新生儿甲状腺功能低下的筛查分析

目的：探讨开封市新生儿先天性甲状腺功能低下的发病率及治疗愈后观察。方法：以本院出生的新生儿为筛查对象。于出生后４８－７２小时,充分哺乳后采取足跟血,应用ＤＥＬＦＩＡ法检测标本中ＴＳＨ水平（ＴＳＨ≥２．１μＩＵ／ｍｌ为阳性）。亲用放免法检测阳性患儿血清中ＴＳＨ、Ｔ３、Ｔ４水平确诊。确诊后即给予口服甲状腺素片治疗并定期随访。结果：４０９２例新生儿中检出ＣＨ患者２例,发病率为１／２０４６,高于文献报道。这与样本量小有关。结论：早发现早治疗可获得满意效果。对于减少我国病残儿出生,提高我国人口素质有着十分重要的意义。     

湛江地区新生儿先天性甲低筛查促甲状腺素切值的建立

目的建立湛江地区新生儿先天性甲状腺功能减低症（CH）筛查的促甲状腺素（TSH）切值。方法新生儿出生72h后采集足跟血,滴于S＆S#903滤纸上,采用酶免疫荧光分析法（FEIA）测定TSH含量。结果测定88010例新生儿足跟血血斑滤纸TSH,确定湛江地区新生儿TSH切值为10mlU／L。结论新生儿足跟血血斑滤纸TSH筛查切值的建立为湛江地区今后的新生儿CH筛查提供了依据,减少漏诊和假阳性病例的发生。     

山西地区新生儿先天性甲低筛查中促甲状腺素切值的初探

目的建立山西省新生儿先天性甲状腺功能减低症筛查中促甲状腺素的切值。方法采取出生72h后足跟血,滴在规定滤纸片上,采用酶免疫荧光分析法测定血中TSH浓度。结果测定新生儿足跟血70210例,确定山西省新生儿先天性甲状腺功能减低症筛查中促甲状腺素（TSH）的切值为9．05μIU／ml。结论新生儿促甲状腺素（TSH）切值的确定为山西省今后的新生儿疾病筛查提供依据。     

河南省先天性甲状腺功能减低症的筛查和治疗

目的：探讨河南省先天性甲低的发病率及治疗效果。方法：以非选择的新出生婴儿４１０００人为筛查对象。于出生７２小时，充分母乳后足跟采血，应用ＤＥＬＦＩＡ法检测标本中ＴＳＨ水平（ＴＳＨ≥２０μＩＵ／ｍＬ为阳性）。为了确诊，用放免法检测阳性病人血清中ＴＳＨ、Ｔ３、Ｔ４的水平，确诊的病人立即给予口服甲瘃腺素片治疗并定期进行体格发育和智力发育监测。结果：４１０００例新生儿中ＣＨ病人６例，发病率为１／６８３３，     

新生儿先天性甲状腺功能减低症TSH切值研究

目的建立柳州地区新生儿先天性甲状腺功能减低症（congenital hypothyroidism,CH）中促甲状腺素（TSH）筛查实验切值。方法新生儿于出生72h后采集足跟血,滴于规定滤纸上,采用时间分辨荧光免疫分析方法,检测滤纸干血片TSH浓度。结果通过141 314例新生儿足跟血筛查结果确定柳州地区新生儿先天性甲状腺功能减低症切值为9.0μU/ml。结论新生儿TSH筛查切值的确立为柳州地区今后的新生儿CH筛查提供了依据。     

武汉地区4万例新生儿先天性甲状腺功能低下筛查

建立新生儿疾病筛查网,采用滤纸干血片法,以出生48小时后新生儿足跟血促甲状腺素（TSH）为检测指标,对武汉地区4万多例新生儿先天性甲状腺功能低下症进地了筛查,对TSH超过正常值者召回复查,测血清T3,T4和TSH,检出13例先天性甲低患儿,发病率为1：3245。确诊后立即治疗,效果较好。提示新生儿甲低筛查是早期发现,及时诊断和治疗的重要措施,能有效的改变甲低患儿的预后。     

