超声检查在富硒水治疗桥本氏甲状腺炎伴甲状腺功能减退疗效评价中的应用

目的探讨超声测量甲状腺体积及回声分级法评价富硒水在桥本氏甲状腺炎(HT)合并甲状腺功能减退(简称甲减)辅助治疗中的作用。方法选取HT伴甲减患者80例为观察对象,对照组采用左旋甲状腺素钠片联合百令胶囊进行治疗,联合组在治疗方案上增加富硒水治疗。在治疗结束后,分析甲状腺体积、回声分级、血清硒、甲状腺功能及抗体水平。结果治疗3个月及6个月,联合组血清硒、FT4显著高于对照组(P<0.05),TSH、TGAb、TPOAb及甲状腺体积均显著低于对照组(P<0.05);治疗6个月,联合组FT3水平高于对照组(P<0.05),联合组甲状腺超声分级显著低于对照组(P<0.05),血清硒水平与FT3、FT4具有中等程度的正相关性(0.4 相似文献   

甲状腺功能与血清饥饿素和瘦素水平的相关性研究

目的 观察甲状腺功能亢进症(甲亢)、甲状腺功能减退症(甲减)及正常人血清饥饿素和瘦素水平,并探讨它们与甲状腺功能的关系.方法 采用放射免疫分析法分别检测46例未接受治疗甲亢患者(甲亢A组)、15例131I治疗有效的甲亢患者(甲亢B组)、21例甲减患者和18例正常对照者血清饥饿素及瘦素水平,同时采用全自动化学发光免疫分析法检测血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)水平.结果 (1)甲亢A组的血清饥饿素水平明显低于甲亢B组(t=3.21,P<0.01)、甲减组(t=3.02,P<0.01)和正常对照组(t=3.39,P<0.01);甲亢B组、甲减组和正常对照组之间的血清饥饿素水平比较无显著差异.(2)甲亢A组血清瘦素水平与甲亢B组、甲减组和正常对照组比较无显著差异;甲亢B组、甲减组和正常对照组之间的血清瘦素水平比较无显著差异.(3)血清饥饿素水平与血清兀FT3(r=-0.29,P<0.05)和FT4(r=-0.26,P<0.05)呈负相关,与TSH呈正相关(r=0.36,P<0.05);血清瘦素水平与血清FT3、FT4和TSH无显著相关性.结论 血清饥饿素水平在不同甲状腺功能状态下不同,并与甲状腺激素水平有一定的相关性,而血清瘦素无此作用.     

重症肌无力伴亚临床甲状腺病变（附31例报告）

目的探讨重症肌无力（myasthenia gravis,MG）与亚临床甲状腺病变并存的临床特点。方法对2009年1月至2010年5月总参谋部总医院（解放军309医院）MG治疗中心确诊的508例MG患者中伴亚临床甲状腺病变的31例患者的临床和实验室资料进行回顾性分析。结果 MG伴亚甲减（亢）患者中,女性、眼肌受累率高,年龄构成无明显特点。TSH〉10.0μU/ml较TSH〈0.1μU/ml伴发MG全身型发病率高。MG伴亚甲亢TSH均值TPOAb阳性组大于抗体阴性组,甲状腺激素小于抗体阴性组;MG伴亚甲减则相反。结论 MG伴亚临床甲状腺病变以眼肌为器官特异性;女性免疫更敏感;MG伴亚甲减较伴亚甲亢病情重;TPOAb对病情程度有影响。     

亚硒酸钠治疗桥本甲状腺炎的临床观察

目的探讨硒对成人桥本甲状腺炎(HT)的干预效果。方法将176例HT患者中的甲状腺功能正常者121例和甲状腺功能减退(甲减)及亚临床甲减患者55例,分别分为对照组及治疗组,对照组根据甲状腺功能给予不用药或加用左旋甲状腺素片处置,治疗组在对照组治疗的基础上加用亚硒酸钠,观察亚硒酸钠对患者甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、甲状腺功能的影响。结果甲状腺功能正常组中硒治疗组患者的TPOAb、TGAb明显下降,与对照组比较差异有统计学(P<0.01,P<0.05﹚,而甲状腺功能方面,与对照组比较差异无统计学意义(P>0.05)。甲减及亚临床甲减组,随着TSH的下降,两组TPOAb、TGAb均有不同程度下降,但硒治疗组下降更明显,两组治疗前后比较差异有统计学意义(P<0.05﹚。硒治疗组无明显不良反应。结论补硒能降低HT患者甲状腺的自身抗体水平,可在一定程度上阻止甲状腺损害的发生和发展。     

