七年制醫(yī)學(xué)課件-兒科-18先天性甲低

1、（呆小病 克汀?。?Cretinism)先天性甲狀腺功能減低癥 Congenital HypothyroidismOverviewCongenital Hypothyroidism is common disease of pediatric endocrinology.Congenital factors cause the insufficience of thyriod hormone, which result in the low metabolism, retardation of growth,and mental impairment.The onset during inbo

2、re or newborn peroid,can lead to irreversible mental impairment. Disease incidence In American and Europe: Incidence of neonatal screening: 1/3750In China:Incidence of neonatal screening: 1/3624 -the nationwide neonatal screening from clinical examination center of Health Bureau in 1999 CategorySpor

3、adical congenital hypothyroidism accounting for most patients, a few as family.Endemic congenital hypothyroidism Pregnant women live in iodine insufficient areas, which result in iodine deficiency. along with the population of iodine salt in dietary, the incidence is much lower. Synthesis and releas

4、e of thyroid hormone (TH)Blood thyroid epithelial cell TSH hydrogen peroxidaseI I I O + tyrosineoxidization T1 + T2T3T4 TSH T2 + T2T3、T4 +iodizeiodinasecytolysosomeThyroglobulin (TG)hydrolyzeTGRegulation of thyroid hormone secretion thyroid-stimulating hormone-releasing hormone(TRH)Hypothalamus(HT)t

5、hyroidthyroid stimulating hormone(TSH)T3、T4（+）（+）（）Pituitary Thyriod dysgenesis Athyreotic or hypothyreotic Ectopic Goitrous enzyme defect (thyriod hormone dysgenesis) Iodine deficiency or Iodine transporter defect peroxidase defct thyroglobulin synthetic defect Thyroid-stimulating hormone defect TS

6、H defect or TSH resistance Peripheral thyriod hormone inactivation Transient hypothyriodism maternal antithyriod medications or maternal antithyriod antibodiesEtiological factorThe role on metabolism of human bodyThe role on growth and development The role on function of organs and systemsphysiologi

7、c function of thyriod hormone The role on metabolism Oxidation basal metabolism,heat production protein promote protein synthesis fat promote lipoclasis liquid promote large molecular substance in lymphatic vessel into blood, maintain water balancemineral salt affect turnover rate of calcium and pho

8、sphonium Vitamin participate vitamin metabolismThe role on growth and development tissue Promote tissue,cell growth and development skeleton promote bone and cartilage growth and development, promote calcium and phosphonium deposit.Cerebrum promote proliferation,differentiation,maturity of pallium c

9、ellular Differentiation,maturity process of infant palliumpallium Pregnant 2mo formation Pregnant 5mo DifferentiationLate foetal period peak period of proliferation,-8mo after birth differentiation and maturation Upto 3yr differentiation finishAttention: thyroid hormone is essential for this process

10、The role on organ and systemcirculation system increase myocardial contractility digestive system promote digestive gland secretion, maintain normal enterokinesia. sexual gland promote sexual developmentClinical manifestationtypical symptom典型癥狀Special manifestation of neonatal hypothyroidism新生兒甲低的特殊

11、表現(xiàn)Typical symptome(典型癥狀) Retardation of growth and development生長發(fā)育障礙unusual facies and body carriage特殊面容體態(tài)mental disable智能低下Physiologic Hypofunction生理功能低下 126cm85cm7yr6moRetardation of growth and developmentTypical symptome(典型癥狀) Retardation of growth and development生長發(fā)育障礙unusual facies and body car

12、riage特殊面容體態(tài)mental disable智能低下Physiologic Hypofunction生理功能低下 unusual facies and body carriageunusual facies6yrunusual facies12 yr4 yr2mo1yr6moTypical symptome(典型癥狀) Retardation of growth and development生長發(fā)育障礙unusual facies and body carriage特殊面容體態(tài)mental disabe智能低下Physiologic Hypofunction生理功能低下 Very se

13、vere mental disable智力極度落后。 Very lower Memory and attention記憶力、注意力均低下。Disorder of motor development,delayed walking, poor fine activities運(yùn)動發(fā)育障礙，行走延遲，精細(xì)動作差。partial deafness, disesthesia聽力減退、感覺遲鈍。Typical symptome(典型癥狀) Retardation of growth and development生長發(fā)育障礙unusual facies and body carriage特殊面容體態(tài)men