宁波地区新生儿疾病筛查结果分析

本院应用时间荧光辨法（ＤＥＬＦＩＡ）对宁波市及所属各县市（区）３３家医院出生的７２００例新生儿进行了促甲状腺素（ＴＳＨ）及苯丙酮尿症（ＰＫＵ）的筛查，结果被筛查新生儿患新生儿甲低者３例，发病率为１／２４００，发现一性甲低者１例，占１／７２００；ＰＫＵ阳性１例，发病率为１／７２００，可疑阳性３例。由于这两种病对新生儿生长发育造成的危害大，因此进行新生儿疾病筛查能早期快速的诊断和治疗，对开展优生优育提     

新疆地区新生儿先天性甲状腺功能低下症筛查切值的研究

目的建立新生儿疾病筛查干血片法TSH测定在新疆地区新生儿先天性甲状腺功能减低症(CH)的切值(cutoff)。方法新生儿出生72h后经充分哺乳后采集足跟血滤纸标本,采用时间分辨荧光免疫法(DELFLI),检测滤纸干血斑中促甲状腺素(TSH)浓度。结果通过三年内筛查的67 314例新生儿TSH测定结果确定本实验室新生儿甲低的筛查切值为8.5μU/m L。结论新生儿TSH筛查切值的确立为新疆地区今后的新生儿CH筛查提供了依据。     

福建省新生儿苯丙酮尿症苯丙氨酸筛查切值的研究

目的探讨新生儿足跟血苯丙氨酸(Phe)测定在新生儿苯丙酮尿症筛查的切值(cut-off).方法新生儿出生72h后采足跟血,滴在规定的滤纸上.采用荧光测量法测定Phe浓度.结果通过一年半的新生儿足跟血筛查结果确定福建省新生儿苯丙酮尿症的筛查(Phe)切值为2.0mg/dL.结论新生儿足跟血Phe切值的确定为福建省今后开展大规模的新生儿苯丙酮尿症筛查提供依据:目前各实验室各自确定本实验室的Phe筛查切值,建议由国家卫生部组织进行苯丙酮尿症筛查Phe切值统一确定.     

12例先天性甲状腺功能低下症筛查病例临床分析

先天性甲状腺功能低下症 (以下简称甲低 )为生后初数天即存在的甲状腺功能减退 ,是一种最常见的可预防的智能迟滞原因之一。新生儿甲低的系统筛查始于 1974年 ,现在这项筛查在大多数发达国家已成为早期诊断和及时治疗的有效办法。我市自 1999年 2月开展新生儿甲低筛查以来 ,对筛查出来的 12例甲低患儿进行及时治疗 ,治疗效果满意 ,现分析如下。资料与方法1.临床资料 :1999年 2月 - 2 0 0 0年 10月共进行新生儿筛查 40 810人次 ,确诊甲低 12例 ,其中 :男 3例 ,女 9例 ;血清促甲状腺素 (ＴＳＨ)均 >81ｍＩＵ/Ｌ ,血清游离甲状腺素 (ＦＴ4 )浓…     

羊水中甲状腺激素检测及其临床应用

采用体外放射分析方法对２２例正常和３０例正在治疗的患甲状腺疾病的孕妇羊水Ｔ３、Ｔ４、ＴＳＨ、ｒＴ３及ＦＴ３、ＦＴ４进行了测定。并监测孕妇妊娠期甲状腺功能和进行了新生儿甲低筛查。结果表明羊水中甲状腺激素水平的测定,对了解母体服药对胎儿的影响及有无胎儿甲低是有价值的。羊水中ｒＴ３水平的测定可作为观察及筛选胎儿甲低的方法之一。     

Neonatal thyroid screening in a mild iodine deficiency endemic area in Iran

Background : Evaluated serum thyroid-stimulating hormone (TSH), as an early index for diagnosis of neonatal hypothyroidism, indicates insufficient supply of thyroid hormones. Objective : The aim of the study was to estimate the incidence of neonatal hypothyroidism and assessment of iodine deficiency in the eastern part of Iran. Settings and Design : A cross-sectional study was conducted in a pilot screening. Materials and Methods : The measurement of blood TSH spotted on filter paper was performed by ELISA method in 59,436 neonates. TSH value equal to 5 mU/L was considered cut off point. The diagnosis of hypothyroidism in neonates with the blood TSH higher than the cut off point was based on clinical examinations and laboratory tests (serum TSH and T4). Statistical Analysis: The groups were compared using chi-square and ANOVA tests. Results : In our study, the recall rate and incidence of hypothyroidism were 3.6% and 2 per 1000 neonates respectively. Based on the proposal made by WHO/UNICEF/ICCIDD, the results of our study showed a mild iodine deficiency in the area. Conclusions : A comprehensive policy should be developed for control of iodine deficiency and treatment of hypothyroidism in the studied population and neighboring countries.     

