原发性甲状腺功能减退症的左心室收缩功能和血液流变学

研究了32例原发性甲状腺功能减退症(甲减症)在用甲状腺片治疗前后的左心室收缩功能和血液流变学的变化。本组在治疗前心功能均受损、血液流变学紊乱,但在甲减状态消失时,二者均恢复至正常范围。本研究发现,在心功能和血中甲状腺激素水平,甲状腺自身抗体和血液流变学之间存在良好的相关关系。以上提示血中甲状腺激素水平,血液流变学可作为原发性甲减症心功能判定的两个间接指标。     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

目的 总结飞行人员甲状腺疾病的诊治和医学鉴定经验. 方法 收集我院2000年12月-2009年12月间住院飞行人员67例甲状腺疾病资料,将其归为:①无症状的良性甲状腺结节;②慢性淋巴细胞性甲状腺炎;③甲状腺功能异常类疾病(包括甲状腺机能亢进症和甲状腺机能减退症);④甲状腺恶性肿瘤.分析4类疾病的特点及飞行结论 情况. 结果 ①良性甲状腺结节36例(占53.73%),4例手术治疗(腺瘤3例,结节性甲状腺肿1例),除5例因其他原因停飞外,其余31例均飞行合格,定期复查;②慢性淋巴细胞性甲状腺炎5例(占7.46%),甲状腺功能正常,均飞行合格,定期复查;③甲状腺功能异常类疾病20例(占29.85%,甲状腺机能亢进18例,甲状腺机能减退2例),均行药物治疗,6例飞行合格,3例暂时飞行不合格,11例停飞;④甲状腺恶性肿瘤6例(占8.96%,4例为乳头状癌,2例为滤泡状癌),1例飞行合格,5例停飞.经统计学分析,甲状腺功能异常类疾病和甲状腺恶性肿瘤的停飞率均高于良性甲状腺结节和慢性淋巴细胞性甲状腺炎,且差异有统计学意义(P<0.01或P<0.05). 结论 飞行人员甲状腺疾病以无症状的良性结节常见,要重视功能异常类疾病和恶性肿瘤的早期诊断和治疗. Abstract： Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

2型糖尿病患者甲状腺功能异常的临床特征分析

目的分析2型糖尿病患者甲状腺功能异常的临床特征。方法检测2010年1月~2011年6月于我院住院的1299例2型糖尿病患者的血清游离T3（FT3）、游离T4（FT4）、促甲状腺激素（TSH）。结果①2型糖尿病合并甲状腺功能异常的发生率为25.2%,其中亚临床甲状腺功能减退占50.1%。②与甲状腺功能正常的糖尿病患者相比,糖尿病合并甲状腺功能异常的患者女性多见,HbA1c较高。结论 2型糖尿病合并甲状腺功能异常较常见,应筛查和随访糖尿病患者的甲状腺功能。     

Ultrasonography of Various Thyroid Diseases in Children and Adolescents: A Pictorial Essay

Thyroid imaging is indicated to evaluate congenital hypothyroidism during newborn screening or in cases of a palpable thyroid mass in children and adolescents. This pictorial essay reviews the ultrasonography (US) of thyroid diseases in children and adolescents, including normal thyroid gland development, imaging features of congenital thyroid disorders (dysgenesis, [aplasia, ectopy, hypoplasia], dyshormonogenesis, transient hypothyroidism, thyroglossal duct cyst), diffuse thyroid disease (Grave''s disease, Hashimoto''s thyroiditis, and suppurative thyroiditis), and thyroid nodules. The primary imaging modalities for evaluating thyroid diseases are US and radionuclide scintigraphy. Additionally, US can be used to guide aspiration of detected nodules.     

Radioprotective action of carbimazole in radioiodine therapy for thyrotoxicosis — influence of the drug on iodine kinetics

Pretreatment with carbimazole of patients given radioiodine (¹³¹I) therapy for thyrotoxicosis reduces the incidence of early hypothyroidism. The possibility that this radioprotective effect might be a consequence of drug induced alteration in thyroidal iodide turnover, leading to a reduction in thyroid irradiation, was investigated in a prospective study of 24 thyrotoxic patients. Subjects were randomly assigned to receive ¹³¹I alone or to be treated with carbimazole for a minimum of three months before ¹³¹I. Thyroxine supplements were given in the latter group to prevent iatrogenic hypothyroidism. The effective half-life of therapeutic ¹³¹I in the thyroid was measured using a gamma camera/computer system after oral administration of the dose, allowing the biological half life of the anion and estimated radiation dose to the thyroid to be derived. Effective half life of ¹³¹I, biological half life of ¹³¹I and estimated radiation dose to the thyroid were similar in the two groups of subjects. It is concluded that the radioprotective action of carbimazole is not a consequence of altered thyroidal iodide kinetics.     

