Heart rate variability and its response to thyroxine replacement therapy in patients with hypothyroidism

目的　测定甲状腺功能减退 (甲减 )患者心率变异 (HRV)及观察甲状腺素替代治疗后的变化。方法　记录 38例甲减患者与 2 1例正常者 2 4小时动态心电图 ,并进行HRV分析。 18例甲减患者治疗 3月后重复HRV测定。结果　甲减时 ,HRV的时阈指标较对照组明显降低 ;频阈指标中 ,高频功率 (HF)较对照组明显增高 ,而低频 (LF)与HF比值较对照组显著减低。甲减患者经甲状腺素替代治疗后 ,HRV时阈指标和频阈指标均明显改善 ,且与FT3和FT4 的恢复程度相一致。结论　甲减时 ,自主神经活动明显改变 ,且以迷走神经兴奋性增加占优势。这种自主神经异常在甲状腺素替代治疗后可部分改善。     

Pituitary changes under CT scan before and after replacement therapy in patients with primary hypothyroidism

Pituitary enlargement was detected on CT scanning in 10 of 17 patients with primary hypothyroidism before thyroid hormone replacement therapy. The serum prolactin levels were slightly elevated in patients with pituitary enlargement. After replacement therapy with thyroid tablet, the enlarged pituitary glands were returned to normal in 6 patients when they were in euthyroid, while another patient's pituitary was still enlarged for inadequate dose of thyroid tablet. In conclusion, pituitary enlargement was frequently seen in patients with primary hypothyroidism and can be restored to normal after effective treatment with thyroid hormones.     

先天性甲状腺功能减低症患儿替代治疗后的气质特征

目的 分析先天性甲状腺功能减低症患儿甲状腺激素替代治疗后的气质特征,以寻求改善患儿生存及生活质量的最佳方案.方法 选取2003年6月至2006年12月本院确诊的先天性甲状腺功能减低症患儿30例,年龄(2.9±0.5)岁,选取年龄、性别相匹配正常儿童45名为对照组,采用上海第二医科大学附属新华医院开发的Carey系列气质量表中的TTS进行调查.结果 先天性甲状腺功能减低症患儿治疗后的气质类型分布趋向:中间偏难型(I-D型)占40.0%,容易抚养型(E型)占26.7%,抚养困难型(D型)占20.0%,中间偏易型(I-E型)占6.7%,发动缓慢型(S型)占6.7%,与正常儿童比较差异有统计学意义(χ2=12.89,P＜0.05).先天性甲状腺功能低下症患儿替代治疗后活动水平的分值低于对照组,而节律性、适应性、持久性、注意分散、反应阈的分值高于对照组,经统计学处理差异有统计学意义(P＜0.05).结论 先天性甲状腺功能减低症患儿替代治疗后的气质类型比正常儿童消极,应针对患儿的气质特征进行综合治疗. Abstract： Objective To analyse the temperament characteristics of congenital hypothyroidism after replacement therapy and find the best ways to improve the quality of life. Methods From 2003 to 2006,there were 30 children aged (2.9±0.5) with congenital hypothyroidism diagnosed in the second people's hospital of Liaocheng and 45 normal children at that age,sex matched with congenital hypothyroidism patients who were tested by TTS in Carey temperament scale which was developed by Xinhua hospital affliated to the second medical university of Shanghai. Results There were significant differences between congenital hypothyroidism group and normal group(P<0.05). The scores of the congenital hypothyroidism group were higher than that of normal group in their activity level,rhythmicity,adaptability,persistence,distraction and threshold of reaction. Conclusions The temperament of congenital hypothyroidism children have peculiar characteristics, and they have a more negative temperament.     

