手术对甲状腺机能亢进患者T3,T4,TGA,TMA,TSH及皮质醇的影响

对３０例甲状腺机能亢进患者手术前后血清甲状腺激素（Ｔ３、Ｔ４）、促甲状腺激素（ＴＳＨ）、甲状腺球蛋白抗体（ＴＧＡ０、甲状腺微粒体抗体（ＴＭＡ）及皮质醇进行测定。结果：行甲状腺大部切除术后患雾血清Ｔ３、Ｔ４、ＴＭＡ、ＴＧＡ在短期内迅速下降，皮质醇则在原低下的水平上更趋下降，而ＴＳＨ的变化不大。甲太腺大部切除术对非甲状腺机能亢进患者的上述指标影响不大。因此，此类激素和抗体的测定对判断手术效果及预防甲状     

低T3综合症与危重症

许多研究发现。严重非甲状腺疾病可以引起甲状腺激素(TH)的代谢异常,表现为低T_3和/或低T_4,促甲状腺激素(TSH)正常,称为正常甲状腺功能病态综合症或低T_3综合症。本文目的在于阐述低T_3综合症与严重应激状态、危重疾病的关系、临床意义及发生机制。     

甲状腺机能亢进症围手术期T_3、T_4值变化及其意义的探讨

甲状腺机能亢进症(下称甲亢)手术后发生甲状腺危象(下称危象)的发病机理迄今尚未肯定。但有人认为手术应避免过度挤压甲状腺组织,防止大量甲状腺素入血引起危象。本院1986～1989年对30例甲亢病人做了前瞻性围手术期血清三碘原氨酸(简称T_3)和甲状腺素(简称T_4)值的测定,并探讨了甲亢手术时机和T_3、T_4值变化的意义。     

甲状腺部分切除术后甲状腺功能减退的相关原因分析

目的　探讨继发于部分甲状腺 ( 5 0 %～ 70 % )切除术后甲状腺功能减退 (甲减 )的发病率和相关原因。方法　回顾性分析 1988～ 2 0 0 0年行部分甲状腺切除术 12 10例患者的临床资料 ,包括年龄、性别、血清TSH水平、甲状腺球蛋白抗体 (TGA )、甲状腺过氧化物酶抗体 (TPO )、切除甲状腺组织重量等 ,以确定外科术后甲减的发生率和相关原因。结果　 12 10例中有 41例 ( 3 .4% )诊断为甲减 ,其中亚临床甲减 2 8例 ,临床甲减 13例。术后TSH平均水平为 ( 9.2 2± 3 .3 6)mU /L。与甲状腺功能正常患者的术前TSH水平 [( 1.0 7± 0 .72 )mU /L]相比 ,甲减者术前TSH平均水平 [( 3 .14±1.0 5 )mU /L ]明显升高 (P 0 .0 5 ) ;术前、术后的TGA及TPO水平比术后功能正常者明显升高 (P 0 .0 5 )。在年龄、性别或切除甲状腺组织重量上无显著性差异。平均甲状腺片的有效治疗剂量为1mg/ (kg·d) [范围 0 .3～ 1.3mg/ (kg·d) ]。 结论　继发于部分甲状腺切除术后的甲减常见于术前TSH和甲状腺自身抗体水平较高的病例 ,而与年龄、性别或切除甲状腺组织重量等因素无关 ,通常是症状轻微或无症状者 ,且用小剂量的甲状腺激素治疗效果良好。     

甲状腺腺叶切除术对甲状腺结节患者甲状腺激素水平的影响分析

目的探讨单侧甲状腺切除术对甲状腺结节患者甲状腺激素的影响。方法回顾性医院2014年1月至2016年1月经B超等检查证实为甲状腺结节的90例患者临床资料。行单侧甲状腺结节腺叶切除术,为治疗组;另选取同期健康体检的健康人群90例作为研究对照组。比较两组血清甲状腺激素水平。结果治疗组患者术前血清甲状腺激素水平处于正常范围内,且与对照组相比较,P0.05;治疗组术后1周与术前比较,T_3水平则明显下降,TSH水平明显升高,P0.05;术后1个月血清T_3、T_4水平明显下降,TSH明显升高,P0.05。术后3个月血清各项甲状腺激素水平均恢复至正常范围,与术前比较,P0.05。结论应用单侧甲状腺腺叶切除术治疗甲状腺结节可致患者出现暂时性甲状腺功能不全,所以临床可予以激素替代治疗。     

