橋本甲狀腺炎課件-2

1、The ultrasonic diagnosis of Hashimoto thyroiditisTutor:ZhengMin Speaker: WangLing1The ultrasonic diagnosis of HaIntroductionClinical manifestationsUltrasound performanceDifferential diagnosisSummary2Introduction2 Hashimoto thyroiditis also called chronic lymphocytic thyroiditis, Japanese scholars Ha

2、shimoto reported firstly according to the histologic features ，that is the most common one of autoimmune thyroid diseases. HT disease slowly, clinical manifestation is not very typical; And the course of a long, pathological changes and thyroid function state performance is different, so the ultraso

3、nography findings is complex.Introduction3 Introduction3 From 80% to 90% patients mainly manifested as thyroid diffuse enlargement of asymmetry,thyroid texture tough such as rubber sample, with the surrounding tissue without adhesion. The late course is more nodular or atrophy. Early may have hypert

4、hyroidism performance；Late hypothyroidism,May be due to thyroid atrophy performance for myxedema, impotent and so on.Clinical manifestation4 Clinical manifestation4 Ultrasonographic characteristics 5 Ultrasonographic characterist thyroid diffuse enlargement of asymmetry, isthmus is obvious.The inter

5、nal echo reduction, uneven distribution.The visible thin wire-like or coarse network-like strong echo . Two dimensional ultrasonography6 thyroid diffuse enlargement o Local HT is relatively rare,that is a special type,early manifest .Such as effectively and timely treatment, prognosis and outcome is

6、 betterUltrasonography is one side or both side lobe of thyroid own single or multiple uneven and hypoechoic zone,boundary clear,form owe rules,like “pattern”,space occupying lesion effect is not obvious.7788Echo Unevenness type:Normal thyroid volume or biger,multiple uneven,Increasing coarse or fin

7、e wire sample strong echo.Patch type:Normal thyroid volume or biger,diffused distribution sheet hypoecho.Diffuse type:Thyroid volume increase,Essence is diffuse type echo reduce.Nodules type:Thyroid volume increase,diffuse distribution ranging from the size of the high 、low or equal echo .Classifica

8、tion9Echo Unevenness type:Normal th回聲不均型：甲狀腺球蛋白抗體（TGA）陽性，T3、T4、TSH正常10回聲不均型：甲狀腺球蛋白抗體（TGA）陽性，T3、T4、TS斑片型11斑片型11彌漫型12彌漫型12結(jié)節(jié)型13結(jié)節(jié)型13 Ultrasonic found tracheal side swollen lymph nodes,Is autoimmune thyroid disease more specific ultrasonic one of the signs,manifest:Thyroid isthmus front, bilateral leaf

9、 under round or oval echoic,morphological rules,part of the skin medulla boundary clear. 14 Ultrasonic found tracheal early period:essence Blood flow signal rich,Even the inferno sign,PSV rise ,Prompt hyperthyroidism or normal.With the progress of the disease:The rich blood flow significantly lower

10、level,PSV dropped even lower than normal,Prompt typothyroidism.later period:Blood flow signal significantly reduced,velocity obviously reduced,Prompt Thyroid function significantly impaired.CDFI15early period:essence Blood flo HT flow signal most significantly increased - fire syndrome,The signs may

11、 occur early hyperthyroidism stage,also be found in the late hypothyroidism stage,This note should notice thyroid PSV,and combine thyroid function tests .16 HT flow signal most signifiSubacute thyroiditisNodular goiterHyperthyroidismDifferential diagnosis17Subacute thyroiditisDifferenti Thyroid prof

12、ile is normal or increased，seen in sheet hypoechoic area，more irregular， rear echo slightly enhanced，the isthmus is no obvious thickening。 CDFI：blood flow is rich surrounding hypoechoic area， but internal flow signals is fewer or no Signal。 Subacute thyroiditis18 Thyroid profile is normal or 1919202

13、02121 The former increase mainly about the size of thyroid，the latter increase mainly anteroposterior diameter，Isthmus thickening，an internal network or a cord-like echogenic。Hyperthyroidism22 Hyperthyroidism22甲亢23甲亢23橋本24橋本24 Two dimensional ultrasonography：Thyroid solitary or multiple nodules，Vary

14、 in size、Echo diversification， CDFI：Blood flow signal occurring in between nodule，but Nodules in the peripheral and intranodular blood flow signal less. Nodular goiter 25 Nodular goiter 2526262727 HT ultrasonography has certain characteristics, in the diagnosis and differential diagnosis of clinical significance.In view of the long course of disease, comorbidity, with complicated clinical manifestations, its sonographic appearances are also different, still needed to be combined with clinical and laboratory