不同补碘时期可疑亚临床克汀病儿童甲状腺激素水平变化

目的检验不同补碘时期,激素性甲状腺功能低下对亚临床克汀病(亚克汀病)诊断的有效性.方法从1996年至1999年,对秦巴山区3个缺碘地区的可疑亚克汀儿童与正常儿童的血清T3、T4、TSH进行测定.结果①当该地区处于补碘不稳定时期(1996),在缺碘时期出生的可疑亚克汀病儿童T3、T4均值与正常儿童差异无统计学意义,TSH高值率却显著高于正常儿童(P＜0.05);②当该地区补碘正常时期(1999),可疑亚克汀病儿童与正常儿童的T3、T4均值以及TSH高值率差异无统计学意义(P＞0.05).结论激素性甲状腺功能低下与近期摄碘量不足有关,在儿童机体碘营养状况已趋于正常状况下,不宜用其辅助诊断亚克汀病患儿.     

新生儿TSH测定与成人尿碘测定的对比

本文报道了用纸片法测定沈阳碘缺乏病区新生儿 TSH6498人,结果显示亚临床甲低人群占11.9%,与尿碘测定显示结果12.0%是一致的。进一步比较各县区新生儿 TSH 值与成人尿碘值,发现二者之间成高度负相关,且有较好的直线回归关系。笔者对两种测定方法做了简单对比,认为新生儿纸片TSH 测定是碘缺乏病监测的可靠指标,建议在我国逐步推广应用。     

新生儿TSH水平与其母亲尿碘值的相关研究

本文旨在通过对新生儿母亲尿碘值及其新生儿 TSH 值的相关分析,以探讨中国正常新生儿 TSH 值分布的临界点。结果显示,当新生儿母亲尿碘值<50ug/L 时,仅有9%的新生儿其TSH 值<5mIu/L,当尿碘值>50<100μg/L 时,33%的新生儿其 TSH 值<5mIu/L。当尿碘值>100ug/L 时,大多数(90%)的新生儿其 TSH 值<5mIu/L,因此,我们认为 TSH 值5mIu/L可能是中国正常新生儿 TSH 值分布的临界点。     

The influence of gestational stage on urinary iodine excretion in pregnancy

INTRODUCTION: Median urinary iodine concentration (UIC) is the most commonly used indicator of population iodine nutrition. However, its validity as an indicator of dietary intake relies on a stable relationship between dietary iodine intake and urinary excretion. Physiological alterations in normal pregnancy, such as increased glomerular filtration rate, potentially invalidate UIC as an assessment tool in pregnancy. OBJECTIVE: The objective of the study was to document the impact of advancing gestation on UIC in normal pregnancy and determine whether the current reference intervals for general population iodine monitoring are appropriate for use in the context of pregnancy. DESIGN: Tasmania has a well-described history of mild iodine deficiency (school-age median UIC of 84 microg/liter). We assessed UIC in 759 urine samples from 431 women attending the Antenatal Clinic at the Royal Hobart Hospital, Tasmania's primary teaching hospital. MAIN OUTCOME: The overall median UIC during pregnancy was 75 microg/liter (95% confidence interval 70.03-79.97 microg/liter) at a median gestation of 19.4 wk. Stratification by gestation, however, revealed a dynamic relationship between ioduria and gestation. Median UIC was elevated in early pregnancy and subsequently declined with advancing gestation. CONCLUSION: In this mildly iodine-deficient population, current reference intervals for UIC overestimated the adequacy of iodine nutrition during the first and early second trimester of pregnancy. Gestation-specific UIC reference intervals are required to classify iodine nutrition during pregnancy. This is particularly important in populations with borderline iodine deficiency.     

Variation in serum levels of T3, T4, FT4 and TSH during thyroxine replacement therapy

Serum levels of T3, T4, FT4 and TSH were determined in 9 euthyroid patients during 6 h after intake of morning thyroxine replacement medication. Four hypothyroid patients were studied in the same way after the intake of 50 micrograms thyroxine. In the euthyroid patients the FT4 level increased by 31%, while the increase of T4 was 16% and the increase of T3 11%. In the hypothyroid patients levels of T3, T4 and FT4 did not change after ingestion of 50 micrograms thyroxine, while the TSH level was decreased by 30%. It is concluded that during thyroxine replacement therapy hormone analysis must be interpreted in relation to the time of thyroxine administration.     

Short-term changes in maternal and neonatal urinary iodine excretion.

Investigation of maternal urinary iodine (UI) excretion in the immediate antenatal and early postpartum periods showed a precipitous fall in median values from 93 microg/L antenatally to 36 microg/L at delivery subsequently rising to 49 microg/L and 63 microg/L at days 3 and 10 postpartum respectively. The fate of ingested iodine not appearing in the maternal urine is unknown but measurement of UI in babies born to nursing mothers suggested transfer from the mother with median neonatal values of 117 and 159 microg/L being recorded at days 3 and 10. While maternal UI seemed to relatively unaffected by breast feeding, median UI from breast feeding babies (148 microg/L) was significantly greater than in those bottle feeding (50 microg/L). This was also reflected by the finding that no breast feeding baby had a UI values < 50 microg/L in comparison to 50% of bottle feeders. The depressed values in mothers and relatively high values in their infants could present a false picture and suggest the need to defer any investigations of iodine status at this time. The findings do however suggest a need for further investigations aimed at determining the fate of iodine ingested perinatally and its possible physiological significance in maintaining thyroid status in the mother and neonate.     

甲状腺肿,T3、T4升高伴TSH升高

李栩医师(上海同济大学附属东方医院内分泌科):女性患者,12岁,因"反复颈前部肿大4年"入住上海同济大学附属东方医院内分泌科.患者4年前偶因"上感"至外院就诊时,体检发现颈前部肿块,经B超检查为"甲状腺肿大",患者当时无明显心悸、多汗,无多食消瘦,无双手震颤、大便增多等不适.     

血尿碘及甲状腺功能测定对鉴别无痛性甲状腺炎的意义

目的　探讨血尿碘质量浓度及甲状腺功能在无痛性甲状腺炎患者与其他甲状腺毒症患者中的区别。方法　 2 0 0 2 - 0 1～ 0 4在第四军医大学西安医院住院初诊血甲状腺激素水平升高的患者 75例分为无痛性甲状腺炎组、亚急性甲状腺炎组、格雷夫斯病组 ,测量血清学及血、尿碘指标 ,观察各组与指标间的关系。结果　T3 、T4及血、尿碘与甲状腺毒症的种类有关。结论　无痛性甲状腺炎的发病并非少见 ,可通过临床表现、血尿碘和甲功测定等对此类疾病进行诊断和鉴别诊断。