胺碘酮致老年患者甲状腺功能异常临床病例分析

目的长期服用胺碘酮引起甲状腺功能异常增高,且在不同地区胺碘酮引起甲状腺功能异常的类型差异很大。本文观察广东地区老年心律失常患者长期口服胺碘酮导致甲状腺功能异常的临床特征及转归。方法263例口服胺碘酮老年患者,其中男性184例,女性79例,年龄60~87平均(74.6±11.3)岁。在服药前均经放射免疫法测定血液甲状腺功能,排除了甲状腺功能异常。在服药中和停药后半年多次测定甲状腺功能,并同时测定自身免疫学指标TGA、MCA、TG。结果随访过程中出现甲状腺功能异常的老年患者62例,其中男性45例,女性17例。本组患者中,服用胺碘酮后甲状腺功能异常出现时间最短为3周,最长为2.5年。11例服药后出现甲状腺功能亢进,51例出现甲状腺功能减退,82%的患者在停药3个月后T3、T4、FT3、FT4恢复正常,而只有23%的患者TSH恢复。所有患者服药前、服药中和停药后自身免疫学指标甲状腺球蛋白(TGA)、甲状腺球蛋白抗体(MCA)、甲状腺微粒体抗体(TG)均未发现明显改变。结论在广东地区,胺碘酮引起甲状腺功能异常以甲状腺功能减退为主,临床病程个体差异较大;自身免疫在胺碘酮所致的甲状腺功能异常中不起主要作用;胺碘酮引起的甲状腺功能异常在停药后均可恢复,无需长期治疗。     

亚临床甲状腺功能异常与骨质疏松

亚临床甲状腺功能异常(STD)和骨质疏松是常见的内分泌疾病,主要发生在女性和老年人群中.甲状腺激素和促甲状腺激素可直接或间接影响骨代谢,导致骨密度发生变化.而STD患者体内这两种激素水平异常,提示STD和骨质疏松之间存在一定的联系.此外,外源性甲状腺激素替代治疗亦可影响骨代谢,导致骨密度下降和骨质疏松.因此,明确STD和骨质疏松之间的联系并采取适当干预措施对于预防STD患者发生骨质疏松有重要意义.     

冠心病患者血清甲状腺激素水平及临床意义

目的：探讨冠心病（ＣＨＤ）患者血清中甲状腺激素水平及临床意义。方法：观察５２ 例ＣＨＤ患者及３０ 例正常对照者,测定血清中总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）、极低密度脂蛋白（ＶＬＤＬ）、三碘甲腺原氨酸（Ｔ３）、甲状腺素（Ｔ４）、促甲状腺素（ＴＳＨ）水平。结果：ＣＨＤ患者血清Ｔ３、Ｔ４、ＴＳＨ分别为１．７０ ｎｍ ｏｌ／Ｌ、１１３．９０ ｎｍ ｏｌ／Ｌ、０．００２ ＩＵ／Ｌ,其中Ｔ３、Ｔ４ 水平明显低于对照组（Ｐ＜ ０．０１,＜ ０．０５）;ＣＨＤ患者ＴＣ、ＴＧ、ＨＤＬ、ＬＤＬ、ＶＬＤＬ与对照组比较无显著性差异（Ｐ＞ ０．０５）。结论：ＣＨＤ患者中虽存在Ｔ３、Ｔ４ 下降,但与原发性甲状腺功能减退有明显的不同,这可能是由于ＣＨＤ引起的甲状腺功能继发性低下,而且不伴有明显的高脂血症。     

High prevalence of subclinical thyroid dysfunction and the relationship between thyrotropin levels and cardiovascular risk factors in residents of the coastal area of China

OBJECTIVES:

To investigate the prevalence of subclinical thyroid dysfunction and the relationship between thyrotropin levels and cardiovascular risk factors in residents of the coastal area of China.

METHODS:

Atotalof4256individuals(mean[±SD]age50.51±14.24years; 2079 males, 2177 females,) were enrolled in the present study. Sex, blood pressure, body mass index, waist-to-hip ratio, serum levels of fasting glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid and smoking status were measured. The relationship between thyrotropin levels and cardiovascular risk factors was analyzed.