人血清TRAb酶联免疫吸附试验检测在甲状腺疾病患者中的临床应用

目的 探讨促甲状腺激素受体抗体（TRAb）水平对健康人和不同甲状腺疾病患者的临床意义.方法 分别以重组人促甲状腺激素受体（TSHR）膜外区氨基（N）端蛋白和羧基（C）端蛋白作为抗原建立N法和C法,分别检测89名健康者（正常对照组）和254例各种甲状腺疾病患者的血清TRAb水平,组间血清TRAb水平比较采用方差分析,组间阳性率比较采用x2检验.结果 应用N法检测发现：89名健康者405 nm处的光吸收值（（x）±s）为0.511±0.135,阳性切限值（（x）±2s）为0.789,阳性率为4.5％（4/89）;初发Graves病（毒性弥漫性甲状腺肿）患者及Hashimoto甲状腺炎伴甲状腺功能减退症（简称甲减）患者405 nm处的光吸收值（（x）±s）分别为：0.95±0.30、0.61±0.22,高于健康者（F=2.4851和2.0763,P均＜0.05）;N法对初发Graves病患者、治疗中的Graves 病患者、Graves病治疗恢复期患者、Hashimoto甲状腺炎伴甲减患者检测的阳性率分别为73.2％、55.9％、32.1％、45.0％,与正常对照组阳性率之间的差异均有统计学意义（x2=68.55、56.45、20.71和25.51,P均＜0.05）;初发Graves病患者阳性检出率高于Hashimoto甲状腺炎伴甲减患者（x2=4.63,P＜0.05）,初发Graves病患者与Graves病治疗恢复期患者阳性率之间的差异有统计学意义（x2=15.94,P＜0.05）.应用C法检测发现：89名健康者405 nm处的光吸收值（（x）±s）为0.507±0.142,阳性切限值（（x）＋2s）为0.791,阳性率为3.4％（3/89）;Hashimoto甲状腺炎伴甲减患者及初发Graves病患者405 nm处的光吸收值（（x）±s）为1.18±0.25、0.78±0.25,明显高于健康者（F=3.8164和2.4539,P＜0.05）;C法对Hashimoto甲状腺炎伴甲减患者、初发Graves病患者、治疗中的Graves病患者、Graves病治疗恢复期患者检测的阳性率分别为：75.0％、46.3％、23.6％、16.1％,与正常对照组阳性率之间的差异均有统计学意义（x2=66.34、36.87、15.79和7.30,P均＜0.05）;Hashimoto甲状腺炎伴甲减患者阳性检出率明显高于其他患者（x2=4.48、19.70和23.68,P均＜0.05）.结论 应用N法和C法检测Graves病和Hashimoto患者血清TRAb水平均有重要意义,可用于临床Graves病和Hashimoto甲状腺炎伴甲减患者的诊断、治疗及疗效的评估.     

Thyroid scintigraphy and perchlorate discharge test in the diagnosis of congenital hypothyroidism

Quantitative thyroid scanning using low doses of technetium-99m sodium pertechnetate was performed on 147 infants (55 males and 92 females) with congenital hypothyroidism detected through the national neonatal screening programme. Thirty-two (21.8%) were athyrotic, while 62 (42.2%) had an ectopic thyroid and 53 (36%) had a eutopic gland with increased^99mTc uptake (mean 17%; range, 5%-38%). The perchlorate discharge test (PDT) was performed in nine of the infants with ectopic glands and 15 with eutopic glands; the findings were consistent with an organification defect in 22 cases (seven ectopic and 15 eutopic). Thyroid scintigraphy and PDT can add useful aetiological, genetic and prognostic information in the clinical evaluation of infants with congenital hypothyroidism detected by neonatal screening.     

