治概述6概述一自身免疫性甲狀腺炎分類橋本甲狀腺炎口萎縮性甲狀腺炎Hashimoto'sthyroiditisatrophicthyroiditis慢性淋巴細(xì)胞性甲狀腺炎chronicautoimmunethyroiditis無痛性甲狀腺炎自身兔疫性甲狀腺炎painlessthyroiditisautoimmunethyroiditis產(chǎn)后甲狀腺炎o(hù)stpartumthyroiditis中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治概述一自身免疫性甲狀腺炎分類7概述-自身免疫性甲狀腺炎分類分型特點(diǎn)1型自身免疫1A有甲狀腺腫甲狀腺功能正常促甲狀腺激素(TSH水平正常甲狀腺腫常有抗甲狀腺球蛋白(Tg)和甲狀腺過氧化物(橋本病1型酶(TP0)抗體存在2型自身免疫2A有甲狀腺腫(經(jīng)典橋本病)持續(xù)存在甲減TSH水平升高,常有抗Tg和TP0抗性甲狀腺炎體存在,一些2B型伴有阻斷型TSH受體抗體存橋本病2型)2B腺腫性粘液在性水腫,萎縮性甲狀腺炎20暫時(shí)加重的甲狀腺炎可能開始表現(xiàn)為暫時(shí)的甲狀腺毒癥(血清甲狀腺激素升高伴有甲狀腺攝碘率減低),然后經(jīng)常出現(xiàn)暫時(shí)性甲減。但患者也可表現(xiàn)為暫時(shí)性甲減而沒有之前的甲狀腺毒癥?？筎g和TP0抗體存在甲狀腺功能亢進(jìn)的Graves病甲狀腺功能亢進(jìn)或甲狀腺功能正常而TSH被抑性甲狀腺炎制,有刺激型TSH受體抗體存在,抗Tg和TP0Graves病)3B甲狀腺功能正常的Graves病抗體也常存在3甲狀腺功能減低的Graves病眼病伴有甲狀腺功能減低,有診斷水平的刺激型或阻斷型TSH受體抗體可被發(fā)現(xiàn),常有抗Tg和TP0抗體存在中華然學(xué)會(huì)繼線教商項(xiàng)目概述-自身免疫性甲狀腺炎分類8Table2.CharacteristicsofThyroiditisSyndromes.hSuppuraCharacteristithyroiditisThyroiditisAgeatonset(yr)Allages,peakChildbearingageAllages,peakn20403060M)891PathologicalfinLymphocyticinfil-Giantcells.Abscessforma-DensefibrosisThyroidfurHypothyroidismhyrotoxicosis,Thyrotoricosis,Thyrotoxicosis,Usuallyeuthy.Usuallyeuthyism,orbothism,orbothTPOantibodiesHightitertiter,orab.AbsentHiNormal24-Hour123IuptakeVariable<5%%NormalwInformationisfromFarwellandBraverman.TPOdenotesthyroidperoxidase,ESRerythrocytesedimentationrate,and1231iodine-123PearceEN,FarwellAP,BravermanLEThyroiditis.NEnglJMed2019:348:2646-2655中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治Table2.CharacteristicsofTh9內(nèi)容概述■流行病學(xué)■病因和發(fā)病機(jī)制病理臨床表現(xiàn)■實(shí)驗(yàn)室檢查和輔助檢查■診斷與鑒別診斷治療中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治內(nèi)容10慢性淋巴細(xì)胞性甲狀腺炎課件11慢性淋巴細(xì)胞性甲狀腺炎課件12慢性淋巴細(xì)胞性甲狀腺炎課件13慢性淋巴細(xì)胞性甲狀腺炎課件14慢性淋巴細(xì)胞性甲狀腺炎課件15慢性淋巴細(xì)胞性甲狀腺炎課件16慢性淋巴細(xì)胞性甲狀腺炎課件17慢性淋巴細(xì)胞