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[内分泌疾病中的一些神经和精神并发症:甲状腺]

[Some neurologic and psychiatric complications in endocrine disorders: the thyroid gland].

作者信息

Aszalós Zsuzsa

机构信息

Semmelweis Egyetem, Altalános Orvostudományi Kar, II. Belgyógyászati Klinika, Budapest.

出版信息

Orv Hetil. 2007 Feb 18;148(7):303-10. doi: 10.1556/OH.2007.27988.

Abstract

Thyroid hormones are of primary importance for the perinatal development of the central nervous system, and for normal function of the adult brain. These hormones primarily regulate the transcription of specific target genes. They increase the cortical serotonergic neurotransmission, and play an important role in regulating central noradrenergic and GABA function. Thyroid deficiency during the perinatal period results in mental retardation. Hypothyroidism of the adults causes most frequently dementia and depression. Other less common clinical pictures include myxoedema coma, dysfunction of cerebellum and cranial nerves. Hypothyroidism also increases predisposition of stroke. Peripheral diseases frequently include polyneuropathy, carpal tunnel syndrome, myalgic state, and rarely myokymia. Nearly all the hyperthyroid patients show minor psychiatric signs, and infrequently psychosis, dementia, confusion state, depression, apathetic thyrotoxicosis, thyrotoxic crisis, seizures, pyramidal signs, or chorea occur. The peripheral complications may be indicated by chronic thyrotoxic myopathy, infiltrative ophthalmopathy, myasthenia gravis, periodic hypokalemic paralysis and polyneuropathy. Generalized resistance to thyroid hormone was confirmed in a number of patients with attention deficit-hyperactivity disorder. Significantly elevated antithyroid antibody titers characterize Hashimoto's encephalopathy. This condition is a rare, acute - subacute, serious, life threatening, but steroid-responsive, relapsing-remitting, autoimmune disease.

摘要

甲状腺激素对中枢神经系统的围产期发育以及成人大脑的正常功能至关重要。这些激素主要调节特定靶基因的转录。它们增强皮质5-羟色胺能神经传递,并在调节中枢去甲肾上腺素能和GABA功能中发挥重要作用。围产期甲状腺功能减退会导致智力发育迟缓。成人甲状腺功能减退最常导致痴呆和抑郁。其他较不常见的临床表现包括黏液性水肿昏迷、小脑和颅神经功能障碍。甲状腺功能减退还会增加中风的易感性。外周疾病常包括多发性神经病、腕管综合征、肌痛状态,罕见肌纤维颤搐。几乎所有甲状腺功能亢进患者都有轻微的精神症状,很少出现精神病、痴呆、意识模糊状态、抑郁、淡漠型甲状腺毒症、甲状腺危象、癫痫发作、锥体束征或舞蹈病。外周并发症可能表现为慢性甲状腺毒性肌病、浸润性眼病、重症肌无力、周期性低钾性麻痹和多发性神经病。在一些注意力缺陷多动障碍患者中证实了对甲状腺激素的全身性抵抗。抗甲状腺抗体滴度显著升高是桥本脑病的特征。这种疾病是一种罕见的、急性-亚急性、严重的、危及生命的,但对类固醇有反应的、复发-缓解型自身免疫性疾病。

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