Clinical significance of thyroid uptake on F18-fluorodeoxyglucose positron emission tomography

Significant uptake of the thyroid is often identified as an incidental finding on whole-body F18-fluorodeoxyglucose positron emission tomography (FDG-PET) for non-thyroid disease. Sometimes, it is a dilemma for radiologists to interpret clinical significance of thyroid uptake and give adequate recommendation for further evaluation. In general, diffuse uptake of the thyroid glands on FDG-PET is considered to be benign and very likely secondary to thyroiditis and/or hypothyroidism; a further correlation or investigation of the thyroid function and/or ultrasound is helpful. Focal uptake of the thyroid on FDG-PET is defined as an incidentaloma, which is more clinically significant owing to its high risk of malignancy ranging 25–50%. Although maximum standardized uptake value and corresponding computed tomographic finding may help to differentiate benign from malignant lesion, a cytological diagnosis is often advised. The clinical significance of diffuse plus focal uptake of the thyroid on FDG-PET is not well known; it may also be associated with an increased risk of malignancy when compared with a diffuse uptake pattern only.     

The clinician and the thyroid

The goiter prevalence in iodine-deficient regions is up to 25%–54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a minor role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. Offprint requests to: H.J. Biersack     

Thyroid uptake of <Superscript>67</Superscript>Ga-citrate is associated with thyroid autoimmunity and hypothyroidism in patients with sarcoidosis

Purpose  To evaluate the association of gallium-67 (⁶⁷Ga)-citrate thyroid uptake with the presence of thyroid disorders in patients with sarcoidosis (S patients). Methods  Eighty-four S patients were evaluated by a complete thyroid work-up (neck ultrasound, circulating thyroid hormones and anti-thyroid antibodies, fine-needle aspiration). Results  In S patients with ⁶⁷Ga thyroid uptake (respect those without): serum thyroid-stimulating hormone, the titre of anti-thyroid peroxidase (AbTPO) and/or anti-thyroglobulin antibodies (AbTg), and the prevalence of S patients with hypothyroidism or with positive AbTg or AbTPO was significantly higher; a thyroid hypoechoic pattern was more frequent. The prevalence of thyroid nodules was not significantly different between the two groups. Two cases of papillary thyroid cancer were observed in S patients without ⁶⁷Ga thyroid uptake, whilst no case in those with ⁶⁷Ga thyroid uptake. Conclusions   ⁶⁷Ga thyroid uptake is associated with the presence of aggressive autoimmune thyroiditis and hypothyroidism in S patients; thyroid function and ultrasonography should be performed in the presence of ⁶⁷Ga thyroid uptake.     

Effect of hypothyroidism on phosphorus metabolism in muscle and liver: in vivo P-31 MR spectroscopy study.

Hypothyroidism is known to affect nearly every organ and organ system of the human body. The goal of the present study was to gain insight into the phosphorus metabolism and bioenergetic function of striated (calf) muscle and liver in patients with hypothyroidism before and after thyroid hormone treatment. With an ISIS (image-selected in vivo spectroscopy) magnetic resonance (MR) technique for volume selection, phosphorus-31 metabolism of the calf muscle in 10 patients and of the liver in seven patients with severe hypothyroidism was studied before and after treatment. In addition, spectra from the calf muscle and liver were obtained in 10 healthy volunteers. Relative to those from the healthy subjects, the P-31 MR spectra from patients with hypothyroidism showed a significantly diminished phosphocreatine/inorganic phosphate ratio (P less than .01). After thyroid hormone substitution therapy, this ratio returned to normal values within several weeks. No statistically significant changes in the spectra of liver tissue could be detected. The results support the theory that hypothyroidism induces a hormone-dependent, fully reversible impairment of the energy metabolism of striated muscle. Changes in liver metabolism observed with biochemical methods are apparently not detectable with state-of-the-art P-31 MR spectroscopy.     

重组人促甲状腺激素在甲状腺疾病诊治中的应用

重组人TSH (rhTSH)于1998年在国外进入临床应用,其临床适应证由辅助DTC患者的随访检查和检测逐渐扩展到辅助131I清除手术后残留甲状腺组织.近期研究表明,rhTSH在辅助131I治疗DTC转移灶、辅助131I治疗非毒性结节性甲状腺肿、提高18F-FDG PET对甲状腺癌的诊断效能及对先天性甲状腺功能减退症的病因鉴别诊断等多方面亦有应用潜力.     