RESULTS:

The overall prevalence of thyroid dysfunction was 11.07%. The prevalence of subclinical hypothyroidism (6.32%) was higher than that of hyperthyroidism (1.53%). The prevalence of thyroid dysfunction among female subjects was higher than that among male subjects (16.54% versus 5.34%, respectively; P<0.001). Significant differences were detected with respect to body mass index (P=0.026), waist-to-hip ratio (P<0.001), fasting glucose levels (P=0.001), total cholesterol levels (P=0.013), triglyceride levels (P=0.003) and smoking status according to different thyrotropin levels.

CONCLUSION:

The prevalence of thyroid dysfunction was high in residents of China’s coastal area. Significant differences were detected with regard to body mass index, waist-to-hip ratio, fasting glucose levels, total cholesterol levels, triglyceride levels and smoking status according to different thyrotropin levels.     

甲状腺功能异常与男性性腺功能减退症

甲状腺在维持性腺功能方面起着极为重要的作用.甲状腺功能异常可引起性激素结合球蛋白及性激素水平的变化,进而对男性性功能产生危害,尤其在性激素水平、睾丸功能和性行为方面.当甲状腺功能恢复正常时,性激素及性功能异常即可显著改善.     

Autocrine growth factors produced in the thyroid

This catalogue of autocrine growth factors is limited to proteins — metabolites of iodine and prostaglandins are omitted and they are undoubtedly of autocrine importance in the thyroid, as elsewhere. However this summary of polypeptide growth factors secreted by the thyroid illustrates the potential cells have to condition their environment to modify their responses to external stimuli. This enables cells in different tissues to respond to agonists in different ways. The effects of TSH on IGF, IGFBP and IGF receptor production and the effects of IGFBPs on IGF action are good examples of this amplified response. Many pieces of the jigsaw, however, remain to be found and put in place before a clear picture of the regulation and roles of these factors can be made.     

Graves病甲状腺功能亢进症性肝损害的相关因素分析

目的 探讨影响Graves病甲状腺功能亢进症(甲亢)性肝功能损害的相关因素.方法 回顾性分析天津医科大学总医院2013年1月至2015年12月收治的Graves病住院患者254例,根据肝功能将患者分为Graves病甲亢性肝损害组(A组,n=159)和甲亢肝功能正常组(B组,n=95),比较两组的基础代谢率(BMR)、甲状腺重量、FT3、FT4、促甲状腺激素(TSH)、TSH受体抗体(TRAb)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb).采用Pearson相关性分析甲状腺重量、BMR、FT3、FT4、TRAb与甲亢性肝损害的相关性,应用Logistic回归分析甲亢性肝损害的独立危险因素.结果 A组的甲状腺重量、BMR、FT3、FT4、TRAb、TPOAb均高于B组,而TSH低于B组(t或z=-4.720～-2.276,P均＜0.05).Pearson相关性分析显示,甲状腺重量、BMR、FT3、FT4、TRAb与甲亢性肝损害的发生呈正相关(r=0.157～ 0.270,P均＜0.05).Logistic回归分析显示,FT3(OR=1.052,95％ CI:1.001～1.105)、BMR(OR=1.019,9.5％ CI:1.006 ～ 1,033)是Graves病甲亢性肝损害发生的独立危险因素(P均＜0.05).结论 Graves病甲亢性肝损害与FT3、FT4、TRAb、BMR、甲状腺重量有关.其中FT3、BMR为甲亢性肝损害发生的独立危险因素.     

Prognostic impact of subclinical thyroid dysfunction in heart failure

Background

Therapeutic and prognostic implications of subclinical thyroid dysfunction in patients with heart failure (HF) are unclear. We compared the prognostic impact of euthyroidism, subclinical thyroid dysfunction, and euthyroid sick syndrome (ESS) in systolic HF.

Methods

We included 1032 patients hospitalized for systolic HF (left ventricular ejection fraction [LVEF] ≤ 40%) who participated in a randomized trial assessing the effects of a HF disease management program. Patients with incomplete thyroid function tests or thyrotropic medication were excluded. In the remaining 758 subjects, the risk of all-cause death was estimated based on TSH only, or full thyroid function profile. Changes of thyroid function after six months were assessed in 451 subjects.