25例妊娠合并甲状腺功能减退症临床结局分析

目的:对妊娠合并甲状腺功能减退症进行分析,探讨其治疗及对胎儿的影响.方法:对我院25例妊娠合并甲减的临床资料进行回顾性分析.结果:25例妊娠合并甲减及妊娠合并亚临床甲减病例中有3例早产,其余22例患者维持至足月妊娠.其中剖宫产15例,会阴侧切分娩3例,自然分娩7例,合并妊娠期高血压疾病5例,妊娠期糖尿病3例,合并贫血19例,新生儿无先天性甲减及畸形.产后随访15例2年,小儿体格及其智力发育无异常.结论:妊娠合并甲状腺功能减退症患者及时给予足量甲状腺激素替代治疗,可有效预防不良妊娠结局,减少先天甲低及其它畸形胎儿的出生.但孕妇多种妊娠并发症的发病率仍较高,应加强高危人群的早期筛查、治疗.     

25例妊娠合并甲状腺功能减退症临床结局分析

目的:对妊娠合并甲状腺功能减退症进行分析,探讨其治疗及对胎儿的影响。方法:对我院25例妊娠合并甲减的临床资料进行回顾性分析。结果:25例妊娠合并甲减及妊娠合并亚临床甲减病例中有3例早产,其余22例患者维持至足月妊娠。其中剖宫产15例,会阴侧切分娩3例,自然分娩7例,合并妊娠期高血压疾病5例,妊娠期糖尿病3例,合并贫血19例,新生儿无先天性甲减及畸形。产后随访15例2年,小儿体格及其智力发育无异常。结论:妊娠合并甲状腺功能减退症患者及时给予足量甲状腺激素替代治疗,可有效预防不良妊娠结局,减少先天甲低及其它畸形胎儿的出生。但孕妇多种妊娠并发症的发病率仍较高,应加强高危人群的早期筛查、治疗。     

甲状腺功能异常与妊娠不良结局的关系研究新进展

<正>甲状腺功能异常是由多种因素导致的甲状腺激素分泌及合成发生变化,从而引起的全身性代谢综合征。根据甲状腺激素的浓度分为甲状腺功能亢进症(简称甲亢)和甲状腺功能减退症(简称甲减)。有文献报道妊娠合并甲状腺功能异常的发病率呈现逐年上升的趋势~([1])。而妊娠与甲状腺功能异常相互影响,及时的诊断和治疗甲状腺功能异常是改善妊娠不良结局的关键,从而保证母婴健康,达到优生的目的。1甲亢与妊娠     

软坚消瘿颗粒联合左甲状腺素钠片治疗桥本甲状腺炎伴甲状腺功能减退临床疗效

目的探讨软坚消瘿颗粒联合左甲状腺素钠片治疗桥本甲状腺炎伴甲状腺功能减退的临床疗效。方法选取2018年1—9月于北部战区总医院门诊就诊的120例桥本甲状腺炎伴甲状腺功能减退患者为研究对象。采用随机数字表法将患者分为常规组与观察组,每组各60例。常规组给予口服左甲状腺素钠片治疗,观察组给予口服软坚消瘿颗粒联合左甲状腺素钠片治疗。两组连续给药6个月后,比较两组患者治疗前后中医症候疗效、甲状腺功能[血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、血清促甲状腺素(TSH)]及甲状腺相关抗体水平[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)]的差异。结果观察组治疗有效率为93.3%(56/60),高于常规组的51.7%(31/60),差异有统计学意义(P<0.05)。两组治疗后TSH、FT3、FT4、TPOAb、TgAb水平均优于各组治疗前,差异有统计学意义(P<0.05);且治疗后,观察组的TSH、FT4、TPOAb、TgAb水平优于常规组,差异有统计学意义(P<0.05)。结论软坚消瘿颗粒联合左甲状腺素钠片治疗桥本甲状腺炎伴甲状腺功能减退临床疗效显著。     

甲状腺功能检测异常954例结果分析

目的了解我院周边人群甲状腺功能异常的情况。方法采用酶联免疫法对2009年1月-2013年12月来我院检查甲状腺功能的患者血清游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)及促甲状腺激素(TSH)进行检测,对954例检测异常的结果进行分析。结果在检测出的954例异常病例中,女性病例数显著多于男性,各异常类型的比例大小依次为甲亢>亚临床甲亢>亚临床甲减>甲减。原发性甲亢、甲减、继发性甲亢、甲减的例数分别为208、25、36、4,还有167例甲亢和56例甲减的类型无法做出判断。结论我院周边人群甲状腺功能异常类型以甲亢为主,男性患病率低于女性;甲功三项检测有其局限性,临床医生应结合其他检查作出诊断。     