结节性甲状腺肿术后甲状腺激素水平的变化及其对抑制治疗的意义

目的:研究结节性甲状腺肿(甲肿)患者甲状腺切除术后血清甲状腺激素水平的变化,探讨术后抑制治疗的起始时间、剂量与腺体切除范围的关系。对象与方法:26例女性甲肿患者分为单侧切除组(n=17)和双侧切除组(n=9),术前、术后第五天和术后3周分别检测血清甲状腺激素水平,配对比较前后变化。术后予甲状腺片对s-TSH作部分抑制治疗。结果:单侧切除组术后第五天,T_4、FT_4(P<0.05)较术前升高,s-TSH明显降低(P<0.01),但术后3周与术前比较无明显变化。双侧切除组术后甲状腺激素水平呈逐渐下降,至术后3周T_4、FT_4较术前明显降低(P<0.05)。两组服抑制剂量的甲状腺片分别平均为42.7mg/d±12.79mg/d和67.5mg/d±14.9mg/d(P<0.01)。结论:术后短期甲状腺激素水平变化与腺体切除范围有关。术后两周内不宜开始抑制治疗。单侧切除组所需抑制性外源甲状腺激素较双侧切除组量少,s-TSH水平监测有助于药量调整,以避免抑制不足或过分抑制。     

不同手术方法对甲状腺切除术患者血清甲状腺激素水平的影响

目的:探讨不同手术方法对甲状腺切除术患者血清甲状腺激素水平的影响。方法:选取行甲状腺切除术的120例患者为研究对象,其中40例单侧腺叶切除术,40例双侧次全切除术,40例全切除术。全切除术组在术后给予替代治疗,将单侧腺叶切除术和双侧次全切除术两组按照术后治疗方法的不同分为观察组和对照组,观察组给予替代治疗,对照组不给予。分析各组在术前,术后10 d,1个月,3个月时的总三碘甲状腺原氮酸(TT3),总甲状腺激素(TT4),游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)的变化。结果:单侧腺叶切除术和双侧次全切除术两对照组的FT3和FT4在术后10 d时较术前显著降低(P<0.05);双侧次全切除术对照组术后及1个月FT3和FT4均低于术前水平(P<0.05),3个月时恢复。单侧腺叶切除术和双侧次全切除术观察组和全切除术组各时间段甲状腺激素水平无统计学差异(P>0.05)。结论:甲状腺切除术在术后一段时间内会引起甲状腺激素水平降低,需采用替代疗法,以弥补术后出现甲状腺功能不足。     

甲亢手术前后血清游离甲状腺素水平变化

用放射免疫分析法(RiA)检测86例甲亢手术前后患者及100例健康人血清FT_3、FT_4、TSH水平并进行了分析比较,结果显示:手术前甲亢患者血清FT_3、FT_4水平与正常对照组有非常显著性差异(P<0.01),TSH有显著性差异(P<0.05),甲亢手术后有81例甲亢症状消失,FT_3、FT_4、TSH均与正常水平相接近(P>0.05),2例甲亢复发,5例出现甲低(甲状腺功能低下)症状。提示:甲状腺激素水平测定为甲亢手术前的诊断及手术后病情变化和予后估价提供了可靠的指标。     

