关键区别 - Graves疾病与桥本
由于人体对其自身细胞和组织的免疫反应引起的疾病被称为autoimmune disorders。Graves disease and Hashimoto are two such autoimmune disorders that affect both structure and function of thethyroid腺。但是，这两种情况的最终病理结局彼此截然不同。在Graves病中，甲状腺激素水平升高，导致甲状腺功能亢进whereas, in Hashimoto, the thyroid hormone level drops well below the par value, resulting在甲状腺功能减退症。激素水平的这种不和谐是Graves病和桥本的关键区别。
CONTENTS
1.Overview and Key Difference
2.什么是坟墓疾病
3.什么是桥本
4.Similarities Between Graves Disease and Hashimoto
5.并排比较 - 格雷夫斯病与悬花的表格形式
6.Summary
什么是坟墓疾病?
Graves病是一种自身免疫性甲状腺疾病，病因未知。
Pathogenesis
An autoantibody ofIgG类型称为甲状腺刺激免疫球蛋白binds to TSH receptors in the thyroid gland and mimics the action of TSH. As a result of this increased stimulation, there is an excessive production of the thyroid hormone associated with the增生of the thyroid follicular cells. The end result is the diffuse enlargement of the thyroid gland.
甲状腺激素的刺激增加会扩大轨道结缔组织的体积。这与眼外肌肉的水肿，细胞外基质材料的积累以及周围空间的渗透lymphocytes脂肪组织会削弱眼外肌肉，将眼球向前推。
Figure 01: Exophthalmos in Graves disease
Morphology
There is a diffuse enlargement of the thyroid gland. Cut sections will show a red meaty appearance. Follicular cell hyperplasia which is characterized by the presence of a large number of small follicular cells is the hallmark microscopic feature.
Clinical Features
The distinguishing clinical features of Graves disease are,
- 扩散的甲状腺肿
- 分娩
- Periorbital myoedema
除这些症状外，由于甲状腺激素水平升高，患者还具有以下临床特征。
- 温暖而潮红的皮肤
- Increased sweating
- 体重减轻和食欲增加
- 腹泻due to increased bowel motility
- 同情的语调增加会导致震颤，失眠，焦虑和近端肌肉无力。
- Cardiac manifestations such astachycardia, palpitations, and心律不齐。
调查
- Thyroid function tests to confirm thyrotoxicosis
- Checking for the presence of thyroid stimulating immunoglobulin in blood.
Management
- 药物治疗
抗甲状腺药物（例如甲虫唑和甲咪唑）的给药非常有效。与连续使用这些药物有关的最常见的不良影响是农业细胞增多症，所有在抗肌动物药物下的患者应在无法解释的发烧或喉咙痛的情况下寻求立即医疗护理。
- Radiotherapy with radioactive iodine
- 甲状腺的手术切除。这是最后一次度假选择，仅在医疗干预措施无法实现所需结果时才使用。
什么是桥本?
桥本thyroiditis is an autoimmune disease which is a common cause of hypothyroidism, especially in areas where iodine deficiency is not prevalent.
由于自身免疫介导的淋巴细胞浸润，这种情况的特征是甲状腺卵泡逐渐破坏，最终导致甲状腺衰竭。
Morphology
The thyroid gland is diffusely enlarged, and cut sections show a pale firm and solid appearance with vague nodularity. An intense infiltration of the thyroid gland by the plasma cells and lymphocytes can be observed under the microscope.
Clinical Features
Usually, middle-aged women are more likely to be affected by this condition.
- 扩散的甲状腺肿
- Tiredness
- Weight gain
- Cold intolerance
- Depression
- Poor libido
- 眼睛浮肿
- Dry and brittle hair
- 亚属和肌痛
- 便秘
- Menorrhagia
- Psychoses
- Deafness
Children with hypothyroidism can have cretinism which is characterized by poor mental and physical development.