血清维生素D水平与桥本氏甲状腺炎的相关性研究

目的 探讨血清维生素D水平与桥本氏甲状腺炎(hashimoto’s thyroiditis, HT)的关系。方法 选取2021-10至2022-05在武警安徽总队医院就诊的HT患者160例作为病例组，其中男38例，女122例，同时选取医院体检中心健康体检者160例作为对照组，其中男43例，女117例。收集两组患者的年龄、性别、体重指数(BMI)、吸烟史相关资料及促甲状腺素(TSH)、三碘甲状腺原氨酸(T₃)、游离三碘甲状腺原氨酸(FT₃)、甲状腺素(T₄)、游离甲状腺素(FT₄),甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、25羟维生素D[25(OH)D]数据。病例组再分3组：就诊时甲功正常组(HT1组),就诊时甲功异常组(包括甲减、亚临床甲减、甲亢、亚临床甲亢)(HT2组),以及已接受左甲状腺素或抗甲状腺药物治疗组(无论目前甲功是否正常)(HT3组)。结果 病例组25(OH)D水平较对照组均明显降低。对照组25(OH)D的缺乏率为47.68%,病例组维生素D缺乏率均较对照组高...     

Is it safe to treat hyperthyroid patients with I-131 without fear of thyroid storm?

OBJECTIVES: Thyroid storm is extremely rare. However, hyperthyroid patients with severe thyrotoxicosis are frequently not treated immediately with I-131 for fear of thyroid storm but are placed on thiouracil drugs for varying periods of time. We demonstrate herein that it is safe to treat these patients with 1-131, without pretreatment with thiouracil drugs, provided they do not have complicating intercurrent disease. Our definition of severe hyperthyroidism includes marked signs and symptoms of thyrotoxicosis, suppressed TSH, markedly elevated free T4 and/or free T3 and elevated radioactive iodine uptake (RAIU) (>30%) at 4 or 24 hours. Our diagnostic criteria for thyroid storm include two or more findings of fever (>38 degrees C, 100 degrees F), severe tachycardia, high pulse pressure, agitation with tremors, flushing, sweating, heart failure, nausea, vomiting, diarrhea, jaundice associated with high free T4 and/or free T3. METHODS: Patients were selected retrospectively for the period between August 2003 and December 2004. One hundred and twenty-two patient visits were identified. These patients were treated with 370-740 MBq (10-20 mCi) of I-131 and were evaluated for any evidence of thyroid storm. Most of the patients were placed on beta blocker drugs at the time of initial I-131 therapy; these were continued for at least two months, when the first follow-up visit occurred. At the time of I-131 therapy, it is our policy to educate the patients to seek immediate medical attention for exacerbation of symptoms of thyrotoxicosis. RESULTS: Not one of these patients developed thyroid storm. A subset of 25% of these cases with higher potential for thyroid storm (RAIU more than 65%, very marked signs and symptoms, and very markedly elevated free T4 and/or free T3) also tolerated the I-131 therapy well with marked clinical improvement and no exacerbation of the thyrotoxic state. CONCLUSION: It is safe to administer I-131 to patients who are severely hyperthyroid without fear of thyroid storm, provided beta blockade drugs are used to control the signs and symptoms; patient education is also important. With these steps, 4-6 weeks of prior medical treatment may not be necessary.     

Radiation exposure of the families of outpatients treated with radioiodine (iodine-131) for hyperthyroidism

