甲状腺功能减退症（Hypothyroidism）的影像学表现

zskyteacher 2018-11-17

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甲状腺功能减退症Hypothyroidism：简称甲减，是由于甲状腺激素的合成，分泌或生物效应不足而引起的一种综合征。病因较复杂，以原发性者多见，其次为垂体性者，其他均属少见。患者可能会出现四肢无力、内分泌功能减退、低血压、眩晕、肌性肌无力、体型异常、呼吸异常等症状。

甲状腺功能减退症可能是先天性的，这会导致严重的骨骼畸形和发育迟缓，也可能后天获得，这将导致相对温和的骨骼异常。获得性甲状腺功能减退可能发生在手术后或治疗后（放射性碘治疗）或可能是由于腺性萎缩，急性或慢性（桥本）甲状腺炎，浸润性疾病如淀粉样变性或淋巴瘤，某些药物治疗，碘缺乏症或垂体紊乱导致甲状腺激素激素缺乏。在儿童患者中，骨骼发育迟缓，往往伴有缺血性、不规则或碎片性远端股骨和近端胫骨骨骺（图1），类似于多发性骨骺发育不良。牙齿发育也可能延迟。

图1a。12岁的男孩，先天性甲状腺功能减退症，身材矮小，发育迟缓。（a）右侧腕关节X线片显示只有头状骨（箭头），钩状骨（箭头）和桡骨（圆）的骨化中心。骨龄估计为1.5年。

图1b。（b）腰椎横断面显示出发育不全的椎体。 L1具有子弹状椎体（箭头）。

图1c。（c）骨盆前后位置X线照片显示髋关节髋臼变浅（实心箭头），边缘不光整。股骨头骨骺（虚线箭头）小而分散。

图1d。（d）右膝的前后X线照片显示小而不规则的远端股骨和近端胫骨骨骺（箭头）。

图1e。（e）经过2年甲状腺激素替代治疗后获得的左手X线片显示所有腕骨骨化中心的间歇性骨化。骨龄仍然延迟，但进展到约9年（患者年龄，14岁）。

图1f。（f）2年甲状腺激素替代治疗后，获得的右膝前后X光片显示骨骺的成熟，但胫骨和股骨可见残留不规则的改变（箭头）。（图片由Ok-Hwa Kim，MD，Ajou大学，韩国首尔）提供。

Woltman征是指深腱反射的延迟松弛阶段，是甲状腺功能减退症的神经系统表现。

一名53岁的男性前来内分泌科诊所，有6个月的进行性全身性疲劳和对感冒的敏感性增加。在发表时，身体检查显示弥漫性扩大的甲状腺的存在和踝关节反射的延迟放松。实验室研究显示，血清促甲状腺素水平为200 mIU / L（参考范围，0.35至5.50），血清游离甲状腺素水平为0.05 ng / dl（1 pmol / L）（参考范围，每分升0.89至1.76 ng [每升11至23 pmol]）。Woltman征是指深腱反射的延迟松弛阶段，是甲状腺功能减退症的神经系统表现。这种延迟的放松也可能与怀孕，神经性厌食症，糖尿病和高龄有关。患者接受甲状腺激素替代治疗，左旋甲状腺素治疗原发性甲状腺功能减退症。一个月后，血清游离甲状腺素水平增加到每分升1.23 ng（每升16 pmol），血清促甲状腺激素水平为每升20.5 mIU，）。在随后的随访中，促甲状腺素水平归一化至每升3.2mIU。

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