图02：桥本
Complications
桥本thyroiditis increases the likelihood of having
- Other autoimmune diseases such assle
- Malignancies such asnon- Hodgkin lymphomaand papillary癌甲状腺。
调查
- Measurement of serum TSH level which is unusually increased in hypothyroidism
- The T4水平大大降低
- 检查是否存在抗甲状腺抗体 - 在桥本甲状腺炎中，抗甲状腺过氧化物酶的水平，抗甲状腺甲状腺甲状腺球蛋白和抗肌瘤微粒细胞抗体的水平异常升高。
Management
甲状腺功能减退症是通过左甲状腺素的替代疗法来管理的。
Graves病和桥本之间有什么相似之处
- Both are autoimmune diseases that affect the thyroid gland.
- The thyroid gland is diffusely enlarged in both Graves disease and Hashimoto thyroiditis.
Graves病和桥本有什么区别？
格雷夫斯病与桥本 |
|
| Graves病是一种自身免疫性甲状腺疾病，病因未知。 | 桥本thyroiditis is an autoimmune disease which is a common cause of hypothyroidism especially in the areas where iodine deficiency is not prevalent. |
| Thyroid Levels | |
| 这导致hyperthyroidism. | 这导致hyperthyroidism. |
| 甲状腺卵泡 | |
| 甲状腺卵泡细胞的增生。 | 甲状腺卵泡被破坏，浆细胞和淋巴细胞浸润甲状腺组织。 |
| Cross Section | |
| The cross sections taken from a thyroid gland affected by Graves have a red meaty appearance. | 横截面具有苍白，坚固和坚实的外观。 |
| Clinical Features | |
|
由于甲状腺功能减退症，在甲状部甲状腺炎中观察到以下临床特征。 · There is diffuse goiter ·疲倦 · 体重增加 ·冷酷的不宽容 · Depression · Poor libido · Puffy eyes · Dry and brittle hair ·亚氏痛和肌痛 · Constipation · Menorrhagia · Psychoses · Deafness |
| TSH Levels | |
| The serum TSH level is decreased, but the T4 level is increased. | TSH level is increased, but the T4 level is decreased. |
| Antibodies | |
| Thyroid Stimulating Immunoglobulin is the antibody whose levels are increased in Graves disease. | In the Hashimoto thyroiditis, the levels of antithyroid peroxidase, antithyroid thyroglobulin, and antithyroid microsomal antibodies are abnormally elevated. |
| 与癌症有关 | |
| There is no correlation with the incidence of cancers. | 桥本thyroiditis increases the chance of having papillary carcinomas of the thyroid gland and non-Hodgkin lymphomas. |
| 医疗管理 | |
| Medical management is through the administration of antithyroid drugs such as carbimazole. Radiotherapy with radioactive iodine and surgical removal of the thyroid gland are the other treatment options. | Medical management is the replacement therapy using levothyroxine. |
Summary – Graves Disease vs Hashimoto
Graves disease and Hashimoto are two autoimmune disorders that affect the thyroid gland. In Graves disease, the thyroid hormone level increases causing hypothyroidism, but in Hashimoto, the thyroid hormone level is unusually reduced. This is the basic difference between Graves disease and Hashimoto.
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References:
1. Kumar，Parveen J.和Michael L. Clark。Kumar＆Clark临床医学。爱丁堡：W.B。桑德斯，2009年。印刷。
2. Kumar，Vinay，Stanley Leonard Robbins，Ramzi S. Cotran，Abul K. Abbas和Nelson Fausto。罗宾斯和科特兰疾病的病理基础。第9版。宾夕法尼亚州费城：Elsevier Saunders，2010年。印刷。
Image Courtesy:
1. “Proptosis and lid retraction from Graves’ Disease” By Jonathan Trobe, M.D. – University of Michigan Kellogg Eye Center – The Eyes Have It(CC BY 3.0)viaCommons Wikimedia
2. Drahreg01的“ Struma 001” - 自己的工作(CC BY-SA 3.0)viaCommons Wikimedia
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