介入栓塞甲状腺动脉与口服抑亢丸联合治疗Graves病

目的：观察抑亢丸与介入栓塞甲状腺动脉联合治疗甲状腺机能亢进症(Graves病)的临床疗效。方法：16例Graves病患均行介入栓塞甲状腺上、下动脉后，8例术后口服他巴唑或丙基硫氧嘧啶，8例患术后口服抑亢丸，观察比较抑亢丸的疗效。结果：介入术后口服抑亢丸与口服他巴唑或丙基硫氧嘧啶效果相同。结论：介入栓塞甲状腺动脉后口服中药抑亢丸与口服他巴唑或丙基硫氧嘧啶治疗Graves病疗效相同。     

介入栓塞治疗10例甲状腺功能亢进症的分析

目的探讨用介入栓塞治疗甲状腺功能亢进症(甲亢)的方法、临床疗效及安全性。方法10例反复复发的甲亢患者,经选择性插管至甲状腺双侧上动脉,使用明胶海绵糊进行栓塞治疗,观察栓塞后的临床症状、甲状腺功能及甲状腺大小的变化。结果10例患者均获临床治愈,随访12个月,术前TT32.5~3.5μg/L、TT4125.4~236.8μg/L,术后TT3降至1.3~2.0μg/L,TT4降至64.3~99.3μg/L。甲状腺明显缩小,无严重并发症。结论介入栓塞甲状腺上动脉,能使甲亢达到临床治愈,且安全、副作用少,是治疗甲亢的新方法。     

三种栓塞方法治疗甲亢对照研究

近年来发现介入栓塞治疗甲亢安全简便，疗效可靠，但栓塞剂的种类较多，疗效、反应和费用不一。为选择一种疗效好、反应轻、费用低的甲状腺栓塞方法，我们应用聚乙烯醇微粒(PVA)、α-氰基丙烯酸正辛酯(TH胶)及平阳霉素碘油乳剂(PLE)分别栓塞动物甲状腺动脉并进行对照研究。现报告如下。     

介入栓塞治疗在高龄难治性前列腺癌出血中的临床效果

目的观察介入栓塞治疗在高龄难治性前列腺癌出血中的临床效果。方法前列腺癌合并持续性出血患者共80例,其中采用超选择性髂内动脉栓塞治疗患者58例,采用止血药物进行保守治疗患者22例。对比分析两组患者的成功止血时间、并发症等不良反应和复发出血的发生情况,评估超选择性介入栓塞治疗高龄难治性前列腺癌出血的疗效和安全性。结果介入栓塞治疗技术成功率100%,58例患者中,47例平均3 d血尿停止,8例转为镜下血尿,3例经第二次栓塞术后停止出血。栓塞术后无严重不良反应。术后平均随访12个月,复发出血5例。药物保守治疗22例患者中,5例平均7 d血尿停止,9例平均15 d转为镜下血尿,8例保守治疗失败,转为采用介入栓塞治疗后止血成功。保守治疗有效的14例患者中8例12个月内出血复发。结论超选择性介入栓塞治疗高龄难治性前列腺癌出血安全且有效。     

Graves′病的介入栓塞治疗

Graves′病的介入栓塞治疗目前在国内外应用刚刚起步,但已取得了显著效果,使一些久治不愈或有某些禁忌症的甲亢患者病情得到缓解,开辟了治疗Graves′病的一条新途径。传统上,Graves′病有三种治疗方法:抗甲状腺药物治疗,放射性~(131)I治疗和手术治疗。每一种治疗各有优缺点。抗甲状腺药物治疗疗程长,治愈率低,易复发,可引起药物过敏和粒细胞缺少,限制了其应用范围。~(131)I治疗方便快捷,但甲状腺功能减退发生率高,需甲状腺素片终身替代治疗,在儿童、青少年和生育期妇女,甲减可影响生     

真丝线段栓塞甲状腺上动脉治疗难治性甲状腺功能亢进症

近年来 ,国内外一些学者相继报道用栓塞甲状腺上动脉的方法治疗临床上的难治性甲亢 ,均取得一定的疗效。本研究采用真丝线段血管内栓塞的方法 ,治疗了 6例患者 ,取得同样的效果 ,现报道如下。一、对象和方法6例甲亢患者均为我院内分泌科住院患者 ,入院前有不同程度的心悸、消瘦、怕热、多汗等症状 ,甲状腺Ⅱ Ⅲ度肿大 ,无结节 ,无压痛 ,不伴突眼 ,经查血Ｔ3 、Ｔ4、ＴＳＨ、ＦＴ3 、ＦＴ4、甲状腺球蛋白抗体 (ＴＧＡ)、甲状腺微粒体抗体 (ＴＭＡ) ,甲状腺ＥＣＴ ,甲状腺细针穿刺检查等明确诊断为Ｇｒａｖｅｓ病 ,其中 1例为13 1Ｉ治疗术后半…     

