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1、甲亢手术指征lcc手术指征fA A 55-year-old 55-year-old man man begins begins to to be be emotionally emotionally labilelabile（不不稳稳定定）,tensetense（紧紧张张）,hyperexcitable.hyperexcitable.He He has has recently recently had had difficulty difficulty with with his his job.job.He He has has lost lost 20 20 lbs lbs in in
2、weight.weight.He He is is distractabledistractable（精精力力不不集集中中）,has has a a short short attention attention span,span,and and has has impairedimpaired（损损害害）recent recent memory.memory.Your Your initial initial workup workup reveals reveals a a fine fine tremor tremor of of the the hands,hands,and and
3、 laboratory laboratory work work suggests suggests an an endocrine endocrine abnormality.abnormality.What What is is the the most most likely likely diagnosis?diagnosis?fa.Hypoparathyroidismfb.Hyperthyroidismfc.Hyperparathyroidismfd.Hypothyroidismfe.Addisons disease手术指征f女女，4040岁岁，2828岁岁时时因因心心慌慌、怕怕热热
4、、多多汗汗、消消瘦瘦就就诊诊，确确诊诊GravesGraves病病，他他巴巴唑唑规规则则治治疗疗2 2年年。3232岁岁甲甲亢亢复复发发。再再次次他他巴巴唑唑治治疗疗，2 2个个月月后后甲甲状状腺腺功功能能正正常常，继继续续治治疗疗一一年年半半停停药药。最最近近2 2个个月月甲甲亢亢的的症症状状、体体征征再再现现，查查血血T3T3，T4T4及及TSHTSH确确认认为为甲甲亢亢第第2 2次次复复发发。患患者者结结婚婚1010年年，尚尚未未生生育育，希希望望治疗甲亢后怀孕，甲亢的治疗拟治疗甲亢后怀孕，甲亢的治疗拟（）（）fA大剂量碘剂fB再次他巴唑治疗，疗程延长至3-4年fC用他巴唑，甲功正常后加
5、用131I治疗fD用他巴唑，甲功正常后行甲状腺大部切除手术fE直接行甲状腺大部切除术术前准备f一般准备一般准备：f术前检查术前检查：f药物准备药物准备1.硫氧嘧啶类（2-4M)+碘剂(卢戈溶液tid，3滴/d-16滴/d，2W)2.单用碘剂：2-3W3.普萘洛尔：60mg/d-160mg/d，q6h，4-7d，术前1-2h再口服1次，术后继续服用4-7d；哮喘及心动过患者禁用哮喘及心动过患者禁用术前准备f甲亢病人术前准备可以手术的基础代谢率，至少降至：甲亢病人术前准备可以手术的基础代谢率，至少降至：fA.+10%以下fB.+20%以下fC.+25%以下fD.+30%以下fE.+35%以下BMR正常：正常：10%轻度甲亢：轻度甲亢：+20%-+30%中度甲亢：中度甲亢：+30%-+60%重度甲亢：重度甲亢：+60%以上以上此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