性甲狀腺炎課件18慢性淋巴細(xì)胞性甲狀腺炎課件19慢性淋巴細(xì)胞性甲狀腺炎課件20慢性淋巴細(xì)胞性甲狀腺炎課件21慢性淋巴細(xì)胞性甲狀腺炎課件22慢性淋巴細(xì)胞性甲狀腺炎課件23慢性淋巴細(xì)胞性甲狀腺炎課件24慢性淋巴細(xì)胞性甲狀腺炎課件25慢性淋巴細(xì)胞性甲狀腺炎課件26慢性淋巴細(xì)胞性甲狀腺炎課件27慢性淋巴細(xì)胞性甲狀腺炎課件28慢性淋巴細(xì)胞性甲狀腺炎課件29慢性淋巴細(xì)胞性甲狀腺炎課件30慢性淋巴細(xì)胞性甲狀腺炎課件31慢性淋巴細(xì)胞性甲狀腺炎課件32慢性淋巴細(xì)胞性甲狀腺炎課件33慢性淋巴細(xì)胞性甲狀腺炎課件34慢性淋巴細(xì)胞性甲狀腺炎課件35慢性淋巴細(xì)胞性甲狀腺炎課件36慢性淋巴細(xì)胞性甲狀腺炎課件37慢性淋巴細(xì)胞性甲狀腺炎課件38慢性淋巴細(xì)胞性甲狀腺炎課件39慢性淋巴細(xì)胞性甲狀腺炎課件40慢性淋巴細(xì)胞性甲狀腺炎課件41慢性淋巴細(xì)胞性甲狀腺炎課件42慢性淋巴細(xì)胞性甲狀腺炎課件43慢性淋巴細(xì)胞性甲狀腺炎課件44慢性淋巴細(xì)胞性甲狀腺炎課件45慢性淋巴細(xì)胞性甲狀腺炎課件46慢性淋巴細(xì)胞性甲狀腺炎課件47慢性淋巴細(xì)胞性甲狀腺炎課件48慢性淋巴細(xì)胞性甲狀腺炎課件49慢性淋巴細(xì)胞性甲狀腺炎課件50慢性淋巴細(xì)胞性甲狀腺炎課件51慢性淋巴細(xì)胞性甲狀腺炎課件52慢性淋巴細(xì)胞性甲狀腺炎課件53慢性淋巴細(xì)胞性甲狀腺炎課件54慢性淋巴細(xì)胞性甲狀腺炎課件55《中國甲狀腺疾病診治指南》中華醫(yī)學(xué)會(huì)內(nèi)分洶學(xué)分會(huì)《中國甲狀腺疾病診治指南》56慢性淋巴細(xì)胞性甲狀腺炎(Chroniclymphocyticthyroiditis)慢性淋巴細(xì)胞性甲狀腺炎57內(nèi)容概述流行病學(xué)病因和發(fā)病機(jī)制病理臨床表現(xiàn)實(shí)驗(yàn)室檢查和輔助檢查診斷與鑒別診斷治療預(yù)后中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治內(nèi)容58內(nèi)容概述流行病學(xué)病因和發(fā)病機(jī)制病理臨床表現(xiàn)實(shí)驗(yàn)室檢查和輔助檢查診斷與鑒別診斷治療預(yù)后中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治內(nèi)容59中華然學(xué)會(huì)育項(xiàng)目Dr,Hakaruhashimoto甲狀疾病臨床規(guī)化診治中華然學(xué)會(huì)育項(xiàng)目60概述日本學(xué)者Hashimoto于1912年首先報(bào)道■橋本病Hashimoto'sdisease(HT■慢性淋巴細(xì)胞性甲狀腺炎Chroniclymphocyticthyroiditis(CLT自身免疫性甲狀腺炎(AT)Chronicautoimmunethyroiditis中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治概述61概述一自身免疫性甲狀腺炎分類橋本甲狀腺炎口萎縮性甲狀腺炎Hashimoto'sthyroiditisatrophicthyroiditis慢性淋巴細(xì)胞性甲狀腺炎chronicautoimmunethyroiditis無痛性甲狀腺炎自身兔疫性甲狀腺炎painlessthyroiditisautoimmunethyroiditis產(chǎn)后甲狀腺炎o(hù)stpartumthyroiditis中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治概述一自身免疫性甲狀腺炎分類62概述-自身免疫性甲狀腺炎分類分型特點(diǎn)1型自身免疫1A有甲狀腺腫甲狀腺功能正常促甲狀腺激素(TSH水平正常甲狀腺腫常有抗甲狀腺球蛋白(Tg)和甲狀腺過氧化物(橋本病1型酶(TP0)抗體存在2型自身免疫2A有甲狀腺腫(經(jīng)典橋本病)持續(xù)存在甲減TSH水平升高,常有抗Tg和TP0抗性甲狀腺炎體存在,一些2B型伴有阻斷型TSH受體抗體存橋本病2型)2B腺腫性粘液在性水腫,萎縮性甲狀腺炎20暫時(shí)加重的甲狀腺炎可能開始表現(xiàn)為暫時(shí)的甲狀腺毒癥(血清甲狀腺激素升高伴有甲狀腺攝碘率減低),然后經(jīng)常出現(xiàn)暫時(shí)性甲減。