重组人TSHR片段蛋白建立人TRAb ELISA及临床应用

目的建立2种检测人血清促甲状腺激素受体抗体（TRAb）酶联免疫吸附测定（ELISA）方法,分别以测定刺激性抗体（TSAb）和阻断性抗体（TSBAb）为主,并用于甲状腺疾病检测。方法分别以重组人促甲状腺激素受体（TSHR）膜外区氨基端（N端）蛋白和羧基端（C端）蛋白作为抗原建立N法和C法,各检测健康人229名,初诊Graves病（GD）451例、初诊慢性淋巴细胞性甲状腺炎（HT）伴甲状腺功能减退症（简称甲减）104例、单纯性甲状腺肿35例、非毒性结节性甲状腺肿47例、亚急性甲状腺炎38例。组间比较采用方差（ANOVA）分析,组间阳性率比较用χ^2检验。结果N法：（1）与商品TSAb试剂盒检测法明显相关（r=0．7422,P〈0．05）。（2）批内、批间CV分别为3．96％～4．67％和7．32％～8．33％。（3）健康人405nm处吸光度（A405）值为0．44±0．15,阳性切点（x＋2s）为0．74。（4）初诊GD A405为0．93±0．28,高于健康人（F=2．0341,P=0．001）,阳性率82．8％。（5）初诊HT伴甲减A405,为0．64±0．23,高于健康人（F=1．7822,P=0．003）,阳性率62．1％。C法：（1）批内、批间CV分别为3．24％～4．72％和7．22％-8．55％。（2）健康人A405为0．56±0．11,阳性切点（x＋2s）为0．78。（3）初诊HT伴甲减A405为1．17±0．26,明显高于健康人（F=3．0333,P=0．002）,阳性率93．4％。（4）初诊GD A405;为0．74±0．23,明显高于健康人（F=1．8339,P=0．03）,阳性率66．3％。N法、C法检测单纯性甲状腺肿、非毒性结节性甲状腺肿、亚急性甲状腺炎患者与健康人差异均无统计学意义（N法：F=1．6134,1．5772和1．6208,C法：F=1．5910,1．5369和1．6055,P均〉0．05）。结论N法以检测人血清TSAb为主,C法以检测TSBAb为主;其为临床GD诊断、HT辅助诊断、疗效观察提供了新型、特异、稳定、可靠、操作简便的方法     

Functional results of radioiodine therapy with a 300-GY absorbed dose in Graves' disease

The aim of this study was to assess the results of high-dose radioiodine therapy given to 43 patients with recurrent hyperthyroidism due to Graves' disease between 1986 and 1992. We chose an intrathyroidal absorbed dose of 300 Gy and determined the applied activity individually, which ranged from 240 to 3120 MBq with a median of 752 MBq. Hyperthyroidism was eliminated in 86% of cases after 3 months and in 100% after 12 months. No patient required a second radioiodine treatment. The incidence of hypothyroidism was 63% after 3 months and 93% after 18 months. Neither the pretherapeutic thyroid-stimulating immunoglobulin level nor the degree of co-existing endocrine ophthalmopathy was correlated with the time at which hypothyroidism developed. Patients with previous radioiodine therapy developed hypothyroidism earlier than patients with previous thyroid surgery. The results show that ablative radioiodine therapy with a 300-Gy absorbed dose is a very effective treatment of hyperthyroidism in Graves' disease, but it should be restricted to patients with recurrent hyperthyroidism combined with severe co-existing disorders or episodes of unfavourable reactions to antithyroid drugs. Correspondence to: U.F. Willemsen     

