Biological markers reflecting peripheral effects of thyroid hormones in autonomous thyroid adenoma

In some patients with functioning thyroid autonomous nodules preclinical hyperthyroidism is detected. It is important to know, whether in this intermediate clinical state beside the suppression of pituitary TSH secretion other target organs are also affected by serum free-thyroxine and free-triiodothyronine levels still within the normal range. Determining some sensitive, but not specific biologic markers reflecting the impact of thyroid hormones at the peripheral tissue level, it was demonstrated that in the group of preclinical hyperthyroidism the mean level of plasma fibronectin exceeded that of the controls (mean +/- S. D.: 583.5 +/- 163.9 vs. 424.2 +/- 84.1 micrograms/ml, p less than 0.001), serum procollagen-III-peptide concentration was already significantly raised, though its value was still within the normal range (mean +/- S. D.: 0.73 +/- 0.17 vs. 0.57 +/- 0.16 U/ml, p less than 0.05), conversely, mean sex-hormone binding globulin level was the same as in euthyroid controls (mean +/- S. D. 47.4 +/- 18.2 vs. 48.3 +/- 16.3 nmol/l). The value of all three parameters was significantly elevated in patients with toxic nodular goiter. Based on the results of this study "tissue"-thyrotoxicosis is suspected in some patients with preclinical hyperthyroidism, which may have therapeutical implications.     

过量碘摄入对孕妇甲状腺功能及妊娠结局的影响

目的探讨过量碘摄入对孕妇甲状腺功能及妊娠结局的影响。方法选取河北省沧州市海兴县医院妊娠晚期孕妇210例,平均年龄(27.69±4.73)岁,采集空腹晨尿及静脉血,采用砷-铈催化分光光度法测定尿碘浓度,化学发光法测定血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)及敏感促甲状腺激素(sTSH),并详细记录妊娠结局。结果被调查的孕妇尿碘中位数为1240.70μg/L,有84.3%的孕妇尿碘超过500μg/L,处于碘过量状态。孕妇甲状腺疾病总患病率为19.5%,其中亚临床甲状腺功能亢进、甲状腺功能减退、亚临床甲状腺功能减退的患病率分别为1.0%、2.4%、16.2%。不同尿碘水平或不同甲状腺功能的孕妇,不良妊娠结局的发生率差异没有统计学意义(P>0.05),但碘过量组孕妇不良妊娠结局的发生率有升高趋势。结论孕妇摄入过量碘时,甲状腺疾病患病率较高,其中以亚临床甲状腺功能减退为主;同时不良妊娠结局的发生率也有随尿碘升高而升高的趋势,提示应重视对高碘地区孕妇碘营养状况的监测。     

月经失调与甲状腺功能的联系——对1495例临庆系列病例的分析

目的探究月经失调形式和甲状腺功能（甲功）之间的联系。方法系列分析2006年1月4日至2011年3月2日妇科内分泌中心就诊的1495例患者的临床资料,均填写详细病史表格及检测促甲状腺激素、游离三碘甲状腺氨酸与游离甲状腺素水平。结果①临床月经失调和不育患者在系列病例中甲功异常发生率为13．4％;②甲功正常与甲功异常的月经分布情况无统计学差异（P=0．107）。但甲功异常者发生月经失调率是甲功正常者的1．49倍;③不同甲状腺功能状态下的月经分布情况均无统计学差异（P〉0．05）。但甲亢者发生月经失调率是甲功正常者的2．31倍。亚甲亢者是甲功正常的1．40倍。亚甲减者是甲功正常的1．27倍。甲减者发生月经失调率最高,是甲功正常的3．31倍;④甲亢与甲功正常者相比,月经过少发生率有统计学差异（P=0．025）。亚甲减者发生子宫异常出血率和月经稀发率分别是甲功正常者的1．36倍和1．34倍;甲减者发生闭经率最高,是甲功正常者的5．96倍;亚甲亢和甲亢发生月经过少率均最高,分别是甲功正常者的3．42倍和10．3倍;⑤各类与甲功异常类型联系最密切的月经失调患者的促甲状腺激素、游离三碘甲状腺氨酸与游离甲状腺素水平均有统计学差异（P〈0．001）。结论甲状腺功能低落或亢进均有可能发生月经失调。甲减合并的月经失调类型总体偏于月经稀发和闭经。亚甲减与合并子宫异常出血和月经稀发的发生都较密切。甲亢和亚甲亢的月经失调类型均以月经过少为主。     

