核医学 内分泌系统 ppt
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IN VIVO TESTS
Thyroid function
2. Thyroid hormone suppression test (甲状腺激素抑制试验)
抑制率％ Suppression rate＝
1st 131I rate-2nd 131I rate 1st 131I rate
× 100%
Normal thyroid function： > 50% 甲状腺功能正常 Thyroid auto function ：< 50% 甲状腺自主功能
IN VIVO TESTS
Thyroid function
2. Thyroid hormone suppression test (甲状腺激素抑制试验)
Ths
TSH
Uptake of 131I
Pituitary-thyroid axes Hyperthyroidism
Suppression rate 抑制率
TT4, TT3, FT4, FT3, rT3, etc.
Techniques: Radioimmunoassay (RIA，放射免疫分析法) Immunoradiometric assay (IRA，免疫放射分析法) Chemiluminescence immunoassay (CLIA，化学发光法) Time-resolved fluorescent immunoassay (TRFIA，时 间分辨荧光免疫分析法)
内分泌系统
协和医院核医学科 曹卫
Endocrine organs
Thyroid
甲状腺
Parathyroid
甲状旁腺
Genital glands
性腺
Adrenal glands
肾上腺
1
2
Thyroid
下丘脑 hypothalamus
TRH
垂体
pituitary
ห้องสมุดไป่ตู้
TSH
甲状腺
thyroid
T3 T4
3
tissue
13
Thyroid 131I Uptake Test
Thyroid function
Indications
1. Diagnosis of hyperthyroidism
2. Differential diagnosis of thyroid toxicosis (甲状腺毒症) 3. Assistant diagnosis of subacute thyroiditis and
Thyroid function
• Clinical significance 临床应用
Diagnosis of hyperthyroidism, 甲亢的诊断
hypothyroidism, thyroiditis, goiter (甲状腺肿)
% goiter
hyper
normal hypo
24h
16
SPECT or γ camera can detect the γ ray.
28
Thyroid imaging
Imaging agents
Half life Image time Energy Dosage
131I
8d
123I
13h
99mTcO4-
6h
24h 4h 20min
364
0.05~0.1mCi
19
IN VIVO TESTS
Thyroid function
3. Thyroid stimulation test (甲状腺兴奋试验) TSH 10U i.m. 3d
Stimulating value (兴奋值)＝ 2nd 131I 24h rate - 1st 131I 24h rate
Obvious stimulating ：> 10% secondary hypothyroidism Stimulating: 5~10% No stimulating: < 5% primary hypothyroidism
11
IN VITRO TESTS
Thyroid function
• Measurement of autoimmune antibodies
microsomal fraction antibody (TmAb /TPO-Ab)
(甲状腺微粒体抗体)
thyroglobulin antibody (TgAb),
4
I-
Blood
T3 T4
Iodide trapping
I-
Oxidation Organification
I0
thyroid
tyrosine
T3 T4
MIT DIT
Coupling
5
T3 and T4
Approximately 90% of the released thyroid hormone is in form of T4, and 10% in the form of T3. The great majority of T3 (80~90%) is produced by the peripheral conversion of T4.
chronic lymphocyte thyroiditis
亚急性甲状腺炎 慢性淋巴细胞性甲状腺炎
4. Calculating the dose of 131I for therapy of hyperthyroidism
5. Can be used in thyroid hormone suppression test and TSH stimulating test 甲状腺激素抑制试验 TSH 兴奋试验
（2）慢性淋巴细胞性甲状腺炎
26
MEASUREMENTS OF THYROID FUNCTION
• In vitro tests • In vivo tests • Thyroid imaging
27
Principle
Thyroid imaging
Thyroid cell can uptake 131I or 99mTc-pertechnetate
21
TRH stimulating test
Thyroid function
Clinical significance:
a) Normal reaction: top value at 15-30 min;
b) Hyperthyroidism: no reaction;
c) Hypothyroidism: Primary (very-high); Secondary (pituitary - no or very slight; hypothalamic – delayed)
• In circulation, both T4 and T3 are avidly bound to plasma proteins, particularly to thyroid-binding globulin (TBG).
