131^I治疗甲亢后早发甲低的临床分析

目的：探讨影响131^I治疗后甲状腺功能低下的因素及治疗措施。方法：对我院1998年1月-2005年12月收治的136例131^I治疗后早发甲低患者疗效进行观察、总结,对早发甲低患者的发生率及影响因素进行分析。结果：101例暂发性甲低患者均未行甲状腺素替代治疗,98例1年内恢复正常,3例在6月后服用左旋甲状腺素片替代治疗。结论：131^I治疗后早发甲低受多种因素的影响,早发甲减的患者以观察为主。     

甲状腺功能减退症与亚临床甲状腺功能减退症患者认知功能的比较

目的 探讨甲状腺功能减退症与亚临床甲状腺功能减退症患者认知功能的特点.方法 用简易智力状态检查、韦氏成人智力量表、逻辑记忆测验、视觉再生测验、威斯康星卡片分类测验评估甲状腺功能减退症(甲减组)、亚临床甲状腺功能减退症(亚甲减组)患者及正常对照组的认知功能.结果 甲减组和亚甲减组在逻辑记忆[分别为(10.32±3.39)分、(13.57±4.49)分]、视觉再生[分别为(5.96±2.57)分、(7.97±2.83)分]方面均差于健康对照组[(16.38±3.95)分、(9.11±2.65)分],在威斯康星卡片分类测验的总应答数、准确应答数、持续错误数、完成分类数等方面亦差于健康对照组(亚甲减组的完成分类数除外),差异有显著性(P<0.05);甲减组较亚甲减组在以上认知功能方面受损更明显,差异有显著性;而3组在简易智力状态检查总分、总智商方面差异无显著性.结论 甲状腺功能减退症与亚临床甲状腺功能减退症患者均存在明显认知功能受损,前者较后者认知功能受损更明显.     

Low thyroxinaemia occurs in the majority of very preterm newborns

Transient hypothyroxinaemia with normal thyroid stimulating hormone (TSH) levels is a well-known condition in preterm neonates and is generally assumed to be a harmless epiphenomenon of prematurity. This assumption is, however, based on studies that included very few neonates with a gestational age (GA) below 30 weeks. We therefore measured serum free thyroxine (FT₄) and serum TSH on days 1 and 14 in 263 neonates with a GA between 26 and 41 weeks. In 13 infants (5%), transient hypothyroidism (low FT₄ and TSH>20 mU/l on day 14) was found. In the remaining 250 patients FT₄ on days 1 and 14 but not TSH correlated positively with GA. In neonates with a GA of 35–41 weeks, FT₄ increased postnatally to levels within or above the normal adult range. In contrast, in the very preterm group (26–31 weeks) the already low FT₄ levels declined to values significantly below the range observed in term neonates. A significant proportion of these neonates had FT₄ levels within the hypothyroid range. There was no difference in thyroid function between neonates treated with povidone-iodine or chlorhexidine.Conclusion Very preterm neonates have FT₄ levels on day 14 that are much lower than is generally assumed while TSH remains in the normal range. We therefore propose to measure FT₄ in all preterms with a GA below 33 weeks, during the 2nd week of life.     

Prevalence of hypothyroidism and diabetes mellitus in elderly kibbutz members

The aim of this study was to determine the prevalence of hypothyroidism and diabetes mellitus (DM) in elderly (aged 65–92 years) kibbutz members in Northern Israel. Method: The medical records of 1096 elderly (642 females and 454 males) residing in 11 kibbutzim were reviewed for data regarding thyroid function tests (TSH and FT4) and fasting blood glucose. Fasting blood glucose levels above 7.8 mmol/l was considered diagnostic for diabetes mellitus. Results: The prevalence of hypothyroidism was 14% (9.7% in males and 18.2% in females) and that of DM was 11.5% (12.1% in males and 11.1% in females). In 74% of the diabetics the diagnosis was made after the age of 60 years. Distribution of treatment modalities in diabetics was as follows: diet only 42%, oral hypoglycemic agents 52% and Insulin 6%. Subclinical hypothyroidism (serum TSH levels above 4.5 mU/L with normal FT4 levels) was detected in 38% of all the hypothyroid subjects. Conclusion: The data suggest that diabetes mellitus and primary hypothyroidism are common disorders in elderly subjects. DM in the elderly can usually be handled with diet and oral hypoglycemic drugs. Since the clinical features of hypothyroidism in the elderly are often atypical, we suggest that elderly subjects should be screened for hypothyroidism.     