Possible consequences of subclinical hypothyroidism

Subclinical hypothyroidism is defined as elevated TSH in the presence of normal free T4 and T3 levels. This review discusses the following questions concerning subclinical hypothyroidism that have not been solved yet: 1) does elevated TSH always mean failure of the thyroid gland? 2) Do patients with subclinical hypothyroidism always develop overt hypothyroidism? 3) Are they symptomatic? 4) Does treatment with L-Thyroxine cure these symptoms,--if they exist? Summarizing the results of the literature one can give the following answers: 1) Elevated TSH with normal free T4 can but does not necessarily mean thyroid failure. 2) Patients with positive thyroid antibodies and especially with TSH levels above 10 mU/l are at high risk to develop overt hypothyroidism. 3) Typical symptoms (thyroid-specific, cardiovascular, neurological and psychiatric and finally alterations of risk factors for atherosclerosis) seem to occur in a greatly varying percentage of patients--some of the described symptoms are of questionable clinical importance. 4) Some of the symptoms, especially the cardiovascular, seem to be treatable by L-T4, whereas others like most of the changes in lipid metabolism can not be influenced by normalization of the TSH levels. In conclusion, screening for TSH and free T4 seems to be justified in elderly women, where the prevalence of the disease is approximately 20%. However, treatment of "symptoms" of subclinical hypothyroidism like elevated cholesterol levels or depression should be done only in patients with a TSH > 10 mU/l and there only with great caution in order to avoid unnecessary overdosage with the danger of eliciting atrial fibrillation.     

Episodic variations of prolactin, thyroid-stimulating hormone, luteinizing hormone, melatonin and cortisol in infertile women with subclinical hypothyroidism

Preliminary data have suggested that female infertility due to corpus luteum insufficiency may be caused by subclinical hypothyroidism [exaggerated thyroid-stimulating hormone (TSH) response to thyrotrophin- releasing hormone (TRH) stimulation]. L-Thyroxine supplementation has been recommended to achieve pregnancies in subclinical hypothyroid women. This controlled study was carried out in order to investigate the biochemical diagnosis of subclinical hypothyroidism as a possible infertility factor. Five infertile patients (aged 25-36 years) with subclinical hypothyroidism (n = 4, stimulated TSH >20 microU/ml) or primary hypothyroidism (n = 1) and five healthy controls (aged 22-39 years) with normal thyroid function (stimulated TSH <15 microU/ml), regular cycles and no history of infertility were studied in the early follicular phase. In the pre-study evaluation, eight of 23 volunteers (34.8%) had to be excluded because of subclinical hypothyroidism with stimulated TSH values (TSHs) >15 microU/ml. Cycle function of patients and controls was compared by the method of LH pulse pattern analysis. Therefore blood samples were drawn every 10 min during a 24 h period. Sleep was recorded from midnight to 7 a.m. Repetition of the TRH tests at the end of the 24 h blood sampling period confirmed the difference in stimulated TSH values of the two study groups. Pulse analysis for luteinizing hormone (LH), TSH and prolactin showed no differences between patients and controls for pulse frequency, amplitude, height, length, area under curve (AUC) and the 24 h mean. Even the hypothyroid patient had a normal LH pulse pattern. Additional measurement of melatonin in pooled sera every 30 min gave the well-documented diurnal profiles during day and night for both groups. Patients had significantly higher melatonin values at seven time points during the night. Peaks for LH, TSH, prolactin and cortisol were correlated with the sleep stages wake, rapid eye movement, 1 + 2 and 3 + 4. We concluded that corpus luteum insufficiency in female infertility cannot be explained by subclinical hypothyroidism and thus should not be treated with L-thyroxine for fertility reasons.      