甲状腺素替代治疗甲状腺功能减退症对新生儿左心功能的影响

目的　评价新生儿期先天性甲状腺功能减退症(CH)患儿的左心收缩和舒张功能改变,以及甲状腺素替代治疗后的左心功能变化,并探讨其与血甲状腺激素水平的相关性。方法　对40例CH新生儿分别以左旋甲状腺素(L T4 )为起始量4~8μg·kg-1·d-1治疗1个月,治疗前后与30例对照组均进行超声心动图检查,测量左室射血分数(LVEF)、左室短轴缩短率(LVFS)、二尖瓣口血流舒张早期峰值速度(Em)、二尖瓣口血流舒张晚期峰值速度(Am)、二尖瓣环收缩期运动峰值速度(sm)、二尖瓣环舒张早期运动峰值速度(em)、二尖瓣环舒张晚期运动峰值速度(am)、收缩期二尖瓣环下移距离(MAD),同时用化学发光法测定血总三碘甲状腺原氨酸(TT3 )、总四碘甲状腺原氨酸(TT4 )和促甲状腺激素(TSH),并对血甲状腺激素水平和心功能指标行相关性分析。结果　CH组替代治疗前左心功能指标LVEF、sm、MAD、Em和em为0 .61±0 .08、2 .60cm/s±0. 60cm/s、0 .29cm±0 .06cm、0 .59m/s±0 .12 m/s和2 .72 cm/s±1 .43 cm/s,对照组上述指标较低,分别为0 .67±0 06、3. 25cm/s±0 .51cm/s、0 .41cm±0 .08cm、0 .72m/s±0. 11m/s和4.51cm/s±1 .23cm/s(与CH组比较P< 0 .01 );CH组用L T4替代治疗1个月后,上述指标分别为0 .69±0 .05、3. 46 cm/s±0 .64cm/s、0 .45cm     

Empty sella developing during thyroxine therapy in a patient with primary hypothyroidism and hyperprolactinaemia.

A 35 year old woman presented with severe primary hypothyroidism and galactorrhea. A very high prolactin level was also detected and computerized tomography scan of the sellar region demonstrated an enlarged pituitary gland associated with contrast enhancement. Replacement therapy with thyroxine corrected both biochemical and clinical abnormalities but empty sella developed during this therapy. It is concluded that empty sella may be related to thyroxine-induced shrinkage of lactotroph and/or thyrotroph cell hyperplasia.     

Reversible hypothyroidism after steroid replacement for Addison's disease.

An insulin-requiring diabetic patient who developed Addison''s disease is described. At diagnosis, investigations revealed biochemical hypothyroidism and these abnormalities resolved after replacement therapy for the adrenal failure only. The possible mechanism of this change is discussed in relation to the presence of organ-specific antibodies.     

Hyperthyrotrophinaemia during thyroxine replacement therapy

During the follow-up of 224 cases of treated hypothyroidism, 14 clinically euthyroid patients were found to have elevated serum thyrotrophin and normal total thyroxine concentrations. Closer observation of these patients during the following 27 months resulted in the serum thyrotrophin levels returning to normal spontaneously in 8 patients (Group 1) whilst remaining elevated in 6 (Group 2), despite no significant differences in thyroid hormone levels between the two groups. Serum thyrotrophin in Group 2 patients remained high until an additional 50 micrograms/day thyroxine was prescribed although only 2 patients noted any benefit. Non-compliance or inadequate dosage of thyroxine are the probable causes of this sub-clinical hypothyroidism. Thyroid hormone estimations fail to differentiate the two conditions and we recommend a period of closer observation before making any thyroxine dosage adjustments in order to detect non-compliance.     

IgA deficiency during treatment of infantile hypothyroidism with thyroxine

Serum IgA concentrations in five children with infantile hypothyroidism fell soon after the start of treatment with thyroxine. In one child the IgA concentration fell appreciably (to less than 0.01 g/1) and remained reduced; in the four others it returned to normal. IgM and IgG concentrations were roughly normal throughout. The deficiency in IgA concentrations may have been due to stimulation by thyroxine treatment of a T cell suppressor system that, in the original hypothyroid state, was less than normally active.     