14、tally disable智能低下Physiologic Hypofunction生理功能低下 Lower basal metabolic rate(基礎(chǔ)代謝率低表現(xiàn))Quiet and less activities,lower voice,limited food-intake,lower body temperature. 安靜少動、聲音低啞、進(jìn)食量少、體溫偏低;Lower cardiovascular function心(血管功能低下表現(xiàn))Bradycardia,lower cardiechema, hydropericardium, electrocardiogram show lo

15、w tension, lengthened P-R interval , conduction blockade.心率緩慢、心音低鈍、可有心包積液、心電圖呈低電壓、P-R間期延長、傳導(dǎo)阻滯; Lower digestion function(消化功能低下表現(xiàn))Decreased enterokinesia, abdominal distention, constipation, dry stool.腸蠕動減少、腹脹、便秘、大便干結(jié)Special manifestation of neonatal hypothyroidism新生兒甲低的特殊表現(xiàn)Appearance of overall hyp

16、o-metabolic function全面代謝低下的表現(xiàn) Special manifestation of neonatal hypothyroidism post-term birth, large for date infant, birth weight4000g, oedema,prolonged jaundice.過期產(chǎn)、巨大兒、體重4000g、水腫、黃疸時間延長。Poor-feeding, poor-sucking, fewer food-intake, sleepiness, dull reaction,hoarse cry,lower body temperature,poo

17、r peripheral circulation,easy to stiff edema.喂養(yǎng)困難、吸吮差、少吃、多睡不動、對外界反應(yīng)遲鈍、哭聲低微、低體溫、末稍循環(huán)差、易發(fā)生硬腫；Decreased enterokinesia, abdominal distention, constipation腸蠕動少、腹脹、便秘，易被誤診為巨結(jié)腸Laboratory examination Newborn screening Time: 23 days after birthMothed: use dry blood slip and detect TSH level.Results: positive

18、 : TSH 20uU/ml then detect T4 and TSH to further determineLaboratory examinationEvaluate thyriod function primarily hypothyriodism: T4 T3 TSH (甲狀腺性甲低) secondary hypothyriodism: T4 T3 TSH (垂體性甲低)TRH stimulating test (TRH刺激試驗(yàn)) objective: suspected insufficient TSH or TRH objectivesmothed: TRH 7ug/kg,I

19、V,detect TSH levelresults:normal: at 30 min appear TSH peak， at 90 min retum to basic level valu abnormal: dont appear TSH peak - pituitary disorder appaer delayed TSH peak- hypothalamic disorderLaboratory examinationLaboratory examinationEvaluation bone ageObviously delayed bone age, almost lag 3ye

20、ars oldPosition of detect bone age: younger than 6 month: detect lap older than 6month: detect wrist diagnostic therapyOnly used in the condition that there is suspect clinical manifestation, but can not detect thyriod function. Laboratory examinationDiagnosis as early as possiblediagnostic criteria

21、Children:typical symptom + T4 TSH+ lag bone ageNeonate:Neonatal special manifestation + T4 TSHDifferential diagnosisCongenital megacolon 先天性巨結(jié)腸21-trisome 21-三體癥Bone dysgenopathy 骨發(fā)育障礙病 Achondroplasty 軟骨發(fā)育不全 Mucopolyasccharidosis 粘多糖病Rickets 佝僂病Anaemia 貧血 21-trisome(21-三體癥)21-trisomeDifferential diag

22、nosisCongenital megacolon 先天性巨結(jié)腸21-trisome 21-三體癥Bone dysgenopathy 骨發(fā)育障礙病 Achondroplasty 軟骨發(fā)育不全 Mucopolyasccharidosis 粘多糖病Rickets 佝僂病Anaemia 貧血 AchondroplastyAchondroplasty3yr6moMucopolyasccharidosisDifferential diagnosisCongenital megacolon 先天性巨結(jié)腸21-trisome 21-三體癥Bone dysgenopathy 骨發(fā)育障礙病 Achondroplasty 軟骨發(fā)育不全 Mucopolyasccharidosis 粘多糖病Rickets 佝僂病Anaemia 貧血 TherapyPrinciple Once diagnosis,immediately treatmentLifetime substitute therapyStarted with