00甲状腺激素及抗甲状腺药5课件.ppt

甲状腺激素及抗甲状腺药
主讲李勇文
教学目的及要求
1 了解甲状腺激素制剂的临床应用,β受体拮抗药在甲亢治疗中的作用特点,放射性碘在甲亢治疗中的适应症。
2 熟悉碘及碘化物对甲状腺功能的双向作用;
3 掌握硫脲类抗甲状腺药的作用机制、作用特点、临床应用和不良反应.
第一节甲状腺激素
甲状腺激素是维持机体正常代谢,促进生长发育所必需的重要激素,分泌过多或过少均可引起疾病。
正常情况每天分泌:T3 25ug,T4 75ug
分泌过少:甲状腺功能低下
分泌过多:甲状腺功能亢进
甲状腺激素的合成,贮存,分泌与调节碘的摄取:甲状腺腺泡细胞有高度摄取和浓集碘 的能力,正常时比血浆高25倍,甲亢 时高250倍。
血液中碘化物
碘泵
甲状腺细胞
过氧
化物酶
活性碘
TG上的酪氨酸残基
MIT
DIT
过氧
化物酶
DIT
T3
T4
滤泡腔胶质
蛋白
水解酶
血液
T3
T4
腺垂体
下丘脑
TRH
TSH
甲状腺激素合成、分泌调节
作用机制:
与细胞膜上的T3,T4受体结合,被动转入细胞内,与胞浆结合蛋白结合,进一步调节细胞核内T3受体所中介的基因表达,增加相关mRNA及蛋白质的合成,而发挥作用。
甲状腺激素药理作用:脑和长骨
先天性甲状腺功能不足——呆小病
A 44 yr. old man who has always been cared for by his mother is presented. He is severely retarded and municate. He is only 140 tall, his epiphyses are still open, although severely damaged. He has very thick, dry skin. His tongue is thick, and he has a saddle nose. He still has his primary teeth; the secondary teeth have not erupted.
甲状腺激素药理作用:脑和长骨
43 y/o patient with the plaint of "decreased energy." plains of fatigue, inability to finish tasks, sleeping more, yet always being tired. She has also noticed a decreased cold tolerance, constipation, and dryness of the skin. ments that she is always cold, even in the summer.
幼年及***甲状腺功能
低下——甲状腺机能减退

增加机体耗氧量,提高基础代谢率,产热量增多
-肾上腺系统感受性
A 32 year old man presents with Heat intolerance and weight loss. He has lost ten pounds in the last six weeks but says his appetite is very good. He says he is always hot, even in air-conditioned rooms. After questioning, he also admits to having increased nervousness, trouble concentrating, and palpitations. He is having trouble doing fine motor tasks because of a tremor. Physical exam reveals a patient with warm, smooth, moist skin and a diffuse goiter with a palpable thrill and bruit..