MR IMAGING OF THE LINGUAL THYROID: Comparison to other submucosal lesions

Purpose: To study MR findings for clues to the diagnosis of lingual thyroid.Material and Methods: MR findings and clinical and scintigraphic data of 5 cases of lingual thyroid were reviewed and the MR findings were compared to those of 16 cases of other submucosal lesions in the base of the tongue.Results: Four of the 5 patients with lingual thyroid were women and all had hypothyroidism. MR imaging depicted lingual thyroid in the midline in the base of the tongue (n=5) and additional ectopic thyroid glands in the floor of the mouth (n=2) or between the right and left sternohyoid muscles (n=1). Ectopic thyroid glands appeared isointense or hyperintense relative to muscle tissue on T1-weighted images and showed slight or fair contrast enhancement. All glands had low to intermediate T2 signal, which was also seen in 1 case of non-Hodgkin's lymphoma and 1 case of adenoid cystic carcinoma. All ectopic thyroid glands had well-defined margins, whereas malignant tumors tended to have ill-defined margins and to invade the surrounding structures. All but the 5 cases of lingual thyroid had an MR-demonstrable thyroid gland in the normal cervical position.Conclusion: A well-defined mass of low-intermediate T2 signal in the midline base of the tongue, neither with invasive tendency nor with a cervical thyroid gland in the normal site on MR imaging, may strongly indicate lingual thyroid.     

Thyroid dysgenesis in monozygotic twins: variants identified by scintigraphy

The unusual occurrence of neonatal hypothyroidism in monozygotic twins is reported. Scintigraphy demonstrated that permanent hypothyroidism in one resulted from an ectopic suprahyoid thyroid, while in the other, the transient hypothyroid state was associated with thyroid hemiagenesis. These findings suggest that the anomalies represent variants of the same developmental aberration.     

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

Purpose This study aimed to evaluate the effects of radioiodine (¹³¹I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline.Methods Eighty consecutive patients were randomised to receive ¹³¹I plus lithium (group I+L) or ¹³¹I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment.Results At 1–4 weeks after treatment, ¹³¹I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after ¹³¹I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after ¹³¹I was also due to the significant shrinkage of thyroid nodules.Conclusion This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, ¹³¹I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low ¹³¹I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery.     

对甲状腺良性结节高频超声误诊原因的初步探讨

目的:探讨各不同病理类型良性甲状腺结节的超声声像图表现;探讨超声在甲状腺结节良、恶性鉴别诊断中,出现假阳性的主要原因及可行的避免误诊的方法。方法:经手术病理证实的172例甲状腺良性结节,42例甲状腺微灶癌和26例甲状腺乳头状癌。对比分析超声误诊的43例良性结节、42例甲状腺微灶癌和26例甲状腺乳头状癌的声像图表现、对甲状腺结节的钙化模式进行分型,探讨超声误诊的主要原因。结果:甲状腺恶性结节内伴发钙化的比例明显高于甲状腺良性结节。甲状腺结节不伴发钙化组的诊断准确性明显高于伴发钙化组。结论:结节内伴发的钙化灶已成为影响高频超声良恶性鉴别诊断准确性,尤其是特异性的主要原因。严格定义III型钙化的诊断标准,可以减少部分的假阳性的发生。     

老年恶性肿瘤患者甲状腺功能状态及化学药物疗法对其的影响

目的探讨老年恶性肿瘤患者的甲状腺功能状态及化学药物疗法（简称化疗）对其甲状腺功能的影响。方法选取2010-01至2014-02确诊的老年恶性肿瘤患者398例,并选择400例体检老年人群作为健康对照组,进行甲状腺激素（thyroid hormone,TH）和促甲状腺激素（thyroid stimulating hormone,TSH）水平测定。将激素水平正常,KPS（Karnofsky）评分〉60的老年恶性肿瘤患者分为：肿瘤治疗组132例,肿瘤对照组129例。两组年龄、KPS评分无统计学差异。肿瘤治疗组患者进行相应化疗,观察治疗前及治疗后6个月的TH和TSH水平,肿瘤对照组仅给予对症治疗,同期比较两组TH和TSH水平,分析化疗对老年恶性肿瘤患者甲状腺功能的影响。结果 398例老年恶性肿瘤患者的TH、TSH与健康对照组相比差异无统计学意义（P〉0.05）。肿瘤治疗组患者的TH、TSH与肿瘤对照组相比,TSH的差异存统计学意义（P〈0.05）。肿瘤治疗组中甲状腺功能减退（甲减）的比例为7.58%,亚临床型甲减的比例为23.48%。肿瘤对照组中甲减的比例为5.65%,亚临床甲减的比例为5.65%。两组比较,亚临床型甲减的发生率存在统计学差异（P〈0.05）。结论老年恶性肿瘤患者的甲状腺功能异常发生率与健康群体比较无统计学差异,化疗对老年恶性肿瘤患者的甲状腺功能有一定的影响。