Pericardial effusion as a sign of acquired hypothyroidism in children with Down syndrome

In three children with Down syndrome and acquired hypothyroidism echocardiography was performed before and after the start ofl-thyroxine treatment. Initial studies revealed pericardial effusions which resolved during treatment suggesting that they were caused by hypothyroidism. The incidence of hypothyroidism in Down syndrome is high, but the diagnosis is often missed for lack of specific clinical criteria. The finding of pericardial effusion by echocardiography may be essential in discovering thyroid dysfunction. The cases illustrate that regular thyroid function tests are important in Down syndrome.     

Primary Hypothyroidism with Pituitary Enlargement and a Visual Field Abnormality

A 23 year old man presented with classical hypothyroidism of 9 years duration. This was associated with pituitary enlargement, documented on magnetic resonance imaging (MRI), and abnormal half-field visual evoked responses (VERs). Following the initiation of thyroxine therapy the pituitary enlargement and the VER abnormalities resolved. The final diagnosis was of primary hypothyroidism with secondary pituitary hyperplasia.     

Polyneuropathy in hypothyroidism

Summary Clinical and sural nerve biopsy findings are described in four hypothyroid patients with manifestations of a diffuse peripheral neuropathy. Clinical examination revealed distal sensory inpairment, complaints of burning and lancinating extremity pains, ataxia and a decrease of deep tendon reflexes with total ankle jerk loss. In one patient, signs of the peripheral neuropathy comprised the leading symptomatology of the underlying metabolic disorder. Light and electron microscopic investigations of the sural nerve biopsies revealed a marked reduction of myelinated fibers, affecting mainly the large myelinated axons. The histograms showed a pathological unimodal spectrum of myelinated fiber diameters. Dystrophic and degenerative changes in axons of all fiber classes and the presence of clusters of thinly myelinated small fibers suggest that neuroaxonal degeneration and incomplete regeneration may represent the major pathogenetic mechanism of the neuropathy in these hypothyroid patients. Neuropathological studies on myxoedematous neuropathy are as scarce and insufficient as studies on myxoedematous myopathy are abundant and detailed. G. W. Bruyn and H. Garland, 1970     

Effects of induced thyroid deficiency on the development of suckling behavior in rats

The effects of propylthiouracil (PTU) on the ontogeny of suckling behavior in rats were examined. The drug was given at two dosage levels of 0.3% and 0.5% respectively mixed with rat diet throughout gestation and suckling. The thyroid glands of treated fetuses and pups and of untreated control animals of the same age groups were monitored by histologic examination. At the behavioral level, the frequency of individual movements of head, forelimbs and mouth was significantly reduced in treated fetuses. The combination movements of head, mouth and forelimbs showed severe deficits both quantitatively and qualitatively for all ages in the experimental group from day 18 of gestation. Hypothyroid pups of dams raised on 0.5% PTU were unable to attach to the nipple of the mother and died within a few days. Pups of dams raised on 0.3% PTU showed longer latencies for nipple attachment, and their gross motor movements of rooting and suckling were greatly impaired. These results have been discussed in relation to the development of suckling behavior to indicate that, during ontogeny, some decisive step in the integration of individual movements takes place in utero from day 18 of gestation. This coincides with the establishment of pituitary thyroid relationship, which is continued through postnatal stages.     

Quantitative 123I-iodide scintigraphy and radiation dosimetry in infants with congenital hypothyroidism

Quantitative studies of ¹²³I-iodide uptake using a gamma camera were undertaken in 23 infants with congenital hypothyroidism. Background oral radioactivity was reduced by ensuring that the infants drank fruit juice during the study. In 7 cases, there was no evidence of functioning thyroid tissue, in 13 cases, lingual tissue was present, and in 3 cases, there was uptake at the normal thyroid site. Dyshormonogenesis, as shown by a positive perchlorate discharge at 30–60 min after radioiodine administration, was present in 5 of the cases with demonstrable uptake. The estimated 20-min uptake of ¹²³I-iodide was less than 2.6% of the dose in all cases except 1; in this case, the uptake was 10.4%, but this was completely discharged by perchlorate. There was good agreement between the quantitative radioiodine-uptake and-discharge results and the circulating thyroid-hormone levels. The estimated radiation dose to thyroid tissue using the technique was 9.2 mSv for an intravenous administration of 2MBq ¹²³I-iodide.Formerly at the Duncan Guthrie Institute of Medical Genetics, Yorkhill, Glasgow G3 8SJ, Scotland     

Bilateral anotia with congenital hypothyroidism

Bilateral anotia or microtia is known to be associated with multiple order malformations. The authors report a young infant who presented with failure to thrive and recurrent respiratory tract infections.The patient had bilaterally absent pinnae; instead small skin tags were present. He also had asymmetric crying facies and clinical evidence of hypothyroidism in the form of hoarse voice, constipation and generalized hypotonia. Thyroid function tests confirmed the diagnosis of hypothyroidism