甲状腺腺叶切除术后血清甲状腺激素水平的变化

目的　探讨甲状腺良性结节行单侧腺叶切除术后血清T3 、T4、TSH的变化及其替代治疗。方法　前瞻性随机选择单侧甲状腺良性结节患者4 8例,以4 5岁为界分为两组,行单侧腺叶切除术,术后不服用甲状腺素片。观察术后第5天、1个月、3个月、6个月、12个月血清TT3 、TT4、FT3 、FT4、TSH的变化。结果　甲状腺腺叶切除术后血清TT3 、TT4无显著变化;4 5岁以上组FT3 、FT4分别在术后第5天和1个月呈一过性降低(F =7. 85 3,F =4. 2 4 7,P <0 . 0 1) ,4 5岁以下组FT3 、FT4的变化不明显;TSH则在术后第5天至12个月均高于术前(F =6. 134,P <0 . 0 1) ,1个月后呈下降趋势。结论　甲状腺良性结节行单侧腺叶切除术后甲状腺功能在一定时间内可以自我调节代偿,但年龄大或较年轻代偿能力差者,需进行适当的替代治疗。     

血清TSH及TPOAb、TgAb水平在桥本氏甲状腺炎中的表达及临床意义分析

目的探讨血清促甲状腺激素(thyroid stimulating hormone, TSH)、甲状腺球蛋白抗体(thyroglobulin antibody, TgAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody, TPOAb)在桥本氏甲状腺炎(Hashimoto’s thyroiditis, HT)中的诊断价值。方法在淮安市第一人民医院2019年10月至2022年10月收治的甲状腺疾病患者中选取90例, 包括HT 30例(A组)、毒性弥漫性甲状腺病30例(B组)、甲状腺功能减退症30例(C组), 另选取体检健康人30例作为对照组, 对比所有患者的临床资料及血清指标水平。结果 4组年龄、性别、体重指数(body mass index, BMI)、家族史、吸烟史、饮酒史差异无统计学意义(χ2=0.327、1.358、0.231、1.617、0.592、0.889, P=0.806、0.716、0.875、0.655、0.898、0.828)。4组TSH水平分别为(7.25±1.36)、(1.31±0.25)、(6.58±1.16)、(2.28±0.75...     

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目的 探讨亚急性甲状腺炎药物治疗效果及甲状腺功能与形态变化特点。方法：对２９例病人应用超声显像法观察甲状腺的形态变化，用放免法测定甲状腺素（Ｔ３、Ｔ４）甲状腺微粒体抗体（ＴＭＡ）、甲状腺球蛋白抗体（ＴＧＡ）及促甲状腺素的变化，结果 １６例Ｔ３、Ｔ４增主贩病人，治疗后Ｔ３、Ｔ４明显下降。８例ＴＧＡ、ＴＭＡ增高的病人，治疗后ＴＧＡ、ＴＭＡ恢复正常。１８便腺体增大者，经治疗后体积恢复正常。有１例炎症消退     

Thyroid hormone changes after cardiovascular surgery and clinical implications

Alterations in serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) frequently occur in patients with nonthyroidal illnesses. These changes correlate with the severity of the illness and the prognosis. In this study, 44 patients undergoing a cardiovascular operation had significant declines in serum TT3 and TT4 levels during cardiopulmonary bypass and thereafter. Serum TT3 and TT4 concentrations reached their nadir at 30 minutes after the start of cardiopulmonary bypass with values (mean +/- standard error of the mean) of 0.77 +/- 0.12 nmol/L (50.4 +/- 7.6 ng/dL) and 68.2 +/- 10.2 nmol/L (5.30 +/- 0.79 micrograms/dL), respectively. The mean serum concentrations of TSH and TT4 returned to preoperative levels by the sixth day after operation, whereas TT3 levels remained low throughout the study period. The patients whose recovery was uneventful had higher serum TT3, TT4, and TSH levels than those who had complications or died. The trend toward recovery was initiated by a sharp increase in the serum TSH level and increases in serum TT3 and TT4 concentrations on the fourth day after operation. Patients with complications either did not show these changes or had only a transient increase in TT3 and TT4 levels. All of the patients had a normal serum free T4 level before anesthesia. Those with an uneventful recovery had a higher serum free T4 level on the sixth day after operation than those with complications. Two patients in the latter group had serum free T4 levels less than normal at that time.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes of hypothalamo-pituitary-thyroid function after open heart surgery--especially evaluated by TRH test