Patients who receive radioiodine (iodine-131) treatment for hyperthyroidism (195–800 MBq) emit radiation and represent a potential hazard to other individuals. Critical groups amongst the public are fellow travellers on the patient’s journey home from hospital and members of the patient’s family, particularly young children. The dose which members of the public are allowed to receive as a result of a patient’s treatment has been reduced in Europe following recently revised recommendations from ICRP. The annual public dose limit is 1 mSv, though adult members of the patient’s family are allowed to receive higher doses, with the proviso that a limit of 5 mSv should not be exceeded over 5 years. Unless the doses received during out-patient administration of radioiodine can be demonstrated to comply with these new limits, hospitalisation of patients will be necessary. The radiation doses received by family members (35 adults and 87 children) of patients treated with radioiodine at five UK hospitals were measured using thermoluminescent dosimeters mounted in wrist bands. Families were given advice (according to current practice) from their treatment centre about limiting close contact with the patient for a period of time after treatment. Doses measured over 3–6 weeks were adjusted to give an estimate of values which might have been expected if the dosimeters had been worn indefinitely. Thirty-five passengers accompanying patients home after treatment also recorded the dose received during the journey using electronic (digital) personal dosimeters. For the ”adjusted” doses to infinity, 97% of adults complied with a 5-mSv dose limit (range:0.2–5.8 mSv) and 89% of children with a 1-mSv limit (range: 0.2–7.2 mSv). However 6 of 17 children aged 3 years or less had an adjusted dose which exceeded this 1 mSv limit. The dose received by adults during travel was small in comparison with the total dose received. The median travel dose was 0.03 mSv for 1 h travel (range: 2 μSv-0.52 mSv for 1 h of travel time). These data suggest that hyperthyroid patients can continue to be treated with radioiodine on an out-patient basis, if given appropriate radiation protection advice. However, particular consideration needs to be given to children aged 3 years or younger. Admission to hospital is not warranted on radiation protection grounds. Received 31 December 1998 and in revised form 20 March 1999     

成人亚临床甲状腺功能减退症替代治疗疗效观察

目的探讨左旋甲状腺素替代治疗成人亚临床甲状腺功能减退症（亚临床甲减）的临床疗效。方法成人亚临床甲减46例，在诊断初和经左旋甲状腺素治疗4周、12周时分别测定空腹血清总甲状腺素（TT4）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）。结果亚临床甲减可致血脂增高，替代治疗12周后，甲状腺功能逐渐恢复正常，TC、LDL-C明显下降，HDL无明显变化。结论亚临床甲减患者接受左旋甲状腺素替代治疗可使甲状腺功能逐渐恢复正常，并可带来临床症状及血脂改善等益处。故对高危人群的筛查及针对性地行左旋甲状腺素替代治疗是必要的。     

原发性甲状腺功能减退对尿酸影响的临床观察

目的：研究原发性甲状腺功能减退（甲减）与尿酸的关系并探讨其可能的发生机制。方法测定36例甲减患者的甲状腺功能（ FT3、FT4和TSH）、甲状腺自身抗体（ Anti-TG、Anti-TPO和TRAb）、血尿酸（ UA）、血脂、同型半胱氨酸（Hcy）、胱抑素（Cys）、β2微球蛋白（β2MG）以及24 h尿尿酸定量（24hUA）,并与20例健康对照进行比较。甲减患者根据Anti-TG、Anti-TPO、TRAb存在与否分为桥本（HT）甲减（27例）和非HT甲减（9例）两个亚组,并行亚组间比较。结果与健康对照组比较,甲减组TSH、TC、TG、LDL-C、UA、Hcy、Cys和β2 MG明显高于对照组,而FT3、FT4、HDL-C和24hUA显著低于对照组,均P＜0．05;两亚组之间甲状腺功能及抗体、TC、LDL-C、UA和24hUA也有显著性差异。结论甲减患者更容易出现高尿酸血症,可能与甲状腺激素减少、脂代谢紊乱、高Hcy有关;HT甲减比非HT甲减UA水平更高提示自身免疫异常可能在高尿酸血症的发生中也发挥着重要作用。     

垂体促甲状腺激素分泌瘤5例报告并文献复习

目的 探讨垂体促甲状腺激素(TSH)分泌瘤所致中枢性甲亢的临床特点.方法 对1992～2006年在解放军总医院确诊和治疗的5例垂体TSH分泌瘤患者的临床资料进行回顾性分析,并结合文献资料进行总结.5例患者中男性4例、女性1例,平均年龄39.8(26～51)岁,平均病程为5.84(0.6～16)年.结果 5例垂体TSH分泌瘤占解放军总医院同期诊断的垂体腺瘤的0.33%(5/1 500).所有患者均伴有甲状腺毒症,其中4例为首发症状,例为视物模糊,所有患者均没有视野缺损.确诊之前误诊为原发性甲亢接受抗甲状腺药物治疗者3例,治疗6～16年,其中1例曾2次行甲状腺手术治疗.5例患者均有甲状腺激素水平增高,同时不伴TSH抑制(3.94～54.7mU/L);3例患者行促甲状腺激素释放激素(TRH)兴奋TSH试验,例无反应、1例呈过强反应.鞍区MRI检查4例为大腺瘤(直径1.5～3.6cm),例为微腺瘤.4例大腺瘤患者均行经口鼻蝶入路垂体瘤切除术,术后病理均证实为垂体腺瘤,例术后联合垂体放射治疗.术后1～2周复查血清甲状腺激素和TSH水平正常,随访3～32个月甲状腺功能仍正常.结论 甲状腺毒症患者血清TSH水平不被抑制时应警惕垂体TSH分泌瘤的存在,鞍区影像学检查可以进一步明确诊断,垂体TSH分泌瘤经口鼻蝶入路垂体腺瘤切除术联合垂体放射治疗可获得良好疗效.     

