| 访问我们的完整专题甲状腺功能检测 甲状腺功能测试是最常用的内分泌测试。 在缺乏下丘脑和脑垂体病理学支持下的情况下,可以用血清TSH检测筛查甲状腺功能紊乱。[1]Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000 Jun 12;160(11):1573-5.
https://www.doi.org/10.1001/archinte.160.11.1573
http://www.ncbi.nlm.nih.gov/pubmed/10847249?tool=bestpractice.com
[2]Alberta Medical Association. Investigation and Management of Primary Thyroid Dysfunction. Apr 2014 [internet publication].
https://actt.albertadoctors.org/CPGs/Pages/Thyroid-Dysfunction.aspx
[3]Schneider C, Feller M, Bauer DC, et al. Initial evaluation of thyroid dysfunction - Are simultaneous TSH and fT4 tests necessary? PLoS One. 2018;13(4):e0196631.
https://www.doi.org/10.1371/journal.pone.0196631
http://www.ncbi.nlm.nih.gov/pubmed/29709030?tool=bestpractice.com
TSH 水平降低或升高可证实存在甲状腺功能异常,但无法证实其原因。游离 T4 测定是评估异常 TSH 水平的首选检查。对于一些病例,可能行进一步的检查(例如,放射性碘摄取)来明确病因。 |
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| 访问我们的完整专题Graves 病 Graves 病是一种自身免疫性甲状腺病,在碘摄入量充足的国家,是最常见的甲状腺功能亢进症类型。甲状腺功能亢进症由 TSH 受体抗体(TSH receptor antibody, TRAb)引起。[4]Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26:1343-1421.
http://online.liebertpub.com/doi/10.1089/thy.2016.0229
http://www.ncbi.nlm.nih.gov/pubmed/27521067?tool=bestpractice.com
甲状腺功能亢进症其他病因不会引起的甲状腺外表现包括眼眶病、胫前粘液性水肿(甲状腺皮肤病)或杵状指。 多根据临床进行诊断,通常依据甲状腺功能紊乱的实验室证据确诊,最常见的是甲状腺功能亢进。[5]Smith TJ, Hegedüs L. Graves' Disease. N Engl J Med. 2016 Oct 20;375(16):1552-1565.
https://www.doi.org/10.1056/NEJMra1510030
http://www.ncbi.nlm.nih.gov/pubmed/27797318?tool=bestpractice.com
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| 访问我们的完整专题毒性多结节性甲状腺肿 毒性结节性甲状腺肿(MNG,也被成为Plummer病)包含多个自主功能性结节,导致甲状腺功能亢进。结节功能独立,受TSH调节并且几乎总是良性的。 然而,在同一肿大甲状腺中可能存在恶性无功能性甲状腺结节。[6]Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.
https://www.doi.org/10.1089/thy.2015.0020
http://www.ncbi.nlm.nih.gov/pubmed/26462967?tool=bestpractice.com
世界范围内,碘缺乏是结节性甲状腺肿的最常见病因。[7]Tonacchera M, Vitti P, De Servi M, et al. Gain of function TSH receptor mutations and iodine deficiency: implications in iodine prophylaxis. J Endocrinol Invest. 2003;26(2 Suppl):2-6.
http://www.ncbi.nlm.nih.gov/pubmed/12762632?tool=bestpractice.com
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| 访问我们的完整专题毒性甲状腺腺瘤 一种引起甲状腺功能亢进症的自主功能性甲状腺结节。[4]Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26:1343-1421.
http://online.liebertpub.com/doi/10.1089/thy.2016.0229
http://www.ncbi.nlm.nih.gov/pubmed/27521067?tool=bestpractice.com
通常有单个甲状腺大结节,伴有临床及生化甲状腺功能亢进症。 这些结节几乎总是良性。世界范围内,碘缺乏是结节性甲状腺肿的最常见病因。[7]Tonacchera M, Vitti P, De Servi M, et al. Gain of function TSH receptor mutations and iodine deficiency: implications in iodine prophylaxis. J Endocrinol Invest. 2003;26(2 Suppl):2-6.
http://www.ncbi.nlm.nih.gov/pubmed/12762632?tool=bestpractice.com
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| 访问我们的完整专题无痛性淋巴细胞性甲状腺炎 自身免疫介导的甲状腺炎症伴甲状腺激素释放,导致一过性甲状腺功能亢进症,之后经常在甲状腺功能恢复正常之前,出现一个甲状腺功能减退期。[8]Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20.
http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com
[9]Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33.
