3种药物治疗甲亢的经济学分析

目的:评价3种药物治疗甲亢的经济学效果。方法:将90例甲亢患者分为A、B、C组,分别给予丙硫氧嘧啶片、甲巯咪唑片(国产)、甲巯咪唑片(进口),均治疗28d,观察其疗效和不良反应,并运用成本-效果法进行分析。结果:A、B、C组的平均总成本分别为3947·24、3868·28、3895·72元,有效率分别为83·33%、86·67%、93·33%(P>0·05)。结论:B方案较经济,但综合比较仍是C组方案较佳。     

甲亢肝阳上亢证大鼠肾上腺组织蛋白质组的双向电泳分析

目的观察甲亢肝阳上亢证大鼠与正常大鼠肾上腺中蛋白质的差异表达，以期发现诊断甲亢肝阳上亢证的标志物，为进一步探讨甲亢肝阳上亢证的分子机制提供依据。方法左旋甲状腺素（L-T4）和附子汤灌胃造成甲亢肝阳上亢证模型，应用蛋白质组学技术比较模型组与正常组中肾上腺的差异蛋白质，结合生物信息学对其进行分析鉴定。结果模型组与正常组相比有33个蛋白质上升和6个蛋白质下降，进一步质谱鉴定，其中6个蛋白质为GrpE蛋白同系物1、60kDa热休克蛋白、脂酰辅酶A脱氢酶、钙网织蛋白前体、醛脱氢酶、异戊酰辅酶A脱氢酶。结论甲亢肝阳上亢证大鼠肾上腺中具有特异表达的蛋白质，经质谱鉴定后发现，其蛋白质的变化可能与甲亢肝阳上亢证的形成密切相关。     

TSH-secreting pituitary macroadenoma in an 11-year-old girl

Graves' disease, multinodular toxic goiter or toxic adenoma are the usual causes of hyperthyroidism in children as well as in adults. We report a case of hyperthyroidism due to TSH-secreting pituitary macroadenoma in an 11-year-old girl. The patient was admitted to the Endocrine Department for pituitary function evaluation, five months after transfrontal adenomectomy and pituitary irradiation for a macroadenoma. On admission the patient was clinically hyperthyroid and the work-up established a diagnosis of hyperthyroidism due to TSH-secreting adenoma (high levels of TSH in the face of hyperthyroidism, no TSH response to TRH stimulation, diffuse thyroid goiter without eye signs or pretibial myxedema). Of interest in this case was the fact that: (a) she is the youngest patient reported with hyperthyroidism due to a TSH-secreting macroadenoma and (b) hyperthyroidism was diagnosed after adenomectomy.     

COMPARISON ON THE CLINICAL EFFECT IN THE TREATMENT OF HYPERTHYROIDISM WITH DIFFERENT ACUPUNCTURE INTERVAL

Comparative observation was taken in 112 patients of hyperthyroidism. These patients were treated by both acupuncture and small dosage (10 mg once daily) of Methimazole. The acupuncture was given once weekly in group 1, twice in group 2, and thrice in group 3.     

Development of hyperthyroidism in a patient with idiopathic nephrotic syndrome

We present a 13-year-old boy who developed hyperthyroidism during the clinical course of idiopathic nephrotic syndrome treated with glucocorticoid. He had a second relapse of minimal change nephrotic syndrome, and complete remission of nephrotic syndrome was achieved immediately with oral glucocorticoid. However, when the steroid dosage was reduced, signs of hyperthyroidism such as systolic hypertension and tachycardia were observed. Laboratory findings revealed thyroid-stimulating hormone (TSH) below 0.05 μU/ml, free tri-iodothyronine of 16.1 pg/ml, free thyroxine of 5.6 ng/dl, and anti-TSH receptor antibody of 90%. Thus, a diagnosis of hyperthyroidism was made and treatment with thiamazol was started. Massive proteinuria may decrease the activity of hyperthyroidism due to urinary loss of thyroid hormones. A decrease in glucocorticoid dosage may also be involved in the development of hyperthyroidism due to a reduced immunosuppressive effect. Received: 11 July 2001 / Revised: 22 October 2001 / Accepted: 27 November 2001     

甲状腺功能亢进性心脏病发病的相关因素分析

目的探讨甲状腺功能亢进性心脏病（甲亢心）易发的相关因素及临床特点.方法采用向前逐步筛选变量法对48例甲亢心行Logistic多因素回归分析,内容包括性别、年龄、病程、病情、发病情况、是否规律治疗及有无其他并发症.结果甲亢心的发生与患者年龄、病程、病情、是否规律治疗密切相关,甲亢心的心脏表现呈多样性,以心律失常多见,尤以房颤（75%）为主.结论甲状腺功能亢进症（甲亢）并发甲亢心的因素较多,对于年龄偏大、病程长、病情重、未行规律治疗的甲亢患者要重视甲亢心的发生,可给予必要的预防与治疗.     