餐后血脂抑制甲状腺功能减退症患者的内皮依赖性血管舒张功能

目的探讨临床甲状腺功能减退症(简称甲减)和亚临床甲减患者餐后血脂与血管内皮功能的关系。方法选择10名正常女性受试者为对照组,20名甲减患者分成两组:临床甲减组与亚临床甲减组(每组各10例)。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油(GNT)介导的内皮非依赖性血管舒张功能。结果餐后血脂引起甲减患者血管内皮功能异常与三酰甘油和自由基水平密切相关。脂肪餐负荷试验中,甲减患者及正常对照组在餐后4 h时,内皮依赖性血管舒张功能降低(P<0.05),对照组和亚临床甲减组患者在8 h时内皮依赖性血管舒张功能恢复到基线水平,亚临床甲减组患者在6 h时内皮依赖性血管舒张功能低于基线水平(P<0.05)。然而,临床甲减组患者在进食脂负荷餐后6 h时内皮依赖性血管舒张功能继续下降(P<0.01),在8 h时开始升高,但仍低于基线水平(P<0.05)。Spearman’s分析显示甲减组(P<0.01)和对照组患者(P<0.05)进食脂负荷餐后内皮依赖性血管舒张功能与三酰甘油﹑硫代巴比土酸反应物质(TBARS)水平呈负相关,而三酰甘油水平与TBARS水平呈正相关。结论进食脂负荷餐后,甲减患者和正常对照组的内皮依赖性血管舒张功能降低,且与血清三酰甘油和氧自由基水平密切相关。     

甲状腺功能减退症34例骨骼X线分析

目的　探讨甲状腺功能低下的X线改变 ,提高对该病X线改变的认识和诊断。方法　对 3 4例甲状腺功能低下骨龄落后状况、X线改变与甲状腺功能 (TT3 ,TT4)以及智力障碍程度对比分析。对骨龄与骨皮质厚度的关系和正常对照组对比分析 ,了解有无明显骨皮质厚度落后于骨龄的改变。结果　该病骨龄严重落后 ,骨龄与年龄的直线回归方程为y =0 .75 89x -3 .692 8(t =4.417,P <0 .0 5 ) ,骨龄落后与TT3 、TT4低下的程度无明显关系 (P >0 .0 5 ) ,骨骼改变主要是软骨不能正常骨化等引起的一系列X线改变。骨骼异常X线表现的出现与TT3 、TT4低下的程度有关 (P <0 .0 5～ 0 .0 1) ,TT4越低 ,骨骼X线改变出现率越高 (P <0 .0 5 )。智力障碍明显低下者骨龄落后显著 (P <0 .0 5 ) ,用该症的骨龄与正常年龄 (骨龄 )对比皮质厚度无明显改变 (P >0 .0 5 )。结论　本症的骨骼X线改变结合骨龄严重落后可对本症做出诊断。骨骼X线改变 ,及骨龄与年龄的骨皮质改变关系可为临床提供疗效评价依据。     

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.     

131I治疗甲亢后61例早发甲状腺功能减低分析

目的分析131I治疗甲亢后发生早发甲状腺功能减低(甲减)的转归及与转归有关的因素.方法 61例甲亢经131I治疗后的早发甲减患者,随访1年以上,根据随访结果分为暂时性甲减组(包括转为正常或甲亢者)和永久性甲减组,比较了两组间早发甲减的出现时间、性别、TGA和TMA、甲状腺重量、131I治疗剂量、甲状腺摄碘率峰值.结果 61例患者中有一半以上为暂时性甲减(3.3%转为甲亢,50.4%转为正常).根据甲减出现的时间不同分为≤3个月、4～6个月、>6个月,131I治疗6个月后出现的甲减均为永久性甲减.其他参数与早发甲减的转归无关.结论早发甲减绝大多数为暂时性甲减,甲减出现的时间可能与其转归有关.     

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.