http://www.ncbi.nlm.nih.gov/pubmed/22443972?tool=bestpractice.com
散发、发生于产后或在免疫调节治疗或锂治疗期间发生。 有些患者早期进展为永久性甲状腺功能减退,有些患者则几年或几十年后才进展。 |
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| 访问我们的完整专题亚急性肉芽肿性甲状腺炎 甲状腺炎症的特点有三相即暂时性甲亢,继以甲减,随后恢复正常。[10]Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725-9.
https://www.jstage.jst.go.jp/article/internalmedicine/47/8/47_8_725/_pdf
http://www.ncbi.nlm.nih.gov/pubmed/18421188?tool=bestpractice.com
[11]Fatourechi V, Aniszewski JP, Fatourechi GZ, et al. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted county, Minnesota, study. J Clin Endocrinol Metab. 2003 May;88(5):2100-5.
https://academic.oup.com/jcem/article/88/5/2100/2845301
http://www.ncbi.nlm.nih.gov/pubmed/12727961?tool=bestpractice.com
最初的甲状腺毒性阶段会出现甲状腺疼痛、血清甲状腺激素水平高、放射性碘摄取水平下降、红细胞沉降率上升、C 反应蛋白上升,以及类似于流感的全身症状(例如发热、肌痛和不适)。[12]Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003 Jun 26;348(26):2646-55.
http://www.ncbi.nlm.nih.gov/pubmed/12826640?tool=bestpractice.com
[13]Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: an integrated approach. Am Fam Physician. 2014 Sep 15;90(6):389-96.
https://www.aafp.org/afp/2014/0915/p389.html
http://www.ncbi.nlm.nih.gov/pubmed/25251231?tool=bestpractice.com
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| 访问我们的完整专题原发性甲状腺功能减退症 临床症状是T4和T3减少造成的。 原发性甲状腺功能减退症患者常有虚弱、昏睡、抑郁、体重轻度增加等非特异性症状。 偏低的游离 T4 和升高的 TSH 支持原发性甲状腺功能减退的诊断。[14]National Institute for Health and Care Excellence. Thyroid disease: assessment and management. Nov 2019 [internet publication].
https://www.nice.org.uk/guidance/ng145
在碘摄入量充足的地区,自身免疫性甲状腺炎(桥本病)是原发性甲状腺功能减退症的最常见病因。[15]Chaker L, Bianco AC, Jonklaas J, et al. Hypothyroidism. Lancet. 2017 Sep 23;390(10101):1550-1562.
https://www.doi.org/10.1016/S0140-6736(17)30703-1
http://www.ncbi.nlm.nih.gov/pubmed/28336049?tool=bestpractice.com
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| 访问我们的完整专题中枢性甲状腺功能减退 垂体前叶或下丘脑功能减退的结果。它可能是由先天性、肿瘤性、炎症性、浸润性、创伤性或医源性因素引起。[16]Persani L, Brabant G, Dattani M, et al. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J. 2018 Oct;7(5):225-237.
https://www.doi.org/10.1159/000491388
http://www.ncbi.nlm.nih.gov/pubmed/30374425?tool=bestpractice.com
垂体占位病变,尤其是垂体腺瘤,是最常见的原因。[17]Bates AS, Van't Hoff W, Jones PJ, et al. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996 Mar;81(3):1169-72.
http://www.ncbi.nlm.nih.gov/pubmed/8772595?tool=bestpractice.com
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| 访问我们的完整专题甲状腺癌 最常见的表现为30~40岁女性触诊或超声检出无症状甲状腺结节。 乳头状癌、滤泡癌、未分化癌和髓样癌这四种类型,占了所有甲状腺恶性肿瘤的98%以上。[18]Gimm O. Thyroid cancer. Cancer Lett. 2001 Feb 26;163(2):143-56.
https://www.doi.org/10.1016/s0304-3835(00)00697-2
http://www.ncbi.nlm.nih.gov/pubmed/11165748?tool=bestpractice.com
细针穿刺是最重要的诊断性试验。[19]Gharib H, Papini E, Garber JR, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract. 2016 May;22(5):622-39.
https://www.doi.org/10.4158/EP161208.GL
http://www.ncbi.nlm.nih.gov/pubmed/27167915?tool=bestpractice.com
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| 访问我们的完整专题甲状腺肿块/增大的评估 甲状腺实质扩张可由甲状腺肿大或浸润,或一个或多个甲状腺结节引起。 甲状腺周围其他解剖结构的增大,如甲状旁腺、局部淋巴结,还有鳃裂囊肿、甲状舌管囊肿有时会与甲状腺结节相混淆。 超声检查是评估颈部肿块结构和解剖位置的首选初始检查。 |
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