Results

Subclinical thyroid dysfunction was present in 103 patients at baseline (14%). No differences were found between groups regarding NYHA class (P = 0.29), and LVEF (P = 0.60). After a median follow-up of three years patients with ESS (n = 13) had a 3-fold age-adjusted increased risk of death compared to euthyroid patients (P = 0.001). However, neither subclinical hyperthyroidism (HR 1.18, 95%CI:0.82–1.70) nor hypothyroidism (HR 1.07, 95%CI:0.58–1.98) were associated with increased age-adjusted mortality risk. Subclinical thyroid dysfunction had normalized spontaneously at follow-up in 77% of patients. However, persistent subclinical thyroid dysfunction was also not associated with worse outcome.

Conclusions

In this large well-characterized HF cohort, subclinical thyroid dysfunction did not predict an increased mortality risk. Thus, in patients with moderate to severe HF, further diagnostic and therapeutic procedures for subclinical thyroid dysfunction appear dispensable. ESS was an infrequent but important indicator of a poor prognosis in HF.

Clinical trial registration

URL: http://www.controlled-trials.com. Unique identifier: ISRCTN23325295.     

充血性心力衰竭患者甲状腺激素异常变化及其临床意义

目的探讨充血性心力衰竭(CHF)患者甲状腺激素异常变化及临床意义。方法采用放射免疫法检测30例正常对照组及45例CHF患者,血浆三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、反三碘甲状腺原氨酸(rT3)及促甲状腺激素(TSH)的浓度。结果CHF组T3、T4明显低于对照组,而rT3明显高于对照组,心力衰竭越重,降低越明显,不同程度CHF患者,组间T3、rT3差异显著,二者均有统计学意义,两组之间的TSH无统计学意义。结论提示T3、rT3的变化可作为反映心力衰竭患者心功能状态的指标之一。     

甲状腺功能异常对老年人认知功能的影响

甲状腺功能异常在老年人中较常见,它不仅影响老年人的躯体功能,还可能引起注意力、记忆、情感等认知功能障碍.已有研究从动物实验、神经电生理、神经影像等角度对甲状腺功能与认知功能之间的关系展开探讨.此外,在临床工作中,甲状腺功能异常引起的严重认知功能损害易与老年性痴呆相混淆.因此,医务人员需重视,避免误诊.及时、合理地纠正老年人甲状腺功能异常,可能有利于认知能力的恢复.     

促甲状腺激素的甲状腺外作用

近年来研究证明,促甲状腺激素受体(TSHR)存在于大脑、睾丸、肾脏、心肌、骨骼、胸腺、淋巴细胞、脂肪组织、纤维母细胞和肝细胞等多种甲状腺外组织和细胞上.促甲状腺激素(TSH)可能通过TSHR介导发挥着广泛的、非传统认识的功能作用.现主要列举了TSH在脂肪组织、骨骼和肝脏中的一些重要作用.     

先心病患儿常温体外循环期间胰岛素抵抗的观察及意义

目的　本文探讨先心病患儿常温体外循环 (CPB)下胰岛素抵抗的情况。方法　 10例 CPB心内直视术患儿 ,分别在麻醉 15分钟、CPB15分钟、主动脉开放 10分钟、停机 30分钟及术后 6小时采集血样 ,测定血浆葡萄糖 (G)及胰岛素 (Ins)浓度 ,并计算胰岛素敏感性指数 [1/ (I× G) ]。结果　麻醉 15分钟时 G无明显改变 ,CPB开始后明显增高 (P<0 .0 5 ) ,至主动脉开放 10分钟后最高 (P<0 .0 1)。CPB开始后 Ins逐渐升高 (P<0 .0 5 ) ,至停机 30分钟后达到最高 (P<0 .0 1) ,术后 6小时后降低。胰岛素敏感性指数在 CPB开始后下降 (P<0 .0 5 ) ,至停机30分钟时最低 (P<0 .0 1)。结论　常温体外循环对于婴幼儿的胰腺内分泌功能无明显抑制作用 ,但在此期间胰岛素敏感性降低 ,提示 CPB期间存在胰岛素抵抗现象     

小儿先天性甲状腺功能减退症99mTc甲状腺显像的临床意义

43例先天性甲状腺功能减退症(CH)患儿以左旋甲状腺素钠治疗至2-3周岁,暂停药4周行99mTcO-4甲状腺显像.结果 示甲状腺发育不良37例(86.05%),99mTcO-4甲状腺显像正常6例(13.95%).99mTcO-4甲状腺显像对CH的病因诊断、治疗方案选择有指导作用.