Hormone binding globulins and anticonvulsant therapy

Serum sex hormone binding globulin, thyroxine binding globulin, cortisol binding globulin and vitamin D binding globulin, together with total levels of the appropriate bound hormones, were determined in 21 epileptic subjects who had been stabilised by long-term anticonvulsant therapy. Serum sex hormone binding globulin capacity was higher in these patients than in appropriate control groups (men p less than 0.05; women p less than 0.01), and values correlated with serum phenytoin levels in the female subjects (p less than 0.01). Thyroxine binding globulin levels were unaffected by anticonvulsants, but significant reductions in serum thyroxine (men p less than 0.05; women p less than 0.001) and triiodothyronine (men p less than 0.05; women p less than 0.01) were observed. Cortisol binding globulin capacity was appreciably elevated in patients of either sex (p less than 0.001), and in the women this was accompanied by a reduction in serum cortisol (p less than 0.001) and a significant correlation with the serum phenytoin concentration (p less than 0.01). Neither vitamin D binding globulin capacity nor serum 25-hydroxycholecalciferol levels were influenced by anticonvulsants in this study. It is concluded that anticonvulsant drug therapy causes widespread alterations in the normal homeostasis between hormones and their serum binding globulins. Such alterations may well have clinical significance.     

Subclinical hypothyroidism and the risk of hypercholesterolemia

BACKGROUND: Subclinical hypothyroidism, defined as a mild elevation in thyroid-stimulating hormone (TSH) levels in patients with normal serum thyroxine levels, has been associated with elevationed levels in serum cholesterol in some sample populations. These studies, however, have included referred patients and large numbers of patients with previously treated hyperthyroidism. The aim of this study was to assess whether subclinical hypothyroidism is associated with abnormal lipid levels in a population-based sample. METHODS: Data from adults older than 40 years who did not previously have a diagnosis of hypothyroidism or who were taking thyroid replacement medication were analyzed from the National Health and Nutritional Examination Survey (NHANES) III. Subclinical hypothyroidism was defined as a TSH value of 6.7 to 14.9 mU/L and normal thyroxine (n = 215). Euthyroid control adults included participants with a TSH in a normal range between 0.36 and 6.7 mU/L (n = 8,013). Outcomes examined were serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels in those who had subclinical hypothyroidism and in euthyroid controls. RESULTS: Persons meeting the criteria for subclinical hypothyroidism had higher mean cholesterol levels (226 vs 217 mg/dL, P = .003) and rates of elevated cholesterol levels (74.2% vs 63.9%, P = 0.02) than the euthyroid control group, but there were no significant differences in low-density lipoprotein (LDL) or high-density lipoprotein (HDL) levels. When adjusted for age, race, sex, and the use of lipid-lowering drugs, however, subclinical hypothyroidism was not related to elevations in cholesterol levels (adjusted odds ratio [OR] = 1.06, 95% confidence interval [CI], 0.57-1.97), LDL levels (adjusted OR = 0.89; 95% CI, 0.59-1.35), or triglyceride levels (adjusted OR = 1.83; 95% CI, 0.87-3.85) or to a low HDL level (adjusted OR = 0.94; 95% CI, 0.36-2.48). CONCLUSIONS: Subclinical hypothyroidism does not appear to be associated with abnormalities in serum cholesterol or triglyceride levels when adjusted for confounding variables in this population-based study.     

