个 甲状腺功能亢进症的治疗 南方医科大学珠江医院内分泌科程彦臻副主任医师 Department of Endocrinology Zhujiang Hospital Southern Medical University
甲状腺功能亢进症的治疗 南方医科大学珠江医院内分泌科 程彦臻 副主任医师 Department of Endocrinology Zhujiang Hospital Southern Medical University
General management(一般治疗) 个 ·No iodine intake Energy and nutrients supplement ·Rest enough Avoid heavy physical labour Sedatives for restlessness and insomnia. 还a
General management(一般治疗) • No iodine intake • Energy and nutrients supplement • Rest enough • Avoid heavy physical labour • Sedatives for restlessness and insomnia
Management临床治疗 Three principal therapies are available for hyperthyroidism Antithyroid Agents Radioactive iodine Subtotal thyroidectomy 抗甲亢药物 放射性碘 甲状腺次全切除术
Management 临床治疗 Antithyroid Agents 抗甲亢药物 Radioactive iodine 放射性碘 Subtotal thyroidectomy 甲状腺次全切除术 Three principal therapies are available for hyperthyroidism
Antithyroid Drugs(ATD)抗甲状腺药物 Class Summary: ■Thiourea(疏脲类):Propylthiouracil(PTU,丙硫氧嘧啶) ■Imidazoles(咪唑类):carbimazole(卡比马唑,甲亢平),thiamazole(甲巯咪唑,他巴唑) ■Mechanism: They principally inhibit the function of TPO,reducing iodide organification and coupling processes,thereby preventing synthesis of thyroid hormones. They also reduce thyroid antibody levels. .Inhibits deiodination(脱碘)ofT4toT3
■ Class Summary: ■ Thiourea (硫脲类):Propylthiouracil( PTU,丙硫氧嘧啶) ■ Imidazoles(咪唑类):carbimazole(卡比马唑,甲亢平), thiamazole( 甲巯咪唑,他巴唑) ■ Mechanism: ■ They principally inhibit the function of TPO, reducing iodide organification and coupling processes, thereby preventing synthesis of thyroid hormones. ■ They also reduce thyroid antibody levels. ■ Inhibits deiodination(脱碘)of T4 to T3 Antithyroid Drugs(ATD)抗甲状腺药物
Antithyroid Drugs(ATD)抗甲状腺药物 个 ·Dosage and course---back-titration regimen(逐渐减量方式) 初治期--维持期 p1 st stage(ca.4~8wks):治疗期 full dosage to control symptoms PTU:50-150 mg,Bid or Tid MMI:10-30 mg,Qd p3 rd stage(ca12~18mon):维持期 When serum thyroid hormone levels are normal PTU 50-100mg,Bid or Tid MMI 5-10mg Qd
• Dosage and course------back-titration regimen( 逐渐减量方式) 初治期---维持期 p 1st stage (ca.4~8 wks):治疗期 full dosage to control symptoms PTU: 50-150 mg, Bid or Tid MMI: 10-30 mg,Qd p 3rd stage (ca 12~18 mon) :维持期 When serum thyroid hormone levels are normal PTU 50-100mg, Bid or Tid MMI 5-10mg Qd Antithyroid Drugs(ATD)抗甲状腺药物
Antithyroid Drugs(ATD)抗甲状腺药物 ■适应症: ■轻、中度病情 ■甲状腺轻、中度肿大 ■孕妇、高龄或由于其他严重疾病不宜手术者 ■手术前和碘131治疗前的准备: ■手术后复发且不适宜碘131治疗者: ■中至重度活动的G0病人。 评价:应用最广,疗效肯定,一般不会引起永久性的甲状腺功能减退。但仅能获得40%~ 60%治愈率,且疗程较长,需1~2年或更长,停药后复发率较高。药物的副作用时有发生
■ 适应症: ■ 轻、中度病情 ■ 甲状腺轻、中度肿大 ■ 孕妇、高龄或由于其他严重疾病不宜手术者 ■ 手术前和碘131治疗前的准备; ■ 手术后复发且不适宜碘131治疗者; ■ 中至重度活动的GO病人。 Antithyroid Drugs(ATD)抗甲状腺药物 评价:应用最广,疗效肯定,一般不会引起永久性的甲状腺功能减退。但仅能获得40 ~ 60 治愈率,且疗程较长,需1~2年或更长,停药后复发率较高。药物的副作用时有发生
Antithyroid Drugs(ATD)抗甲状腺药物 Complications: ■Agranulocytosis(粒细胞缺乏症,O.7%):Some people monitor WBCevery two weeks for first month then monthy.Advised to stop drug if they develop sudden fever or sore throat ■Allergy:皮疹(5%) ■Hepatitis:中毒性肝病(PTU2.4%,MMl0.4%) ■Vasculitis:血管炎 ■Aplasia cutis:胎儿皮肤发育不良(2-4%) All of the complications tend to resolve spontaneously if drugs are withdrawn promptly
Antithyroid Drugs(ATD)抗甲状腺药物 ■ Complications: ■ Agranulocytosis(粒细胞缺乏症,0.7%):Some people monitor WBCevery two weeks for first month then monthy. Advised to stop drug if they develop sudden fever or sore throat ■ Allergy:皮疹(5%) ■ Hepatitis:中毒性肝病(PTU 2.4%,MMI 0.4%) ■ Vasculitis:血管炎 ■ Aplasia cutis:胎儿皮肤发育不良(2-4%) ■ All of the complications tend to resolve spontaneously if drugs are withdrawn promptly
Antithyroid Drugs(ATD)抗甲状腺药物 ■Drug withdrawal停药指标 ■甲状腺功能正常 ■TRAb阴性 ■EaSe缓解 停药1年,血清TSH和甲状腺激素正常 ■Relapse复发(in50%of cases) 指甲亢完全缓解,停药半年以后再度发生甲亢者。主要在第1年,75%在停药3个月 内复发,3年后则明显减少
■ Drug withdrawal 停药指标 ■甲状腺功能正常 ■TRAb阴性 ■ Ease缓解 停药1年,血清TSH和甲状腺激素正常 ■ Relapse复发(in 50% of cases) 指甲亢完全缓解,停药半年以后再度发生甲亢者。主要在第1年,75%在停药3个月 内复发,3年后则明显减少 Antithyroid Drugs(ATD)抗甲状腺药物
Radioactive iodine放射性131I治疗 个 ■原理 甲状腺能浓集131,131释放B射线破坏腺泡 ■适应症: ①甲状腺II度肿大以上: ②对ATD过敏: ③ATD或手术治疗后复发: ④甲亢心: ⑤甲亢伴血细胞减少、血小板减少或全血细胞减少: ⑥甲亢合并肝肾功能受损: ⑦拒绝手术治疗或者有手术禁忌症: ⑧浸润性突眼
■ 原理 • 甲状腺能浓集131I,131I释放β射线破坏腺泡 ■ 适应症: ① 甲状腺II度肿大以上; ② 对ATD过敏; ③ ATD或手术治疗后复发; ④ 甲亢心; ⑤ 甲亢伴血细胞减少、血小板减少或全血细胞减少; ⑥ 甲亢合并肝肾功能受损; ⑦ 拒绝手术治疗或者有手术禁忌症; ⑧ 浸润性突眼
Radioiodine(131)放射治疗 个 Contraindications ·妊娠 。 哺乳期妇女 (131川可进入胎盘和乳汁)
Contraindications • 妊娠 • 哺乳期妇女 (131I可进入胎盘和乳汁) Radioiodine (131I) 放射治疗