Autoimmune thyroid diseases and Helicobacter pylori: the correlation is present only in Graves's disease

AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples.METHODS: Authors investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves’ disease and 54 females and 6 males with Hashimoto’s thyroiditis HT), at their first diagnosis of ATDs. Authors tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher’s exact test and the respective odds ratio (OR) was calculated.RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3) in Graves’ disease, but not in Hashimoto’s thyroiditis, where authors found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present.CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.     

Postradiation hypothyroidism in head and neck cancers: A Department of Veterans Affairs single-institution case-control dosimetry study

We performed a case-control study to characterize the dose-volume relationship and other variables leading to hypothyroidism after head and neck (H&N) cancer radiation therapy (RT) in a homogenous Veterans Affairs (VA) population. All records of patients receiving RT for various H&N cancers at a single VA medical center between 2007 and 2013 (n?=?143) were screened for post-RT thyroid stimulating hormone (TSH) levels (n?=?77). The thyroid gland was contoured on each slice of the planning computed tomography scan when available (hypothyroid: n?=?18; euthyroid >?2 years: n?=?16), and dose-volume histograms based on physical dose and biologically equivalent dose (BED) were compared systematically to find the significant dose-volume thresholds that distinguish the patients who developed clinical hypothyroidism. Dosimetric and clinical variables were considered in univariate and multivariate analysis. Preirradiation prevalence of hypothyroidism was 8 of 143 (5.6%). After RT, 36 of 77 (47%) screened patients had abnormally high TSH, of which 22 of 36 (61%) had clinical hypothyroidism after 1.29?±?0.99 years. The median follow-up durations were 3.3 years and 4.7 years for euthyroid and hypothyroid patients, respectively. Compared with the euthyroid cohort (n?=?41), these hypothyroid patients displayed no significant difference in age, gender, primary tumor site, thyroid volume, hypertension, diabetes, or use of chemotherapy, surgery, or intensity-modulated radiation therapy (IMRT). They were more likely to have had stage 3 or 4 cancer than euthyroid patients (86.5% vs 73.2%, p?=?0.01). The odds ratios of hypothyroidism for stage 3?+?4 cancers and V50Gy?<?75% were 5.0 and 0.2, respectively (p?<?0.05). Equivalent BED threshold of V75Gy₃?<?75% gave an odds ratio of 0.156 for developing hypothyroidism (p?=?0.02). The prevalence of post-RT clinical hypothyroidism was relatively high for patients with H&N cancers and warrants routine surveillance, especially in those with higher stage malignancy. V50Gy?<?75% may be a useful guideline to avoid hypothyroidism. We also show BED data which could be used for unconventionally fractionated schemes, and V75Gy₃?<?75% may be a useful guideline.     

甲状腺功能减退症患者血清瘦素水平与颈动脉内膜中层厚度及其相关性研究周卫东

摘要目的探讨甲状腺功能减退症患者血清瘦素（Lep）水平与颈动脉内膜中层厚度（IMT）及其相关性。方法选取甲减患者96例,设为甲减组;另选取健康体检合格者60例,设为时照组。检测两组受试者的血脂、甲状腺激素及Lep水平,超声检测颈动脉IMT,分析甲减患者血清Lep与颈动脉IMT的相关性。结果甲减组FT3、FT4低于对照组,TSH、TG、TC以及Lep、IMT均高于对照组（P〈0．0l或P〈0．05）。动脉弱样硬化（As）组与非As组血清Lep水平为（19．68±5．15）μg／L、（11．23±4．17）gg／L,差异具有统计学意义（P〈0．05）。Pearson相关分析显示甲减组患者血清Lep与FT3呈负相关,与IMT呈正相关（P〈0．01）;而与FT4、TSH、TG、TC无相关关系（P〉0．05）。结论甲减患者血清Lep水平、颈动脉IMT均高于正常水平,血清Lep与FT3负相关,与颈动脉IMT正相关,这提示Lep参与了As的发生发展。     

甲状腺术后的甲状腺功能维护

甲状腺功能减退是甲状腺手术最常见的并发症.左甲状腺素钠（L-T4）是治疗甲状腺功能减退的首选药物,甲状腺功能维护可于术后早期进行,L-T4的需要量受多个因素及目标TSH的影响,实施过程中应考虑患者的特殊性（依从性差、妊娠、老年）,并定期（4～6周）复查甲状腺功能,根据目标TSH调整最佳用药剂量,避免治疗不足和治疗过度.T3分次给药或L-T4/T3联合治疗可作为L-T4治疗失败患者的选择.     

甲状腺疾病、糖尿病相关骨质疏松的病因研究进展

骨质疏松症是临床的常见病和多发病,并严重影响着人们的健康和生活质量,而糖尿病和甲状腺疾病都是继发性骨质疏松的主要病因。了解这两种疾病相关骨质疏松的病因对骨质疏松的治疗和预防有重要意义。本文主要对内分泌代谢病中的甲状腺疾病及糖尿病引起骨质疏松的病因进行了阐述。     

血清TSH和Hcy测定在甲状腺功能减退诊断中的价值

目的 分析血清甲状腺激素（TH）和同型半胱氨酸（Hcy）水平测定在甲状腺功能减退诊断中的价值。方法 选取2018年2月~2019年2月在我院诊治的50例甲状腺功能减退患者设为观察组A,40例亚临床甲状腺功能减退患者设为观察组B,另选同期体检正常者40例设为对照组。分别检测三组TH[三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺素（TSH）]、Hcy水平并进行比较。结果 观察组B血清FT3、FT4水平与对照组比较,差异无统计学意义（P＞0.05）,血清TSH、Hcy水平高于对照组（P＜0.05）;观察组A血清FT3、FT4水平低于对照组,血清TSH、Hcy水平高于对照组（P＜0.05）;观察组A血清FT3、FT4水平低于观察组B,血清TSH、Hcy水平高于观察组B（P＜0.05）;血清TSH、Hcy变化与临床甲状腺功能减退呈正相关（P＜0.05）;血清TSH、Hcy诊断甲状腺功能减退敏感度和特异度均高于FT3、FT4诊断（P＜0.05）。结论 动态监测血清TSH、Hcy 水平,对亚临床甲状腺功能减退向临床甲状腺功能减退转化具有一定的诊断价值。