重度子痫前期合并甲状腺功能减退症患者的甲状腺激素水平与肾功能的相关性

目的探析重度子痫前期合并甲状腺功能减退症患者的甲状腺激素水平与肾功能的相关性。方法选取2012年8月至2014年8月陕西中医药大学第二附属医院128例重度子痫前期患者的临床资料,根据甲状腺激素水平分为亚甲减组(42例),甲减组(54例),单纯子痫前期组(32例),促甲状腺激素(thyroid stimulating hormone,TSH)检测结果均正常。比较3组患者甲状腺激素、肾功能指标;分析甲状腺激素水平与血清尿酸、尿素及肌酐的相关性。结果 3组患者的三碘甲状腺原氨酸(free triiodothyronine,FT3)水平比较差异无统计学意义(P0.05),甲减组游离甲状腺素(free thyroxine,FT4)水平明显低于亚甲减组、单纯子痫前期组(P0.05);单纯子痫前期组TSH与亚甲减组、甲减组比较,明显降低(P0.05)。单纯子痫前期组的各项肾功能检查结果显著低于甲减组(P0.05)。亚甲减组FT3水平与肾功能各项指标呈现负相关状态(P0.05));甲减组患者的FT3水平与血肌酐水平呈负相关,(P0.05);单纯子痫前期组患者的TSH水平与肌酐呈正相关(P0.05)。结论重度子痫前期患者的甲状腺激素的降低程度一定程度地影响了其肾脏代谢的程度,二者有着紧密的相关性。     

Pregnancy (conception) in hyper- or hypothyroidism

Pregnancy is accompanied by changes in thyroid function. Due to the increased synthesis of thyroid binding globulin and the thyroid-stimulating effect of human chorionic gonadotrophin (hCG), serum concentrations of thyroid hormones will increase in the first trimester of pregnancy (total T4, T3). Free T4 levels decrease during the latter half of pregnancy. Hyperthyroidism during pregnancy is usually due to Graves' disease. Definitive therapy may be considered for cases prior to pregnancy, although a medical management as would be given during pregnancy is an equally good option. The medical management of hyperthyroidism consists of a monotherapy with thyreostatics in which the recommended dose needs to be adjusted on the basis of free T4 in the high-normal and thyroid stimulating hormone (TSH) in the low-normal area so as to minimise the risk of foetal hypothyroidism. The transplacental passage of maternal TSH receptor stimulating antibodies may cause foetal hyperthyroidism. Another cause of maternal hyperthyroidism during pregnancy is 'gestational transient thyrotoxicosis', which is associated with high hCG levels during the first trimester of pregnancy. It is nearly always accompanied by hyperemesis gravidarum. Hypothyroidism in pregnancy has negative consequences for the foetus. If the hypothyroidism is apparent prior to pregnancy, it should be corrected before conception (target TSH value of 1 mU/l). If discovered during pregnancy, treatment with levothyroxine should be started as soon as possible. In the case of a pre-existing hypothyroidism a 25-50% increase in the levothyroxine dosage is often needed during the first trimester of pregnancy. This is possibly due to an increased requirement. An adequate serum concentration of T4 is necessary for foetal brain development.     

甲状腺激素水平与卵巢肿瘤关系的临床观察

目的:探讨甲状腺激素水平的高低与卵巢肿瘤之间的关系。方法:收集并分析2010年9月～2011年9月在吉林大学第二医院住院并行手术治疗的卵巢肿瘤45例患者的甲功五项(FT3,FT4,TT3,TT4,TSH),已排除曾患甲状腺疾病。按照患者的促甲状腺激素(TSH)值将患者分为TSH≤0.3 mIU/L甲状腺功能亢进组(甲亢组)、0.3相似文献   

Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants

Controversy persists about the role of subclinical hypothyroidism in hypercholesterolemia. This study aimed to assess in a clinically healthy, middle-aged population of employees the prevalence of thyroid function disorders and their relation to demographic variables and cardiovascular risk factors. 1922 (former) employees were screened with follow-up of newly identified cases of undiagnosed (subclinical) hypothyroidism and hyperthyroidism. Thyroid stimulating hormone (TSH), prevalence and course of (subclinical) hypo- and hyperthyroidism and their relation to cardiovascular risk factors (cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, smoking, systolic and diastolic blood pressure) were assessed. The prevalence of newly diagnosed subclinical hypothyroidism (cut-off TSH concentration: 4.0 mU/L) was 1.1% (17 women and 5 men) with a mean TSH concentration of 7.37 (95% CI 5.18-9.56) mU/L. No case of overt hypothyroidism could be diagnosed. Elevated levels of antibodies to microsomal or thyroglobulin antigens were detected in six subjects with subclinical hypothyroidism (27.3%). Fifteen subjects (0.8%, 13 women and 2 men) had TSH concentrations below 0.1 mU/L. The cardiovascular risk profile of subjects with mild subclinical hypothyroidism was not different from subjects with normal TSH levels. The prevalence of subclinical hypothyroidism was 0.8% in normocholesterolemic (cholesterol <5.2 mmol/l) and 1.4% in hypercholesterolemic subjects (n.s.). One woman each with the subclinical form of the disease developed hypothyroidism or hyperthyroidism after 21 and 11 months of follow-up, respectively. Subclinical hypothyroidism and subclinical hyperthyroidism were rarely observed in a target group for coronary heart disease prevention. Mild subclinical hypothyroidism was not associated with any adverse cardiovascular risk profile. These results argue against indiscriminate measurements of TSH concentrations in clinically healthy subjects either with normocholesterolemia or hypercholesterolemia.     

Effects of growth hormone replacement therapy in adults with severe growth hormone deficiency

The aim of the study was to analyse the effects of GH replacement therapy (1 year duration) on body composition, carbohydrate metabolism, thyroid hormone metabolism and bone mineral density in 8 adults with growth hormone deficiency (5 women, 3 men; mean age 40 years). Mean maintenance dose of GH was 1.5 IU/day-1.76 IU/day for women and 1.07 IU/day for men, respectively--determined according to individual patient requirements. Serum insulin-like growth factor-I standard deviation score increased from -5.4 to 0.0 (p < 0.001). There was a significant negative relationship between serum insulin-like growth factor-I standard deviation score at the start of therapy and the increase in this score (r = -0.85; p < 0.05). The waist:hip ratio decreased after 12 months by 0.039 (p < 0.05). The glycosylated hemoglobin increased (4.43 +/- 0.56% vs. 5.86 +/- 0.27; p < 0.05), and a negative correlation of the baseline glycosylated hemoglobin to the glycosylated hemoglobin increase was found (r = -0.88; p < 0.01). Both the free triiodothyronine and free triiodothyronine:free thyroxine ratio increased (3.09 +/- 0.22 vs. 4.17 +/- 0.40; p < 0.05, and 0.234 +/- 0.02 vs. 0.324 +/- 0.04; p < 0.01), and a positive relationship was observed between this ratio at the start of therapy and the increase in the ratio (r = 0.76, p < 0.05). The bone mineral density of lumbar spine and femoral neck expressed as z-score increased (-1.18 +/- 0.56 vs. -0.75 +/- 0.48; p < 0.01 and -0.06 +/- 0.60 vs. 0.43 +/- 0.43; p < 0.05), while the bone mineral density of forearm was unchanged. CONCLUSIONS: Growth hormone replacement leads to a decrease in visceral fat, modulates the thyroid hormone levels by increasing peripheral conversion of thyroxine to triiodothyronine and probably is a physiological regulator of peripheral thyroxine metabolism, slightly deteriorates the carbohydrate metabolism, and results in an increase of bone mineral density of lumbar spine and femoral neck.     

老年亚临床甲状腺功能减退与代谢因素的相关性研究

目的对老年患者亚临床甲状腺功能减退(亚临床甲减)情况进行调查,研究老年亚临床甲减与血糖、血脂、尿酸、超敏C反应蛋白(Hs-CRP)水平等代谢因素的关系。方法对481例60岁以上的老年患者进行横断面研究,调查收集甲状腺激素及血糖、血脂、尿酸等代谢生化指标。将患者分为亚临床甲减组和甲状腺功能正常组,分析对比两组年龄、性别、体质量指数(BMI)、血糖、血脂、尿酸、Hs-CRP的差异。Logistic回归探讨亚临床甲减与各代谢因素的相关性。结果 481例老年患者中,甲状腺功能正常418例(86.9%),亚临床甲减63例(13.1%),亚临床甲减组与甲状腺功能正常组比较,平均年龄和尿酸水平明显升高。Logistic回归分析显示,老年亚临床甲减与年龄和Hs-CRP水平存在显著的相关性。结论随着年龄增加,甲状腺功能存在逐步减退的趋势。老年亚临床甲减的患者,血尿酸水平明显升高,Hs-CRP与亚临床甲减的发生也相互影响。临床上对老年患者应加强甲状腺功能筛查和监测,以减少其对尿酸等代谢的影响,从而降低动脉粥样硬化及心脑血管疾病的风险。     

