[临床医学]甲状腺入门教育.ppt

Ultrasound examination of the thyroid gland is more sensitive than palpation. Thyroid size can be determined more precisely and also smaller nodules can be detected. Also cysts (filled with liquid) and calcifications can be seen. An ultrasound examination allows the so-called echostructure of the whole thyroid tissue and of single nodules to be assessed. A thyroid which shows up ‘poor in echo’ (dark picture) could be due to an autoimmune thyroid disorder like Graves’ or Hashimoto’s disease. Nodules, which are poor in echo, have to be checked for malignancy. A fine-needle aspiration biopsy (FNAB) is mainly performed to examine nodules for malignancy. If a nodule is easily palpable the puncture can be performed without ultrasound. However, ultrasound guided FNAB makes it easier to be sure that the right area is found. The cells obtained from the FNAB are then microscopically examined. There are several synonyms for this examination: Thyroid nuclear scan, scintigraphy, radionuclide scanning, radioisotope scan, technetium or Tc scan (if performed with 99m-Tc), radioiodine scan (if performed with 123-iodine). A thyroid scintigraphy is usually performed in iodine deficient regions. It allows assessment of thyroid regional function and detection of areas of autonomously functioning thyroid tissue. Depending on the scan results, nodules can be classified as hyperfunctioning (hot) or hypofunctioning (cold). Cold nodules have a reported malignant risk of about 5% to 8%. Aspects of Thyroid Disease 体积(正常,缺少,肿大) 功能(正常, 减退,亢进) Structure/Morphology(homogenous, 低回声的,结节, 囊肿) 发病机理(自身免疫性, 先天性, 碘缺乏性, 恶性) 症状？ 甲状腺疾病的诊断 基础检查 患者病史 体格检查 甲状腺扪诊 实验室检查 (TSH及甲状腺激素) 附加检查 超声检查 抗体检查 细针穿针活检 核医学扫描 实验室检查 激素检查 TSH (促甲状腺激素)= 最重要的参考指标 fT4 (游离T4) fT3 (游离T3) 抗体检查 TPOAb (甲状腺过氧化物酶抗体) TRAb (TSH受体抗体)=Graves病的必要指标 特殊检查 TBG（甲状腺结合球蛋白） total TT4, TT3 （总甲状腺激素） Tg(甲状腺球蛋白), 降钙素 甲状腺激素检查参考标准 （成人） TSH 0.3–5.0 mU/L fT4 0.7–1.8 ng/dL (9–23 pmol/L) fT3 0.2–0.5 ng/dL (3.5–7.7 pmol/L) TT4 4.5–12.6 μg/dL (58–