The Liver Increased LDL cholesterol2 Elevated triglycerides2 The Intestines Constipation4 Decreased GI motility4
The Heart Decreased heart rate3 Increased blood pressure3 Decreased cardiac output3 Diastolic dysfunction3
疲劳 恶心 体重增加 皮肤，毛发，指甲的改变 失眠 便秘 头晕 情绪波动 头疼
怀孕
“妊娠期间对于甲减的诊断至关重要，因为甲减会对妊娠造成潜在的十分不利 的影响。然而，大部分的甲减孕妇不表现出症状„..即使表现出症状的患者也 1 把它们归因于怀孕所造成的。”
1. S Mandel. Best Practice & Research Clinical Endocrinology & Metabolism 2004;18:213-224.
甲状腺疾病与不良妊娠结局 甲亢
亚临床甲减/甲减
单纯低T4血征 TPO Ab阳性 母 • • • • • 体 • • • • 早产 低出生体重 新生儿呼吸窘迫 神经精神发育异常 胎 儿
产后甲状腺炎（PPT） 流产 妊娠期高血压疾病 胎盘早剥 产后出血
甲状腺疾病与妊娠具有许多相似的临床征象
甲状腺疾病
30
16 14 12 10 8 6 4 2 0 TPO-Ab (+), LT4
Age (years) Women Men
JG Hollowell, et al. 2002 J Clin Endo Metab 87:489-499
60
>Βιβλιοθήκη 80999
9
9
9
9
及时干预对预后的影响
p < 0.05 p < 0.01
p < 0.05 p < 0.01
18
Miscarriage Rate (%)
甲状腺自身抗体的流行率
35
女性


TPO-Ab Positive (%)
30 25 20 15 10 5 0
TPO Ab 阳性率高（平 均17％） 随年龄增加逐年增加 育龄妇女中常见
TOP Ab阳性率8.7 % 40岁以后不再升高
男性

-1
-2
-3
-4
-5
-6
-7 70
12
20
30
40
50
The Reproductive System Decreased fertility6 Menstrual abnormalities6
The Kidneys Decreased function5 Fluid retention and edema5
1. 2. 3. 4. 5. 6. 7.
Nemeroff CB. Clinical significance of psychoneuroendocrinology in psychiatry: focus on the thyroid and adrenal. J Clin Psychiatry. 1989;50(suppl):13-20. Klausen IC, Nielsen FE, Hegedü s L, Gerdes LU, Charles P, Faergeman O.Treatment of hypothyroidism reduces low-density lipoproteins but not lipoprotein (a) Metabolism. 1992;41:911-914. Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation. 1993;87:1435-1441. Vassilopoulou-Sellin R, Sellin JH. The gastrointestinal tract and liver in hypothyroidism. In:Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid. 7th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996:816-820. Moses AM, Scheinman SJ. The kidneys and electrolyte metabolism. In:Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid. 7th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996:812-815. Emerson CH.Thyroid function and disease in the female. In: Gold JJ, Josimovich JB, eds. Gynecologic Endocrinology. 4th ed. New York, NY:Plenum Publishing Corp; 1987:109-133. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;341:549-555.
妊娠期甲状腺功能筛查
For internal use only / © 2012 Siemens Healthcare Diagnostics Inc. All rights reserved.
甲状腺疾病对于全身器官有广泛的影响
The Thyroid
The Brain Depression1 Decreased concentration1 General lack of interest1 Impaired fetal intellectual development7