The practice guideline 'Thyroid disorders' (first revision) from the Dutch college of General Practitioners; a response from the perspective of general practice

The Dutch College of General Practitioners has launched its revised guideline for thyroid disorders. By including palpable lesions this guideline now covers a broad range of thyroid disorders. In general, the guideline is clear, usable and evidence-based. The measurement of thyroid antibody concentrations has been added to the work-up of hyperthyroidism, and the treatment of hyperthyroidism is considered optional for the general practitioner. Nearly all forms of hypothyroidism can be diagnosed and treated by a general practitioner, and the guideline provides well-defined recommendations on this topic. Regarding the treatment of subclinical hypothyroidism, however, the guidelines are ambivalent and less clear. The work-up for palpable lesions is unambiguous; this addition certainly enriches the new guideline for thyroid disorders.     

河北部分高水碘地区居民甲状腺功能及血脂水平调查

目的了解河北高水碘地区成人的碘营养状况、甲状腺疾病患病及血脂异常情况。方法选择河北省沧州市海兴县为调查地区,收集成人空腹晨尿及静脉血,测定其尿碘、血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、灵敏促甲状腺激素(sTSH)、血清胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb)水平。结果成人尿碘中位数为1094.92μg/L(627.38～1511.81μg/L);甲状腺疾病患者有66(22.0%)人,其中甲状腺功能亢进患者3(1.0%)人,亚临床甲状腺功能亢进患者7(2.3%)人,甲状腺功能减退患者12(4.0%)人,亚临床甲状腺功能减退患者44(14.7%)人;CHO、TG、HDL-C和LDL-C水平分别为(5.46±1.06)mmol/L、2.19(1.70～2.96)mmol/L、1.18(1.03～1.45)mmol/L和(3.08±1.05)mmol/L;不同甲状腺疾病状态人群的血脂水平差异无显著性。结论该高水碘地区人群血脂异常比率偏高。     

Thyroid function and energy intake during weight gain following treatment of hyperthyroidism

OBJECTIVE: Individuals with hyperthyroidism lose weight despite increased appetite and food intake, and weight is regained after treatment of hyperthyroidism. We asked whether this weight regain is purely a function of lowered metabolic rate coincident with lowered thyroid hormone concentrations or if the weight gain is related to food-energy overconsumption. METHODS: Ten unselected patients with hyperthyroidism treated with 131I were studied. The following measurements were made at 0, 1, 2, 3, 6, and 12 months: total food energy, carbohydrate, fat and protein consumption; serum thyroxine (T4); serum triiodothyronine (T3); T3 resin uptake; serum thyroid stimulating hormone (TSH); weight; height; and 24-hour urinary urea excretion. RESULTS: Inverse changes in body weight and food energy consumption/kg throughout the period of observation was a striking finding (mean initial weight 67.1+/-5 kg, final weight 76.4 kg+/-3 kg, premorbid weight 77.1+/-5 kg). The initial and final food energy intake was 3005+/-199 and 2597+/-137 Kcal/24 hrs, respectively. The thyroid hormone concentrations declined inversely relative to weight gain during the first months of the study, but later the thyroid hormones increased while weight gain continued. Initial serum T4 15.0+/-1 value at three months was 4.0+/-1.0 mg/dl, final T4 11.0+/-1. CONCLUSION: We conclude that weight gain following treatment of hyperthyroidism is due to 1) reduction in metabolic rate consequent upon the decreased thyroid hormone concentrations and 2) food energy intake which was initially greater than required to maintain individuals' premorbid weight. As body weight increased, food intake declined and both reached an asymptotic limit.     