但患者也可表現(xiàn)為暫時(shí)性甲減而沒有之前的甲狀腺毒癥?？筎g和TP0抗體存在甲狀腺功能亢進(jìn)的Graves病甲狀腺功能亢進(jìn)或甲狀腺功能正常而TSH被抑性甲狀腺炎制,有刺激型TSH受體抗體存在,抗Tg和TP0Graves病)3B甲狀腺功能正常的Graves病抗體也常存在3甲狀腺功能減低的Graves病眼病伴有甲狀腺功能減低,有診斷水平的刺激型或阻斷型TSH受體抗體可被發(fā)現(xiàn),常有抗Tg和TP0抗體存在中華然學(xué)會(huì)繼線教商項(xiàng)目概述-自身免疫性甲狀腺炎分類63Table2.CharacteristicsofThyroiditisSyndromes.hSuppuraCharacteristithyroiditisThyroiditisAgeatonset(yr)Allages,peakChildbearingageAllages,peakn20403060M)891PathologicalfinLymphocyticinfil-Giantcells.Abscessforma-DensefibrosisThyroidfurHypothyroidismhyrotoxicosis,Thyrotoricosis,Thyrotoxicosis,Usuallyeuthy.Usuallyeuthyism,orbothism,orbothTPOantibodiesHightitertiter,orab.AbsentHiNormal24-Hour123IuptakeVariable<5%%NormalwInformationisfromFarwellandBraverman.TPOdenotesthyroidperoxidase,ESRerythrocytesedimentationrate,and1231iodine-123PearceEN,FarwellAP,BravermanLEThyroiditis.NEnglJMed2019:348:2646-2655中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治Table2.CharacteristicsofTh64內(nèi)容概述■流行病學(xué)■病因和發(fā)病機(jī)制病理臨床表現(xiàn)■實(shí)驗(yàn)室檢查和輔助檢查■診斷與鑒別診斷治療中華然學(xué)會(huì)育項(xiàng)目甲狀疾病臨床規(guī)化診治內(nèi)容65慢性淋巴細(xì)胞性甲狀腺炎課件66慢性淋巴細(xì)胞性甲狀腺炎課件67慢性淋巴細(xì)胞性甲狀腺炎課件68慢性淋巴細(xì)胞性甲狀腺炎課件69慢性淋巴細(xì)胞性甲狀腺炎課件70慢性淋巴細(xì)胞性甲狀腺炎課件71慢性淋巴細(xì)胞性甲狀腺炎課件72慢性淋巴細(xì)胞性甲狀腺炎課件73慢性淋巴細(xì)胞性甲狀腺炎課件74慢性淋巴細(xì)胞性甲狀腺炎課件75慢性淋巴細(xì)胞性甲狀腺炎課件76慢性淋巴細(xì)胞性甲狀腺炎課件77慢性淋巴細(xì)胞性甲狀腺炎課件78慢性淋巴細(xì)胞性甲狀腺炎課件79慢性淋巴細(xì)胞性甲狀腺炎課件80慢性淋巴細(xì)胞性甲狀腺炎課件81慢性淋巴細(xì)胞性甲狀腺炎課件82慢性淋巴細(xì)胞性甲狀腺炎課件83慢性淋巴細(xì)胞性甲狀腺炎課件84慢性淋巴細(xì)胞性甲狀腺炎課件85慢性淋巴細(xì)胞性甲狀腺炎課件86慢性淋巴細(xì)胞性甲狀腺炎課件87慢性淋巴細(xì)胞性甲狀腺炎課件88慢性淋巴細(xì)胞性甲狀腺炎課件89慢性淋巴細(xì)胞性甲狀腺炎課件90慢性淋巴細(xì)胞性甲狀腺炎課件91慢性淋巴細(xì)胞性甲狀腺炎課件92慢性淋巴細(xì)胞性甲狀腺炎課件93慢性淋巴細(xì)胞性甲狀腺炎課件9