• Although free hormones make up small fractions – less than 0.1% - of the total thyroid hormones, free hormones effect the physiologic and the pathologic responses from tissues in the body.
24
4
2．检查方法
释放率 (%)＝ 服过氯酸盐前摄 131I率－服过氯酸盐后摄 131I率 × 100％ 服过氯酸盐前摄 131I率
3．适应证
（1）甲状腺过氧化酶缺陷的诊断 （2）慢性淋巴细胞性甲状腺炎的辅助诊断。
25
4．结果判定 正常者释放率<10%，若>10%为阳性
5．临床应用
（1）先天性甲状腺过氧化物酶缺乏和结构缺陷及 耳聋-甲状腺肿综合征等致碘有机化障碍。
6
1
MEASUREMENTS OF THYROID FUNCTION • IN VITRO TESTS 体外实验 • IN VIVO TESTS 体内实验 • THYROID IMAGING 甲状腺显像
7
IN VITRO TESTS
Thyroid function
• Measurements of thyroid hormones (THs) includes
22
TRH stimulating test TSH
Normal range
30min
60min
Thyroid function
Hypothalamus hypo-
primary Hyponormal Pituitary hypo-
hyper
120min Time
23
（四）过氯酸钾释放试验
原理：过氯酸盐具有类似卤族元素的作用，能阻 止甲状腺自血液中摄取无机碘离子（I-） 并促使已进入甲状腺但还未有机化的I-从 甲状腺中释出。
24h uptake rate: 25~60%
•Hyperthyroidism: elevated uptake rate •As a factor in calculating the dose of 131I for pts with hyperthyroidism
15
Thyroid 131I Uptake Test
8
THs measurement
Thyroid function
• Clinical significance of measurements of THs: a) Hyperthyroidism: elevated TH levels; 甲状腺机能亢进
IN VIVO TESTS
Thyroid function
2. Thyroid hormone suppression test (甲状腺激素抑制试验)
抑制率％ Suppression rate＝
1st 131I rate-2nd 131I rate 1st 131I rate
× 100%
Normal thyroid function： > 50% 甲状腺功能正常 Thyroid auto function ：< 50% 甲状腺自主功能
IN VIVO TESTS
Thyroid function
2. Thyroid hormone suppression test (甲状腺激素抑制试验)
Ths
TSH
Uptake of 131I
Pituitary-thyroid axes Hyperthyroidism
Suppression rate 抑制率
TT4, TT3, FT4, FT3, rT3, etc.
Techniques: Radioimmunoassay (RIA，放射免疫分析法) Immunoradiometric assay (IRA，免疫放射分析法) Chemiluminescence immunoassay (CLIA，化学发光法) Time-resolved fluorescent immunoassay (TRFIA，时 间分辨荧光免疫分析法)
内分泌系统
协和医院核医学科 曹卫
Endocrine organs
Thyroid
甲状腺
Parathyroid
甲状旁腺
Genital glands
性腺
Adrenal glands
肾上腺
1
2
Thyroid
下丘脑 hypothalamus
TRH
垂体
pituitary
ห้องสมุดไป่ตู้
TSH
甲状腺
thyroid
T3 T4
3
tissue
13
Thyroid 131I Uptake Test
Thyroid function
Indications
1. Diagnosis of hyperthyroidism
2. Differential diagnosis of thyroid toxicosis (甲状腺毒症) 3. Assistant diagnosis of subacute thyroiditis and
Thyroid function
• Clinical significance 临床应用
Diagnosis of hyperthyroidism, 甲亢的诊断
hypothyroidism, thyroiditis, goiter (甲状腺肿)
% goiter
hyper
normal hypo
24h
16
SPECT or γ camera can detect the γ ray.