Abstract：

Forty-three children with congenital hypothyroidism(CH)underwent 99mTc thyroid scintigraphy, after being followed up by receiving levothyroxine till 2 to 3 years of age. The results showed that thyroid agenesia happened in 37 cases( 86.05% ) while entopic gland in 6 cases (13.95% ). Thyroid scintigraphy with 99mTc is an informative procedure in determining etiology and treatment schedules for children with CH.     

Rheumatoid arthritis and thyroid dysfunction: A cross-sectional study and a review of the literature

Thyroid dysfunction appears to show increased prevalence in many autoimmune diseases; however, this comorbidity has not been properly investigated in patients with RA. This issue was addressed in this cross-sectional study.Using the database of the Clalit Health Services (CHS) in Israel, RA patients were paired with age- and sex-matched controls to compare the prevalence of hypothyroidism and hyperthyroidism. Chi-squared and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis.The study included 11,782 patients with RA and 57,973 controls. The rate of thyroid dysfunction diseases in RA patients was increased compared with the prevalence in controls (16.0% and 11.7%, p < 0.001, for hypothyroidism; and 2.33% and 1.81%, p < 0.001 in hyperthyroidism, respectively). In a multivariate analysis, RA was associated with hypothyroidism (OR = 1.42, 95% CI 1.34–1.50) and hyperthyroidism (OR = 1.26, 95% CI 1.10–1.45).RA is associated with thyroid dysfunction. Therefore, physicians treating patients with RA should be aware of the possibility of comorbid thyroid dysfunction and treat accordingly.     

缺氧对老年肺心病患者甲状腺激素水平的影响

目的　探讨缺氧对老年肺心病患者甲状腺激素的影响。　 方法　使用放免法测定 68例老年肺心病急性期、2 8例缓解期及 2 8例对照组患者体内血清三碘甲状腺原氨酸 (T3)、四碘甲状腺原氨酸 (T4 )、促甲状腺激素(TSH)水平 ,同步测定动脉血中氧分压 (PaO2 )。观察T3、T4 和TSH的变化 ,并分析PaO2 与T3、T4 的相关关系。　 结果　老年肺心病急性期的血清T3、T4 水平分别轻度 :(0 70± 0 15 )、(61 7± 12 1)g·L-1;中度 :(0 48± 0 13)、(32 32± 7 9)g·L-1,重度 :(0 2 3± 0 0 9)、(18 7± 4 7)g·L-1。 3组血清T3、T4 显著低于缓解期 (0 88± 0 17)、(75 7± 15 6)g·L-1和对照组 (0 9± 0 35 )、(83 7± 14 6)g·L-1(P <0 0 1)。动脉血氧分压 (PaO2 )与T3、T4 水平是正相关 (P <0 0 5 ) ,轻、中、重度组和缓解组血清TSH较对照组略高 ,但无统计学意义 ,P >0 0 5。　 结论 　缺氧导致肺心病患者体内的甲状腺激素变化 ,并随着病情加重T3、T4 水平显著降低。监测血清T3、T4 水平有助于判断肺心病危重程度及其预后预测     

Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics

Abstract Diabetes mellitus and thyroid disease are common endocrine disorders in the general population. To investigate the association between thyroid dysfunction, thyroid autoimmunity and Saudi type 2 diabetics, a random sample of 100 Saudi type 2 diabetics and 100 age- and sex-matched controls were studied. The mean age was 54 years for diabetics and 55 years for controls while the male:female ratios were 1:1.6 and 1:14 respectively. GAD65ab were found in 26% diabetics and 2% controls (p=0.001). Thyroid autoimmunity were detected in 10% diabetics vs. 5% controls (p=0.05), while thyroid dysfunction was found in 16% and 7% respectively (p=0.03). In GAD65ab-positive diabetics, thyroid autoimmunity was observed in 27% vs. 4% GAD65ab-negative diabetics (p=0.02) and thyroid dysfunction was reported in 42% and 7% respectively. We conclude that thyroid dysfunction and autoimmunity are common in Saudi type 2 diabetics. Further studies are needed on the cost effectiveness of thyroid screening in diabetics.     

