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ENDOCRINE

ENDOCRINE. PITUITARY ANTERIOR POSTERIOR THYROID PARATHYROID PANCREAS (endo.) ADRENAL CORTEX MEDULLA. DEGENERATION (aka, “involution”) INFLAMMATION NEOPLASM BENIGN MALIGNANT. CLASSICAL ALGORHYTHM. 1 Diffuse nontoxic goiter/simple goiter/endemic goiter 弥漫性非毒性甲状腺肿.

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ENDOCRINE

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  1. ENDOCRINE

  2. PITUITARY ANTERIOR POSTERIOR THYROID PARATHYROID PANCREAS (endo.) ADRENAL CORTEX MEDULLA DEGENERATION (aka, “involution”) INFLAMMATION NEOPLASM BENIGN MALIGNANT CLASSICAL ALGORHYTHM

  3. 1 Diffuse nontoxic goiter/simple goiter/endemic goiter弥漫性非毒性甲状腺肿 • Endemic goiter occurs in geographic areas where the soil, water, and food supply contain only low levels of iodine. • The lack of iodine leads to decreased synthesis of thyroid hormone and a compensatory increase in TSH, leading to follicular cell hypertrophy and hyperplasia and goitrous enlargement. • With increasing dietary iodine supplementation, the frequency and severity of endemic goiter have declined significantly.

  4. GOITERS 甲状腺肿(aka, thyromegaly, diffuse or nodular) • IODINE deficiency • Increased TSH • Goitrogens, e.g., cabbage卷心菜, Brussels sprouts, cauliflower 菜花, turnips, cassava 木薯) • Associated with HYPO thyroidism eventually, NOT hyperthyroidism

  5. 3 stages • Diffuse hyperplastic goiter 增生期 • Diffuse colloid goiter 胶质储积期 • Nodular goiter 结节期

  6. 甲亢(hyperthyroidism) 广义上是指多种原因引起甲状腺合成和/或释放过多的甲状腺激素（thyroid hormone,TH）,而导致的以高代谢为主要表现的一组临床综合征，其中以自身免疫紊乱所导致的弥漫性甲状腺肿伴甲状腺功能亢进、即Graves病（GD)最为常见

  7. 甲状腺毒症病因 1.弥漫性毒性甲状腺肿（toxic diffuse goiter, Graves disease, Basedow disease） 2.桥本甲状腺毒症(Hashitoxicosis) 3.新生儿甲亢(neonatal hyperthyroidism) 4.多结节性毒性甲状腺肿(toxic multinodular goiter) 5.甲状腺自主高功能腺瘤（Plummer disease, toxic adenoma） 6.滤泡状甲状腺癌(Follicular thyroid cancer) 7.碘甲亢（IIH） 8.HCG相关甲亢 (绒毛膜癌、葡萄胎) 9.垂体性甲亢 (腺瘤或TSH细胞增生,甲状腺吸碘131率升高）

  8. HYPER-THYROIDISM • HYPERMETABOLISM • Tachycardia, palpitations • Increased T3, T4 • Goiter 甲状腺肿 • Exophthalmos 突眼 • Tremor • GI hypermotility • Thyroid “storm”, life threatening

  9. HYPO-THYROIDISM • 1° Developmental • 1° Surgery, I-131, external radiation • 1° Auto-immune (i.e., Hashimoto’s) • 1° Iodine deficiency • 1° Li+, iodides碘化物 • 2° (pituitary) • 3° (hypothalamic, rare)

  10. THYROIDITIS • Hashimoto (Auto-Immune) (Lymphoid follicles with germinal centers), MOST COMMON cause of acquired hypothyroidism in USA • Subacute Granulomatous • Subacute Lymphocytic (just like Hashimoto’s but NO fibrosis and no germinal centers), often post-partum产后

  11. GRAVES DISEASE(aka, diffuse toxic goiter) • HYPERTHYROIDISM • EXOPHTHALMOS • PRE-TIBIAL MYXEDEMA • Autoimmune, auto-antibodies to TSH receptors, thereby stimulating them

  12. 临床表现 （一）甲状腺毒症表现(甲状腺激素分泌过多) 1.高代谢症状群：产热和散热增多，蛋白质、脂肪和碳水化合物分解加速 2.神经精神系统兴奋表现 3.心血管系统：心动过速，房性心律失常，房颤，脉压增大，心脏病 4.消化系统：胃肠蠕动增快；肝功能异常 5.肌肉骨骼系统:周期性麻痹，急慢性甲亢肌病，骨质疏松 6.其他(生殖、血液） （二）甲状腺肿：弥漫性、质软、无压痛；动脉杂音

  13. （三）突眼（25%～50%）包括： 1.非浸润性（单纯性、良性突眼） （1）上睑挛缩 （2）上睑迟滞（von Graefer征） （3）瞬目减少（Stellwag征） （4）双眼向上看时，前额皮肤不能皱起（Joffroy征） （5）辐辏不良（Mobius征） （6）一般突眼度≤18mm

  14. 2.浸润性(恶性突眼): *是Graves病的自身免疫反应在眼眶的表现 *可单侧突眼 *和甲亢的发生不同步,也可见于其他自身免疫性甲状腺疾病 *眼局部症状和体征明显 *需要免疫抑制治疗

  15. 美国甲状腺协会Graves眼病的分级 (ATA, NOSPECS) 分级 眼部症状和体征 0 (N) 无症状和体征(No signs or symptoms) 1 (O) 仅有体征,无症状(Only signs, no symptoms) 2 (S) 软组织受累(Soft tissue involvement) (既有体征又有症状,signs and symptoms） 3 (P) 突眼(Proptosis,＞18mm) 4 (E) 眼外肌受累 Extaocular muscle involvement 5 (C） 角膜受累(Corneal involvement) 6 (S) 视力丧失Sight loss(optic nerve involvement）

  16. （四）其他表现 1.局限性黏液性水肿（胫前黏液性水肿） 见于Graves病，病因不明 好发于胫前区，亦可见于足背、趾、踝 局部皮肤增厚，突出表面 无压痛，淡红色或淡紫色 毛孔粗，内陷明显，压之无凹陷切迹 2.指端粗厚

  17. Thyroid Neoplasms • “Nodules” vs. true neoplasms • Adenomas vs. Carcinomas

  18. “NODULES” • Solitary vs. Multiple • Younger vs. Older • Male vs. Female • Hx. neck radiation vs. NO Rx. • “Cold” vs. HOT (really NOT-cold)

  19. ADENOMAS FOLLICULAR HÜRTHLE (oxyphilic) CARCINOMAS FOLLICULAR PAPILLARY MEDULLARY (AMYLOID) ANAPLASTIC (worst) NEOPLASMS

  20. Papillary carcinoma (75% to 85% of cases) • Follicular carcinoma (10% to 20% of cases) • Medullary carcinoma (5% of cases) • Anaplastic carcinoma (<5% of cases)

  21. BIOLOGIC BEHAVIOR • Papillary CA lymph nodes • Follicular CA  blood vessels, bone

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