Evaluation of the relationship between subclinical hypothyroidism and metabolic syndrome components among workers

Objectives

Both hyperthyroidism and overt hypothyroidism are associated with increased prevalence of metabolic syndrome and its components, while data on subclinical hypothyroidism is currently limited especially in working populations. The aim of this study was to examine the association between subclinical hypothyroidism and metabolic syndrome components in workers; and to evaluate whether there are differences by sex and occupation.

Material and Methods

A total of 1150 university employees (male — 792, female — 358) aged 30–60 years who came for an annual medical check-up were studied. Anthropometric measurements were taken, and blood pressure, fasting plasma glucose (FPG), lipid profiles, thyroid stimulating hormone (TSH), free thyroxin (FT4) and free triiodothyronine (FT3) levels were measured.

Results

After adjustment for age and body mass index (BMI), TSH was positively associated with increased triglyceride (TG) levels (β = 0.108, p = 0.020) and FPG (β = 0.130, p = 0.006) in subclinical hypothyroid male workers. However, TSH was not associated (p > 0.05) with any component of metabolic syndrome (MS) in the euthyroid group. In females, TSH was not correlated with MS components in both euthyroid and subclinical hypothyroid groups. Furthermore, comparison by occupation showed higher TSH in subclinical hypothyroid male workers employed in administration (5.23±0.52 mU/l) than those working as academics (5.12±0.52 mU/l), which resulted in elevated systolic and diastolic blood pressure, FPG, total cholesterol, TG and high density lipoprotein cholesterol. In females, BMI, systolic and diastolic blood pressure, TG and FPG were significantly (p < 0.05) higher in subclinical hypothyroid administrators than those in academics.

Conclusions

Subclinical hypothyroidism was associated with metabolic syndrome components in male workers and not in females. Administration workers showed increased metabolic risks compared to academics. The findings suggest that the assessment of thyroid function in individuals with metabolic syndrome in the workplace may be favorable especially among men.     

Prevalence of thyroid disorders among older people: results from the São Paulo Ageing & Health Study

This study aimed to estimate prevalence of thyroid disorders in the S?o Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of S?o Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of thyrotropic hormone and free-thyroxine. Among 1,373 people (60.8% women), prevalence rates (95% confidence interval) for thyroid dysfunction (%) were: overt hyperthyroidism, 0.7% (0.2-1.1)[women: 0.8% (0.2-1.5); men: 0.4% (0.01-0.9)]; overt hypothyroidism, 5.7% (4.5-6.9) [women: 5.9% (4.3-7.5); men: 5.4% (3.5-7.3)]; subclinical hyperthyroidism, 2.4% (1.6-3.2) [women: 2.8% (1.6-3.9); men: 1.9% (0.7-3.0)]; and subclinical hypothyroidism, 6.5% (5.2-7.8) [women: 6.7% (5.0-8.4); men: 6.1% (4.1-8.2)]. There was no difference in prevalence rates according to gender, but almost 40% of women were diagnosed and under treatment compared to 9% of men. The burden of thyroid disorders in this sample is high and most participants were not aware of them.     

Cardiovascular consequences of thyroid diseases, their prevalence and treatment, particularly in cases with subclinical hyper- and hypothyroidism

Cardiovascular consequences of thyroid diseases, their prevalence and treatment, particularly in cases with subclinical hyper- and hypothyroidism. The aim of the study was to draw attention to an association between the thyroid and cardiovascular diseases. The main topic was to lay emphasis on the importance of cardiovascular diseases caused by subclinical hyper- and hypothyroidism in the relation to the practice. The subclinical states precede the overt hyper- and hypothyroidism, and they are often present during their treatments. The changes in the levels of thyrotropin demonstrating subclinical thyroid diseases, could be detected in different non-thyroid diseases and resulted from the effect of some drugs. Particularly, the subclinical thyroid diseases become more frequent in older age. In the background of the high prevalences of atrial fibrillation, hypertension and psychosomatic events subclinical hyperthyroidism could be revealed. Subclinical hypothyroidism is characterized by an increased prevalence of elevated serum lipid levels, atherosclerosis, ischemic heart disease and hypertension often associating with the presence of anti-thyroid antibodies. It is important to reveal subclinical thyroid diseases in time for the effective treatment and for stopping of the cardiovascular damages before manifestations of cardiovascular diseases. The paper gives advice for the practice and the rational management. At the end, a survey of the association between thyroid and heart diseases in own department of internal medicine at the last three years is given.     