Concomitant Graves’ disease and primary hyperparathyroidism: clinical implications and preoperative localization of parathyroid adenoma by fine needle biopsy

A 53-year old female patient, who presented with retrosternal pain, which could be ascribed to reflux oesophagitis and gastritis, furthermore stated recurrent palpitations, sweating and the feeling of uneasiness. In routine laboratory investigation hyperthyroidism and hypercalcaemia were detected. Further testing revealed elevated TSH receptor antibodies and a parathyroid hormone level within the normal range. Scintigraphically a homogeneous, but increased uptake was found. In ultrasonography guided fine needle aspiration biopsy of a nodule parathyroid hormone was verifiable by immunochemical means. Under thyrostatic treatment with carbimazole the patient became euthyroid, simultaneous a decrease of serum calcium levels could be observed. Parathyroid hormone level remained in normal range. After confirmation of Graves’ disease and adenoma of the parathyroid gland parathyroidectomy in combination with near total resection of the thyroid gland was performed. In conclusions concomitant Graves’ disease and primary hyperparathyroidism is rare, but should be considered in case of persisting hypercalcaemia after the patient became euthyroid again, when parathyroid hormone level is in normal range or elevated. Thus a potentially required second operation can be avoided. By ultrasonography guided fine needle aspiration biopsy and immunochemical processing adenomas of parathyroid glands can be localized preoperatively.     

放射性131碘治疗老年人甲亢的临床价值

目的 观察老年甲状腺功能亢进症（甲亢）患者放射性^131碘（^131I）治疗的效果。方法 对65例已确诊的老年甲亢患者行放射性^131碘治疗，定期随访并观察治疗后1年甲亢治愈率及其合并症的转归。结果 在治疗后1年，65例接受治疗的老年甲亢患者中痊愈53例（81．5％），好转8例（12．3％），出现甲低4例（6．2％）。25例合并甲亢性心脏病（甲心）的患者中有18例（72％）临床治愈，好转5例（20％）。结论 放射性^131碘治疗老年人甲亢效果显著，可作为老年甲亢患者的首选治疗方法。     

甲亢患者骨代谢指标的变化及治疗对其的影响

目的　探讨甲亢两种骨变化指标的临床意义。　方法　选择 2 7例甲亢和 3 0例正常人作为对照 ,分别采用RIA方法和ELISA方法测定血清骨钙素 (OC)和尿吡啶酚 (PYR)含量。　结果　甲亢患者两项指标皆升高 ,与对照组相比 ,OC分别为 (5 4.7± 2 2 .5 )及 (2 3± 7.4) μg/L ,增加 13 9%。PYR分别为 (2 46.3± 181)及 (3 9.5± 11.6)nmol/mmol肌酐 ,增加 5 15 %。大多数患者都高出正常范围 ,且与血清FT3 浓度相关 ,甲亢经治疗后两项指标在一月内回到正常。　结论　PYR是甲亢骨代谢改变的高灵敏指标 ,OC增加幅度低于PYR ,提示骨吸收和骨形成不平衡。     

消瘿颗粒剂对甲状腺功能亢进症模型大鼠心率、肛温及血清T3、T4的影响

目的　观察消瘿颗粒剂对甲状腺功能亢进症 (以下简称甲亢 )模型大鼠心律、肛温及血清T3 、T4的影响。方法　用甲状腺片灌服Wistar大鼠造成甲亢模型 ,应用消瘿颗粒剂低、中、高剂量治疗后观察大鼠心率、肛温及血清三碘甲状腺原氨酸 (T3 )、甲状腺素 (T4)的变化 ,并设正常对照组、甲亢模型组、他巴唑组、甲亢灵组进行对照观察。结果　治疗 4周后消瘿颗粒剂中剂量组、他巴唑组、甲亢灵组大鼠心率减慢 ,肛温下降 ,与甲亢模型组比较有显著性差异 (P <0 .0 5 ,或P <0 .0 1 ) ;各组血清T3 值均下降到正常范围 ,治疗前后自身对照 ,消瘿颗粒剂中剂量组、他巴唑组血清T3 水平降低明显 (P <0 .0 1 ) ;各治疗组血清T4的水平均明显下降 ,较甲亢模型组有显著性差异 (P <0 .0 1 )。结论　消瘿颗粒剂有与他巴唑类似的抗甲状腺功能亢进作用 ,对甲亢有很好的治疗作用 ,尤以中剂量消瘿颗粒剂作用最为明显