新疆地区45499例新生儿先天性甲状腺功能低下筛查分析

目的探讨新疆地区新生儿先天性甲状腺功能低下症(CH)的发病情况,以便做到早确诊、早治疗。方法新生儿出生后72h,采足跟血,制成干血滤纸片,用时间荧光分辨法检测干血片中促甲状腺素(TSH)的水平,TSH≥9μU/ml为阳性,阳性病人召回采静脉血,用化学发光法测甲功五项(TSH、FT3、FT4、T3、T4浓度)而确诊。确诊患儿立即口服甲状腺素片或优甲乐进行治疗并定期监测其体格和智力发育情况。结果自2003年1月至2010年12月共筛查45499例新生儿,确诊31例,检出率为1/1468,明显高于全国平均水平。结论新生儿促甲状腺功能低下症的筛查和治疗,是减少出生缺陷,提高人口素质的重要措施。     

Pituitary-thyroid activity and longevity in neonatally thyroxine-treated rats

Wistar rats were made hypothyroidic by intraperitoneal thyroxine (T4) injection during the first 10 days of neonatal life. Levels of T4, 3,3′,5-triiodothyronine (T3), thyroid-stimulating hormone (TSH) and prolactin in the blood of these rats were measured by radioimmunoassay. The T4 levels are about two-thirds of control values up to 20 months of age. T3 level is low only at a young age. TSH level shows no significant difference from control, but is about half that of control after the stimulation of secretion by 6-propyl-2-thiouracil. The level of prolactin is much higher in the T4-treated group than in controls. In male rats, life duration of hypothyroid rats was longer than control by about 4 months. The life extension effect of hypothyroidism was observed also in females, although the difference was smaller than that in males. The concentration of T4 in the blood of male rats is higher than females, and the decrease in T4 level by neonatal T4 treatment is also more marked in males.     

A case of hypothyroidism and type 2 diabetes associated with type V hyperlipoproteinemia and eruptive xanthomas

Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.     

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。     

Appropriate replacement dose of thyroxine in primary hypothyroidism

An ultrasensitive thyrotropin (TSH) assay was used to determine how many of 65 patients with primary hypothyroidism on thyroxine (T4) replacement therapy had suppressed serum TSH. In 13 patients (20%) TSH levels less than or equal to 0.1 mIU/l were found, indicating an overdose of thyroxine. After correction of the dose, 48 patients had normal TSH values. Their mean dose of thyroxine was 119 micrograms/24 hours, and the appropriate replacement dose tended to decline with advancing age. The serum level of thyroid hormones during replacement therapy with thyroxine very imperfectly reflected serum TSH values. It is concluded that overdose of thyroxine is common when suppressed serum TSH is used as an end point. Biochemical follow-up of replacement therapy with thyroxine in primary hypothyroidism therefore requires the use of an ultrasensitive TSH assay in order to detect such suppression. Serum levels of thyroxine or triiodothyronine (T3) during thyroxine therapy are poor indicators of pituitary TSH secretion and are therefore not useful as parameters of adequate thyroxine dosage.     

株洲地区新生儿先天性甲状腺功能减低症筛查TSH切值的建立

目的建立本地区先天性甲状腺功能减低症（CH）的筛查阳性切值。方法对2010年7月至2011年7月全市120余家分娩机构分娩的47066例新生儿进行CH筛查,采足跟末稍血制成滤纸干血片,用DELFIA法检测干血片中TSH含量,对筛查阳性结果召回确诊。结果筛查阳性切值为9.0μIU/mL时,筛查灵敏度、特异度和漏诊率分别为：100%,99.53%,0%;通过百分位数法统计分析,99%可信限浓度8.52μIU/mL;8.0-9.0μIU/mL之间召回的23例新生儿中发现9例高TSH血症患者,其初筛TSH浓度下限为8.61μIU/mL。结论为了提高筛查效率,防止漏诊的发生,同时加强对高TSH血症患者的随访,本地区新生儿先天性甲状腺功能低下症筛查的阳性切值调整为8.50μIU/mL。