中国甲状腺疾病诊治指南 – 甲状腺结节

  目的  了解成人甲状腺疾病的流行状况相关影响因素。  方法  2017 — 2018年在辽宁省沿海的营口市和内陆的沈阳市分别抽取1个社区和1个行政村,共计4个社区（村）作为调查点。按年龄和性别构成在调查点整群抽取住满5年 ≥ 18岁常住人口进行问卷调查,甲状腺超声检查,检测血碘、尿碘、盐碘和甲状腺功能及抗体[促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT₃）、游离甲状腺素（fT₄）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）],评价碘营养及甲状腺疾病患病情况及影响因素。  结果   共调查18～85岁成人2931人,尿碘中位数为167.6 µg /L,碘营养水平总体适宜;血碘中位数为62.1 µg /L,低血碘者125例,占4.3 %,高血碘186例,占6.4 %;成人甲状腺疾病患病率37.15 %,其中甲状腺结节、自身免疫性甲状腺炎、地方性甲状腺肿（地甲肿）、甲状腺功能减退症（甲减）、亚临床甲减、甲状腺功能亢进（甲亢）和亚临床甲亢患病率分别为20.37 ％、16.17 %、1.91 ％、1.43 %、5.53 ％、0.92 %和0.61 %。甲减、甲亢、AITD、甲状腺肿和甲状腺病患病率在不同血碘组间差异有统计学意义（P < 0.05）。甲状腺疾病发病与性别（OR = 2.03）、家族史（OR = 1.65）、年龄（OR = 1.33）、超重或肥胖（OR = 1.60）、血碘、富碘食品摄入及收入等因素密切相关。  结论   辽宁地区成人甲状腺疾病患病率居于中等发病水平,性别、年龄、家族史、体质指数过高和碘营养状况与甲状腺病发病密切相关,女性及中老年人应为甲状腺疾病防治的重点人群,各地应结合人群碘营养状况,科学补碘,预防甲状腺病发生。     

Current controversies in endocrinology: screening of asymptomatic elderly for subclinical hypothyroidism

Thyroid disorders are common in elderly patients. In fact, the most common form of thyroid dysfunction in the elderly is subclinical hypothyroidism. Subclinical hypothyroidism is a biochemical state characterized by an increased serum thyroid-stimulating hormone and normal levels of serum-free T4 and free T3. Much attention has been focused on this clinical entity recently, but it remains controversial whether early thyroid replacement therapy improves outcomes in elderly patients with asymptomatic subclinical hypothyroidism. There is a dearth of critical evidence on the effects of subclinical hypothyroidism on target tissues, the natural history of early thyroid dysfunction, and the net benefits and harms of long-term treatment with thyroid hormones. This article reviews the available information on the aging thyroid gland, subclinical hypothyroidism, and issues concerning treatment in asymptomatic elderly patients.     

未实施碘盐防治的社区人群甲状腺疾病的调查

目的 研究未实施碘盐防治的社区人群甲关腺疾病的患病率。方法 辽宁省盘山社区1103名14周岁以上居民参加甲状腺疾病的普查,内容包括填写调查表、接受体格检查、测定血清指标及测定尿碘浓度、进行甲状腺B超检查。结果 盘山社区甲亢与甲低患病率分别为16．3‰和2．7‰;亚临床甲亢与亚临床甲低患病率分别为37．7‰和9．1‰;甲状腺自身抗体阳性率10．9％;B超诊断甲状腺肿大经20．7％,其中弥漫性甲状腺肿占16．8％,结节性甲状腺肿占3．9％。结论 自身免疫参与碘缺乏地区甲状腺肿的发生,而且可能是亚临床甲亢与亚临床甲低的主要病因。