强的松治疗Graves病并发房颤的临床研究

Graves病（Gravesdisease，GD）是一种自身免疫性疾病，心房颤动（AF）是GD并发的最重要的心律失常，此类患者发生心力衰竭、动脉栓塞和中风的危险性高，且在临床上恢复窦性心律非常困难。目前传统的治疗GD抗甲状腺药物效果不满意，大约有61％的甲亢死于患者合并心房纤颤。因此，本研究在未应用抗心律失常药物的情况下，采用强的松治疗GD并发心房颤动，探讨其治疗甲亢房颤的疗效，并观察口服小剂量强的松对甲亢房颤患者的安全性。     

治甲一方对高龄肝火旺盛型Graves病患者甲状腺功能、甲状腺体积及突眼的影响

目的探讨治甲一方治疗高龄肝火旺盛型Graves病的临床疗效及其对患者甲状腺功能、甲状腺体积及突眼的影响。方法肝火旺盛型Graves病高龄患者116例,随机分成对照组和观察组各58例。对照组口服甲巯咪唑,观察组在对照组的基础上加用治甲一方治疗。结果治疗后,观察组患者多汗、心悸、燥热、消瘦、易饥饿等症状体征积分低于对照组(P0.01)。治疗后,观察组血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酸抗体(TPOAb)水平低于对照组(P0.01)。观察组患者突眼度小于对照组(P0.01)。观察组总有效率(89.23%)高于对照组(69.23%)(P0.01)。结论治甲一方治疗高龄肝火旺盛型Graves病能够改善患者症状体征,可缓解甲状腺肿大、促进甲状腺功能的恢复及进甲亢性突眼的好转。     

术前介入化疗与栓塞在中晚期贲门癌治疗中的应用价值

目的探讨术前介入化疗与栓塞治疗中晚期贲门癌的疗效。方法对68例中晚期贲门癌患者术前先行介入化疗与栓塞1～2次后再行贲门癌根治术,观察疗效并随访。结果 68例患者中,86.8%（57/68）的患者术前临床自觉症状减轻或消失,术中83.8%（57/68）的患者可见病灶缩小,肿瘤轻度水肿、缺血,术中出血量少,手术易切除。术后病理分期降级者33例,占48.5%。结论晚期贲门癌术前介入化疗及栓塞有较满意的近期疗效。     

抑亢丸联合丙基硫氧嘧啶治疗Graves病临床观察

目的观察抑亢丸治疗弥漫性甲状腺肿伴甲状腺机能亢进症(Graves病)的临床疗效。方法60例Graves病患者随机分为抑亢丸加丙基硫氧密啶组和丙基硫氧嘧啶组。观察治疗前后甲状腺功能、甲状腺肿大及突眼的变化情况。结果两组在改善甲状腺功能方面结果相似(P>0.05),抑亢丸加丙基硫氧嘧啶组对突眼及甲状腺肿大的有效率优于丙基硫氧嘧啶组(P<0.05)。结论抑亢丸联合丙基硫氧嘧啶治疗Graves病可提高疗效。     

Arterial embolization: a novel approach to thyroid ablative therapy for Graves' disease

Despite the availability of effective treatments for Graves' disease, there are patients who are unable to tolerate, or choose not to accept, current therapies (oral medication, radioactive iodine, or surgery). In this study, we have examined the use of thyroid arterial embolization as an option for patients who suffer from Graves' disease and who fit into one of the preceding patient groups. Selective arteriography, followed by embolization of thyroid arteries, was performed using Seldinger's technique in 22 patients with Graves' disease. Six of the patients received both arterial embolization and surgery at 2-3 wk after embolization. No serious complications were noted in any patient. In those who were treated with only interventional embolization, 14 of 22 (63.6%) became euthyroid and remained in this state for the duration of the study. The remaining 2 patients required a maintenance dose of antithyroid drug therapy (tapazole, 5-10 mg/d; or propylthiouracil, 50-100 mg/d). Patients were followed for a median time of 27 months (range, 6-50). At the end of the follow-up period, all 22 patients were euthyroid, the size of thyroid gland had decreased by one third to one half its original volume, but 2 patients continued to require antithyroid drugs. Histologic analysis of thyroid tissue from 6 patients who had embolization followed by surgery showed that embolization blocked both the superior and inferior thyroid arteries plus most of their branches. Evidence of chemical inflammation, necrosis, and fibrosis were observed in embolized thyroid tissue. The average diameter of capillary network within the body of the thyroid adjacent to superior and inferior artery was 0.12-0.25 mm, with the smallest ones ranging from 0.04-0.11 mm. The diameter of the capillaries in the isthmus ranged from 0.13-0.15 mm. The average diameters of the superior and inferior arteries were 2-5.5 and 3-3.75 mm, respectively, measured using radiographs from angiography. Based on the measured diameters of arteries, the appropriate size of embolizing granules can be selected, and complete embolization of the majority of the thyroid glands was achieved with a high frequency of therapeutic success. Histological examination of the thyroid tissue and clinical follow-up after embolization indicate that this procedure is an effective, minimally invasive, and safe method for the treatment of Graves' disease patients who cannot, or choose not to, accept current therapies.     