28
Thyroid imaging
Imaging agents
Half life Image time Energy Dosage
131I
8d
123I
13h
99mTcO4-
6h
24h 4h 20min
364
0.05~0.1mCi
19
IN VIVO TESTS
Thyroid function
3. Thyroid stimulation test (甲状腺兴奋试验) TSH 10U i.m. 3d
Stimulating value (兴奋值)＝ 2nd 131I 24h rate - 1st 131I 24h rate
Obvious stimulating ：> 10% secondary hypothyroidism Stimulating: 5~10% No stimulating: < 5% primary hypothyroidism
11
IN VITRO TESTS
Thyroid function
• Measurement of autoimmune antibodies
microsomal fraction antibody (TmAb /TPO-Ab)
(甲状腺微粒体抗体)
thyroglobulin antibody (TgAb),
4
I-
Blood
T3 T4
Iodide trapping
I-
Oxidation Organification
I0
thyroid
tyrosine
T3 T4
MIT DIT
Coupling
5
T3 and T4
Approximately 90% of the released thyroid hormone is in form of T4, and 10% in the form of T3. The great majority of T3 (80~90%) is produced by the peripheral conversion of T4.
chronic lymphocyte thyroiditis
亚急性甲状腺炎 慢性淋巴细胞性甲状腺炎
4. Calculating the dose of 131I for therapy of hyperthyroidism
5. Can be used in thyroid hormone suppression test and TSH stimulating test 甲状腺激素抑制试验 TSH 兴奋试验
（2）慢性淋巴细胞性甲状腺炎
26
MEASUREMENTS OF THYROID FUNCTION
• In vitro tests • In vivo tests • Thyroid imaging
27
Principle
Thyroid imaging
Thyroid cell can uptake 131I or 99mTc-pertechnetate
21
TRH stimulating test
Thyroid function
Clinical significance:
a) Normal reaction: top value at 15-30 min;
b) Hyperthyroidism: no reaction;
c) Hypothyroidism: Primary (very-high); Secondary (pituitary - no or very slight; hypothalamic – delayed)
• In circulation, both T4 and T3 are avidly bound to plasma proteins, particularly to thyroid-binding globulin (TBG).
• Although free hormones make up small fractions – less than 0.1% - of the total thyroid hormones, free hormones effect the physiologic and the pathologic responses from tissues in the body.
24
4
2．检查方法
释放率 (%)＝ 服过氯酸盐前摄 131I率－服过氯酸盐后摄 131I率 × 100％ 服过氯酸盐前摄 131I率
3．适应证
（1）甲状腺过氧化酶缺陷的诊断 （2）慢性淋巴细胞性甲状腺炎的辅助诊断。
25
4．结果判定 正常者释放率<10%，若>10%为阳性
5．临床应用
（1）先天性甲状腺过氧化物酶缺乏和结构缺陷及 耳聋-甲状腺肿综合征等致碘有机化障碍。
6
1
MEASUREMENTS OF THYROID FUNCTION • IN VITRO TESTS 体外实验 • IN VIVO TESTS 体内实验 • THYROID IMAGING 甲状腺显像
7
IN VITRO TESTS
Thyroid function
• Measurements of thyroid hormones (THs) includes
22
TRH stimulating test TSH
Normal range
30min
60min
Thyroid function
Hypothalamus hypo-
primary Hyponormal Pituitary hypo-
hyper
120min Time
23
（四）过氯酸钾释放试验
原理：过氯酸盐具有类似卤族元素的作用，能阻 止甲状腺自血液中摄取无机碘离子（I-） 并促使已进入甲状腺但还未有机化的I-从 甲状腺中释出。
24h uptake rate: 25~60%
•Hyperthyroidism: elevated uptake rate •As a factor in calculating the dose of 131I for pts with hyperthyroidism
15
Thyroid 131I Uptake Test
8
THs measurement
Thyroid function
• Clinical significance of measurements of THs: a) Hyperthyroidism: elevated TH levels; 甲状腺机能亢进