SCH患者左甲状腺片替代治疗前后动脉粥样硬化危险因素的变化

目的 观察亚临床甲状腺功能减退左甲状腺素片替代治疗前后动脉粥样硬化危险因素的变化。方法 根据TSH将研究对象分为三组: 对照组: 0.4mU/L10mU/L。比较三组间动脉粥样硬化危险因素(BMI、TC、TG、LDL-C、HDL-C、SBP、DBP、HBA₁C、HCY、baPWV、baABI)的差异,并对A、B两组行左甲状腺素片替代治疗3个月,比较替代治疗后上述危险因素的变化。结果 A、B两组的BMI、TC、TG、LDL-C、HCY、baPWV较健康对照组显著升高,HDL-C显著降低(P<0.05),B组的TG、LDL-C、HCY、baPWV较A组进一步升高,HDL-C进一步降低(P<0.05)。经过替代治疗后,A组TSH、TC、HCY、baPWV较治疗前显著降低(P<0.05)。B组TSH、BMI、TC、TG、LDL-C、HCY、baPWV较治疗前显著降低(P<0.05)。以baPWV作为应变量,其他危险因素为自变量行多元逐步回归分析,提示baPWV与TSH、TC、LDL-C、HDL-C、HCY独立相关,与其他因素无关。结论 亚临床甲减存在多种动脉粥样硬化、心脑血管疾病的高危因素,TSH轻度升高阶段便可采用小剂量左旋甲状腺素钠替代治疗,从而改善血脂异常、防止动脉硬化症,以减少心血管疾病的发生。     

哌罗匹隆联合甲状腺素治疗原发性甲状腺功能减退症所致精神障碍疗效观察

目的：探讨哌罗匹隆联合甲状腺素（thyroxine,T4）治疗原发性甲状腺功能减退症（简称甲减）所致精神障碍的疗效及安全性。方法：使用哌罗匹隆联合T4或左-甲状腺素钠片治疗甲减所致精神障碍34例,采用阳性和阴性症状量表（positive and negative symptom scale,PANSS）及不良反应症状量表（treatment emergent symptoms scale,TESS）于治疗前后进行评定,并在疗程结束后比较治疗前后血促甲状腺激素（thyroid stimulating hormone,TSH）、三碘甲状腺元氨酸（iodine thyroid acid,T3）、T4、游离T3（free iodine thyroid acid,FT3）、游离甲状腺素（free thyroxine,FT4）的变化情况。结果：哌罗匹隆联合Ｔ４或左-甲状腺素钠片治疗后PANSS总分明显下降,治疗前与治疗后第2、4、8周比较差异有统计学意义（P<0.01）。病情疗效评定：总有效率88.2%。治疗后TSH、T3、T4、FT3、FT4明显好转,与治疗前比较,差异有统计学意义（P<0.01）。结论：哌罗匹隆是一种安全有效的抗精神病药物,对精神症状有显著的改善作用。联合T4治疗原发性甲减所致精神障碍病人是安全有效的。     

Massive pericardial effusion in primary hypothyroidism

A 44 year old lady with primary hypothyroidism presented with massive pericardial effusion without cardiac tamponade. Pericardial tap was done twice and the effusion resolved as the hypothyroid state improved. She remained hypertensive despite the euthyroid state. She was discharged well with L-thyroxine and anti-hypertensive therapy.     

Primary hypothyroidism with paradoxically elevated plasma thyroxine due to thyroxine-binding antibody

Investigation of an elderly patient with clinical hypothyroidism revealed a low serum triiodothyronine (T3) but markedly raised levels of total thyroxine (TT4) and free thyroxine (fT4) when measured by radio-immunoassay (RIA). Primary hypothyroidism was suggested by an elevated basal thyroid stimulating hormone (TSH) and confirmed by a low fT4 when measured by a commercial microencapsulated antibody method. The paradoxically elevated levels of fT4 and TT4 were due to the presence of an antibody which specifically bound T4 and grossly interfered with the RIA thus complicating the diagnosis and later the assessment of replacement therapy. The sensitive immunoradiometric TSH assay proved of value in resolving these problems.     