顽固性咯血患者肺叶切除术前行动脉栓塞介入治疗的价值

目的 探讨数字减影血管造影(DSA)引导下超选择性经导管动脉栓塞介入治疗(简称“介入栓塞治疗”)在顽固性咯血患者行肺叶切除术前的应用价值。方法 回顾性分析我院连续收治的 45例因顽固性咯血入院,需施行肺叶切除术患者的临床资料。将肺叶切除术术前进行介入栓塞治疗的20例患者作为研究组,将未施行术前介入栓塞治疗的25例患者作为对照组。观察两组患者引起咯血的责任血管分布情况、与原发病的关系及介入栓塞治疗的效果。对比两组患者手术时间、出血量及并发症发生率等指标的差异。计量资料组间比较采用t检验,计数资料组间比较采用χ²检验,均以P<0.05为差异有统计学意义。结果 DSA检查发现研究组20例患者共有出血责任血管 57支,其中支气管动脉(BA)12支,非支气管性体动脉(NBSA)侧支循环42支,肺动脉(PA) 3支;研究组结核性毁损肺及肺空洞并发曲菌球患者(11例)的NBSA 以肋间动脉、锁骨下动脉及腋下动脉为主(共29支),支气管扩张患者(9例)的NBSA以食管固有动脉、膈下动脉为主(共13支)。介入栓塞治疗后即刻止血13例,占65.0%,咯血减少7例,占35.0%。研究组患者术中出血量平均为(600±155)ml,对照组患者术中出血量平均为(850±210)ml,两组比较差异有统计学意义(t=23.73,P=0.000);研究组患者手术时间为(150±35)min,对照组患者手术时间为(180±40)min,两组比较差异有统计学意义(t=12.40,P=0.000)。结论 NBSA为顽固性咯血的主要责任血管,其分布规律与原发病相关;术前行介入栓塞治疗有助于控制咯血,并能有效减少术中出血,缩短手术时间,从而降低手术风险。     

Exacerbation of thyroid associated ophthalmopathy after arterial embolization therapy in a patient with Graves’ disease

A novel treatment approach to Graves’ disease (GD), embolization of the thyroid gland arteries, is evaluated with respect to its indications and adverse effects. We describe an exacerbation of thyroid associated ophthalmopathy (TAO) following thyroid artery embolization in a woman with GD and mild stable TAO (NOSPECS classification, class I grade a). A 45-year-old woman with GD and inactive TAO, in whom thyroid function was stable following blockade of hormone release combined with replacement therapy, underwent embolization of three thyroid arteries. Initially, there were neither adverse effects nor complications; however, the patient developed severe TAO (NOSPECS classification, class IV grade b) 3 months after the arterial embolization. Steroid pulse treatments followed by total thyroidectomy resulted in improvement of the eye signs and symptoms. The clinical course and the serial changes of the thyroglobulin and thyroglobulin-antibody titers suggested that the destruction of thyroid follicles, induced by the arterial embolization, triggered the exacerbation of her TAO. Our experience argues for the use of caution when arterial embolization is considered for GD patients with even the mildest TAO (NOSPECS classification, class I).     

Adult Perithyroid and Cervical Thymus-Parathyroid Unit: Case Reports of a Rare Entity

The thymus-parathyroid unit (TPU) occurring in adults is rare.The main symptoms and important clinical findings are as follows: 2 patients presented with neomercazole-resistant Basedow–Graves disease. A third patient presented with thyroid nodules and a fourth patient with a neck mass after thyroid resection for medullary thyroid carcinoma.The main diagnoses were those of thyroid nodules (either in the context of goiter, or not). In the fourth case the diagnosis was of thyroid medullary carcinoma recurrence in the neck.Thyroidectomy was performed in the 2 cases of Basedow–Graves disease and in the third case (wherein selective neck dissection was also performed). In the fourth case, a neck dissection was performed for a possible medullary carcinoma recurrence.A TPU was microscopically detected in 2 cases with perithyroid location, on thyroidectomies for Basedow–Graves disease and in the 2 other cases with neck soft tissue location (associated with thyroid papillary carcinoma and thyroid medullary carcinoma extension). Postsurgical hypocalcemia requiring treatment occurred in both patients with Basedow–Graves disease and in the fourth patient.The presence of TPU should be acknowledged because such lesions can be misdiagnosed as suspect lymph nodes during thyroid surgery for malignant tumors.     

