1 / 26

ENDOCRINE 竺可青 2013-5-29

ENDOCRINE 竺可青 2013-5-29. PITUITARY ANTERIOR POSTERIOR THYROID PARATHYROID PANCREAS (endo.) ADRENAL CORTEX MEDULLA. DEGENERATION (aka, “involution”) INFLAMMATION NEOPLASM BENIGN MALIGNANT. CLASSICAL ALGORHYTHM. 1. Thyroiditis

edgart
Download Presentation

ENDOCRINE 竺可青 2013-5-29

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ENDOCRINE 竺可青 2013-5-29

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

  3. 1. Thyroiditis 2. Diffuse nontoxic goiter/simple goiter/endemic goiter 3. Graves Disease / diffuse toxic goiter / hyperthyroidism/ Basedow disease 4. Neoplasms of the Thyroid

  4. HYPER-THYROIDISM • aka, thyrotoxicosis • Diffuse (Graves disease) • Nodular • Adenoma • Carcinoma • Neonatal • Secondary to TSH pituitary adenoma

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

  6. 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, p-aminosalicylates • 2° (pituitary) • 3° (hypothalamic, rare)

  7. HYPO-THYROIDISM • Cretinism 呆小症 • Severe retardation • CNS/Musc-skel • Short stature • Protruding tongue • Umbilical hernia • Maternal iodine defic. • Myxedema 粘液水肿(coma) • Sluggishness • Cool skin, ↑cholesterol

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

  9. Subacute thyroiditisThe thyroid parenchyma contains a chronic inflammatory infiltrate with a multinucleate giant cell (above left) and a colloid follicle (bottom right).

  10. Hashimoto thyroiditis慢性淋巴细胞性甲状腺炎/桥本甲状腺炎 甲状腺实质广泛破坏萎缩， 大量淋巴细胞浸润， 纤维组织增生。

  11. If the thyroid gland looks like a lymph node, the diagnosis is Hashimoto thyroiditis。

  12. 甲状腺肿 • 由于增生和胶质储存伴甲状腺激素不正常分泌而产生的甲状腺肿大。 • 非毒性甲状腺肿（结节性增生） • 毒性甲状腺肿

  13. Diffuse nontoxic goiter/simple goiter/endemic goiter弥漫性非毒性甲状腺肿（结节性甲状腺肿） 缺碘---使甲状腺分泌不足---垂体促甲状腺(TSH)分泌增多---甲状腺滤泡上皮增生---胶质堆积而使甲状腺肿大，一般不伴甲亢。 病因 1 缺碘 2 致甲状腺肿因子的作用 3 高碘 4 遗传与免疫

  14. GOITER Most goiters worldwide are due to iodine deficiency. The thyroid enlarges to try to trap more iodine, when serum levels are low. This is a adaptive response

  15. 甲亢 Graves Disease / diffuse toxic goiter/ hyperthyroidism / Basedow disease Graves disease is the most common cause of endogenous hyperthyroidism. It is characterized by a triad of clinical findings: Hyperthyroidism owing to hyperfunctional, diffuse enlargement of the thyroid Infiltrative ophthalmopathy with resultant exophthalmos Localized, infiltrative dermopathy, sometimes called pretibial myxedema, which is present in a minority of patients.

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

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

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

  19. Several clinical criteria might provide a clue to the nature of a given thyroid nodule: Solitary nodules, in general, are more likely to be neoplastic than are multiple nodules . Nodules in younger patients are more likely to be neoplastic than are those in older patients. Nodules in males are more likely to be neoplastic than are those in females. A history of radiation treatment to the head and neck region is associated with an increased incidence of thyroid malignancy. Nodules that take up radioactive iodine in imaging studies (hot nodules) are more likely to be benign than malignant.

  20. ADENOMAS 胚胎性腺瘤 胎儿型腺瘤 单纯性腺瘤 胶样腺瘤 嗜酸粒细胞腺瘤 非典型腺瘤

  21. 甲状腺腺瘤 • 有完整的包膜； • 腺瘤内滤泡大小胶一致； • 腺瘤与周围甲状腺的实质不同 • 压迫周围甲状腺组织

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

  23. Papillary carcinoma 砂粒体/毛玻璃状核of the thyroid.

  24. 小 结 乳头状癌 最常见，青少年、女性多见，生长慢，恶性度较低，预后较好。砂粒体/毛玻璃状核。 滤泡性癌 比乳头状癌恶性度高，预后差而少见，多见于40岁以上女性，早期易血道转移。注意包膜和血管侵犯。 髓样癌 滤泡旁细胞发生，属APUD瘤。间质常有淀粉样物沉着。降钙素( calcitonin ) 阳性。 未分化癌：恶性度高，预后差。可用keratin\CEA\thyroglobulin证实来自甲状腺上皮。

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

More Related