免疫检查点抑制剂诱发甲状腺功能紊乱的研究进展

随着免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)在肿瘤领域的广泛应用,其诱发的免疫相关不良事件(immune-related adverse events,irAEs)愈发多见.甲状腺功能紊乱在ICIs治疗过程中最为常见,包括甲状腺毒症和甲状腺功能减退,但常因其症状轻微且缺乏特...     

甲状腺功能紊乱患者血清瘦素水平分析

目的　探讨甲状腺功能紊乱患者血清瘦素水平变化及瘦素与垂体—甲状腺轴 (PTA)的关系。方法　对 40例Graves病 (GD)、30例甲状腺机能减退症 (甲减 )患者和 2 8名健康受试者的血清瘦素 (leptin)、游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4 )、促甲状腺激素 (TSH)、体脂百分含量 ( %BF)进行检测 ,所有受检者体重指数 (BMI) <2 5kg/m2 。结果　对照组血清瘦素浓度为 ( 5 .38± 3.11)ng/ml ,GD组为 ( 6 .0 7± 2 .93)ng/ml ,两组比较 ,差异无显著性 ,甲减组为 ( 10 .41± 4.45 )ng/ml,与对照组比较显著升高。三组血清瘦素浓度均与其 %BF显著正相关。对照组瘦素与TSH正相关 ,与FT3 、FT4 无相关关系。GD组瘦素与TSH、FT3 、FT4 无相关关系。甲减组因大多数TSH值增高超出检测范围 ,未作瘦素与之的相关性比较 ,而瘦素与FT3 、FT4 呈负相关关系。结论　甲状腺激素可能通过影响体脂含量而调节瘦素水平 ,瘦素和PTA是共同维持机体能量稳态的两个相互关联的系统。     

甲状腺过氧化物酶及其抗体与甲状腺疾病

在自身免疫性甲状腺疾病（AITD）中,甲状腺过氧化物酶抗体（TPOAb）滴度有不同程度的升高,这对AITD的分类及预后有指导意义。最近研究表明,甲状腺组织甲状腺过氧化物酶（TPO）的异常表达或者血清中TPO含量的变化为甲状腺肿瘤的诊断提供了一种新的途径。另外,部分先天性甲状腺疾病的发生也与TPO基因突变相关。进一步研究TPO及TPOAb,有助于对甲状腺疾病病因的探讨并加深对甲状腺疾病诊断及治疗的认识。     

Cor triatriatum sinistrum in childhood. A single institution��s experience

INTRODUCTION:

Cor triatriatum sinistrum (CTS) is a rare congenital cardiac defect that can present with a wide range of symptoms and may be associated with other structural cardiac defects. Very limited data are available for pediatric patients.

OBJECTIVE:

To analyze the experience with CTS at a single pediatric centre, highlighting symptoms on presentation, mode of diagnosis and outcome.

METHODS:

Hospital databases were searched to identify patients with CTS who were diagnosed between 1954 and 2005. Medical records with demographic data, clinical evaluation, diagnostic approach, interventions and autopsy results were reviewed.

RESULTS:

Between 1954 and 2005, 82 patients (43 female children, 52%) with CTS were diagnosed at the institution. Patients were born between 1951 and 2004, and the median age at presentation was eight months (range one day to 16.1 years). The majority of patients (77%) presented with associated cardiac lesions. Of 82 patients, 57 (70%) underwent resection of the fibromuscular diaphragm, 14 (17%) did not require surgery and 11 (13%) did not survive the time to intervention. Nineteen patients (23%) died a median of two months (range one day to 5.5 years) after presentation. Nine of these patients (11%) died before surgery was attempted. Most patients were completely asymptomatic at the time of the last follow-up at a median of three years (range one day to 18 years). Echocardiography significantly facilitated the diagnosis and subsequent management of patients with CTS.

CONCLUSIONS:

Despite the diversity in presentation and complexity of associated lesions, the outcome for patients with CTS is favourable.