自身免疫性甲状腺疾病树突状细胞和 HLA-DR 抗原的免疫组化研究

用ＡＢＣ免疫组化法研究桥本甲状腺炎（ＨＴ）和Ｇｒａｖｅｓ病（ＧＤ）患者甲状腺内的Ｓ１００蛋白阳性树突状细胞（ＤＣ）和ＨＬＡＤＲ（ＤＲ）抗原阳性甲状腺上皮细胞（ＴＥＣ）。发现ＨＴ和ＧＤ甲状腺内的Ｓ１００蛋白阳性ＤＣ较正常明显增多，且大多数ＤＣ与ＴＥＣ或浸润淋巴细胞密切接触。ＨＴ和ＧＤ的ＴＥＣ常见ＤＲ抗原异常表达，其主要分布在淋巴细胞浸润区。这说明ＤＣ异常增多、ＴＥＣ异常表达ＤＲ抗原可能与甲状腺自身免疫反应的启动和（或）延续有密切关系。     

A woman complicated with immune thrombocytopenic purpura, subclinical Graves disease and peripheral neuropathy 5 years after allogeneic bone marrow transplantation

A 21-year-old woman developed immune thrombocytopenia (ITP), subclinical Graves disease and peripheral neuropathy without typical chronic graft-versus-host disease (GVHD) 5 years following an allogeneic bone marrow transplantation from an HLA-identical sibling. She received high-dose intravenous immunoglobulin (IVIG) and prednisolone (PSL), which resulted in transient recovery of platelet numbers and muscle weakness. A combination of cyclosporine and PSL induced a durable response against not only the thrombocytopenia but also her high levels of thyroid stimulating antibody (TSAb), muscle weakness and sensory abnormality. The level of thyroglobulin in the donor, who had not developed Graves disease, was also elevated, indicating that late onset-subclinical Graves disease was caused by donor lymphocytes that were autoreactive to the thyroid glands.     

Thyroid nodules in Graves disease and the risk of thyroid carcinoma.

BACKGROUND: The risk of thyroid carcinoma in patients with Graves disease has been particularly emphasized when nodules coexist with thyroid hyperplasia; a surgical approach has been suggested. OBJECTIVES: To detect thyroid nodules early in patients with Graves disease and to evaluate the risk of carcinoma. METHODS: The study group included 315 consecutive outpatients with Graves hyperthyroidism not previously treated with surgery or radioiodine therapy. Thyroid ultrasonography was performed at the time of enrollment and repeated annually in all patients; fine-needle aspiration (FNA) was carried out in those patients with nodules and repeated after 2 years or at shorter intervals. RESULTS: One hundred six of 315 patients with Graves disease had thyroid nodules 8 mm in diameter or larger detected by ultrasonography. In 49 patients, nodules were present at the time of the first examination; in 57 patients, nodules developed during follow-up. Fine-needle aspiration cytology results revealed features of carcinoma in only 1 patient; this was confirmed by histologic examination of excised thyroid tissue. The nodules with normal cytologic features at the time of the first examination did not show any clinical and/or cytologic evolution toward malignancy during follow-up. CONCLUSIONS: Ultrasonographic evidence of nodules was frequently found among our patients with Graves disease, but malignant FNA cytologic findings of the examined nodules were rare at the time of diagnosis and throughout the course of the disease. When FNA cytologic evaluation does not indicate malignancy, the presence of thyroid nodules in patients with Graves disease does not indicate an aggressive therapeutic approach.     

Embolization for vertebral metastases of follicular thyroid carcinoma

The technique of selective embolization has been applied for years in the treatment of vascular anomalies, severe hemorrhage and benign or malignant tumors, notably vertebral metastases of renal cell carcinoma. Because this technique is relatively easy to perform and offers immediate relief of symptoms, it is an attractive option for patients with vertebral metastases of thyroid carcinoma with signs of spinal cord compression. In these patients, other treatment modalities like radioactive iodine, external irradiation, or surgery are more cumbersome or less effective in the short term. We describe four patients with metastasized follicular thyroid carcinoma, presenting with neurological symptoms due to vertebral metastases. All patients had undergone total thyroidectomy, ranging from 1 month to 4 yr before embolization. Embolization was combined with iodine-131 therapy when appropriate. Selective catheterization of the arteries feeding the metastases was performed, followed by infusion of polyvinyl alcohol particles (Ivalon). The procedure was technically successful in all patients without adverse effects. In the patients described, embolization resulted in rapid resolution of neurological symptoms, sometimes within hours. The therapeutic effect lasted from months to years. We conclude that embolization of vertebral metastases of follicular thyroid carcinoma is an attractive palliative therapeutic option that may offer rapid relief of symptoms.