左甲状腺素钠治疗老年甲状腺功能减退症的疗效观察

目的观察左甲状腺素钠治疗老年原发性甲状腺功能减退症的疗效及不良反应。方法86例原发性甲状腺功能减退老年患者,随机分为治疗组：43例,采用左甲状腺素钠50—100μg口服,1次／d;对照组：43例,采用干甲状腺片治疗80-100mg口服,2～3次／d,两组均治疗6个月。分别于治疗前后观察血清游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、总胆固醇（CHO）、三酰甘油（TG）变化,对比两组临床疗效,观察治疗不良反应。另选30例健康志愿者做为正常对照组。结果治疗前,治疗组及对照组的FT3、FT4均显著低于正常对照组,而TSH、CHO、TG均高于对照组（P〈0．01）。治疗后,治疗组及对照组的FT3、FT4均显著高于治疗前,且TSH、CHO、TG均明显下降（P〈0．01）。治疗后,治疗组的FT3、FT4明显高于对照组,且TSH、CHO、TG均明显低于对照组（P〈0．05）。治疗组总有效率为95．3％,对照组的总有效率为79．1％,两者比较差异有统计学意义（P〈0．05）。不良反应：治疗组心动过速2例、胃肠不适1例;对照组组：心绞痛过速5例、胃肠不适1例、头痛1例、过敏反应1例。结论左甲状腺素钠治疗老年甲状腺功能减退症可改善脂代谢,临床疗效优于服用甲状腺素片,无明显不良反应。     

甲状腺激素替代治疗甲状腺功能减退症的效果

目的：深入研究分析甲状腺功能减退症患者接受甲状腺激素替代治疗后的各项指标,评估甲状腺激素替代治疗的临床效果,为今后的临床治疗提供参考依据。方法：采用随机抽样调查的方案,选取本市70名符合要求的甲状腺功能减退症患者参加调研,将以上甲状腺功能减退症患者随机分为观察组和参照组,观察组的甲状腺功能减退症患者接受为期4 w 的甲状腺素替代治疗,4 w 之后,分别检测两组前后的血脂指标、心肌酶谱以及甲状腺功能。结果：观察组的原发性甲状腺功能减退患者接受甲状腺激素替代治疗后各项功能指标均显示正常。结论：甲状腺激素替代治疗能够用于甲状腺功能减退症的临床治疗,可将甲状腺激素替代治疗推广至临床治疗。     

中枢性及原发性甲状腺功能减退症临床特征比较

目的 比较中枢性及原发性甲状腺功能减退症的临床特征.方法 对我院内分泌科10年来住院的原发性及中枢性甲状腺功能减退症患者进行临床症状、指标的调查,并进行比较.结果 ①原发性甲状腺功能减退症更容易出现怕冷、乏力、浮肿、懒言、甲状腺肿大,其中浮肿、懒言、甲状腺肿大在两者间有统计学意义(P＜0.05),中枢性甲减恶心、呕吐、闭经等症状更常见(P＜0.05);②中枢性甲减的血钠及血氯均明显低于原发性甲减(P＜0.05),心肌酶谱中,原发性甲减肌酸激酶(CK)升高较明显(P＜0.05);③原发性甲减CK与TSH呈正相关,r=0.383(P＜0.05),中枢性甲减CK与TSH相关无统计学意义(r=0.246,P＞0.05).结论 中枢性及原发性甲状腺功能减退症在临床症状及临床指标上有异同,临床工作应全面考虑,避免误诊.     

左旋甲状腺素替代治疗对亚临床甲减患者颈动脉内中膜厚度的影响

目的评价左旋甲状腺素(L-T4)替代治疗对亚临床甲减患者颈动脉内中膜厚度(IMT)的影响。方法对45例亚临床甲减患者进行血脂及颈动脉IMT的检测,观察其基线及L-T4治疗后的变化,并与甲状腺功能正常对照组比较。结果亚临床甲减患者血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDLc)、载脂蛋白β和C反应蛋白(CRP)的浓度升高,颈动脉IMT增加;逐步回归分析显示IMT平均值与LDLc、促甲状腺激素释放激素(TSH)水平呈正相关。L-T4治疗能显著降低TC、LDLc及颈动脉IMT,IMT的下降与血清TSH及TC值的下降直接相关。结论L-T4替代疗法能改善亚临床甲减患者动脉粥样硬化脂质谱和内中膜增厚,其颈动脉壁的脂质渗透仍可能是IMT增加的一个重要机制。     

甲状腺素片联合左甲状腺素钠片治疗甲减的疗效观察

目的 探究甲减患者采用甲状腺素片联合左甲状腺素钠片治疗的疗效.方法 选取2017年5月至2019年5月于本院诊治的100例甲减患者,按随机数字表法分为两组,各50例.对照组采用左甲状腺素钠片治疗,观察组在对照组基础上联合甲状腺素片治疗,比较两组疗效及甲状腺功能.结果 治疗后,观察组总有效率(86.00％)高于对照组(6...