Changes of pituitary and thyroid functions after operation were studied in the cases with cardiopulmonary bypass (ECC group) and without bypass (Control group). To know mechanisms of these changes, reaction of hypothalamo-pituitary-thyroid axis by using thyrotropin-releasing hormone (TRH) test and influence of serum cortisol level were examined. Serum concentrations of free T3, free T4 and TSH decreased after open heart surgery. The levels of TSH and free T4 were recovered at the second or third post operative day in Control group, but remained low level at the third POD in ECC group. The level of free T3 continued low level at the 7th POD. The feedback mechanism of the hypothalamo-pituitary-thyroid system was not seen in this series. The response of TSH and free T3 due to TRH test decreased in ECC group, and it was suppressed more clearly in the cases of longer bypass than in those of shorter ones. Serum cortisol level was significantly increased at the 3-hours after the operation in ECC group, and was more increased in the cases of longer bypass than in those of shorter ones. The results indicate that the pituitary and thyroid function on the post bypass period remains euthyroid sick syndrome and hypothalamo-pituitary axis remains suppressed state. Those phenomenon suggest that TRH test may be useful in evaluation of the intensity of surgical stress, especially in those who undergo the cardiopulmonary bypass.     

甲状腺腺瘤术后内分泌治疗的研究

目的 探讨甲状腺腺瘤术后内分泌治疗的必要性。方法 对１００例次手术后甲状腺腺瘤标本用ＳＰ法测定ＴＳＨ受体,瘤体周围的甲状腺组织连续病理切片检查有无存在微小瘤灶,并按随机抽签法将病人分成Ａ、Ｂ两组,Ａ组口服甲状腺片治疗,Ｂ组不用任何治疗。术后定期测定血Ｔ３,Ｔ４,ＴＳＨ浓度,＾１３１Ｉ扫描及Ｂ超检查残存甲状腺。结果 甲状腺瘤１００％存在ＴＳＨ受体,８％有微小瘤灶。Ａ组病人血Ｔ３,Ｔ４,ＴＳＨ及残存甲     

Spontaneous pituitary-thyroid function after surgical treatment of nontoxic goitre. A controlled long-term study

The free thyroxine index (FT4I), triiodothyronine (T3) and thyroid stimulating hormone (TSH) in serum and the peak serum TSH (TRH test) were measured in 18 patients with nontoxic uninodular goitre and 32 patients with nontoxic multinodular goitre before and 3, 6, 12, 24 and 36 months after goitre resection. Thyroid hormone therapy was not given postoperatively. Resection of non-toxic goitre provoked a transient rise in TSH baseline level, with peak about one year after surgery. Three years after the resection the TSH baseline had returned to the preoperative level. The TSH changes were significantly more pronounced in the multinodular goitrous group, in which resection was bilateral, than in the uninodular goitrous group. The changes in serum FT4I and serum T3 were of moderate degree and most pronounced in the multinodular group. During long-term observation, serum FT4I increased slightly but significantly in both groups, but serum T3 showed significant reduction, albeit within reference range. The results of the study suggest that thyroid hormone therapy as a routine procedure after simple goitre resection lacks a tenable rational basis.     

不同年龄患者甲状腺腺叶切除术后甲状腺功能变化的研究

目的：探讨不同年龄甲状腺良性肿瘤患者行单侧腺叶切除术后甲状腺功能的变化及激素替代治疗的必要性。 方法：将120例因甲状腺良性肿瘤行单侧腺叶切除术的患者根据年龄不同分为青年组（≤30岁,23例）、中年组（<30~<60岁,69例）、老年组（≥60岁,28例）,检测各组患者术前及术后1周,1、3、6个月,1、2年游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）水平。 结果：青年组FT3水平在术后1周、1个月时较术前明显降低（P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）;FT4水平术后各时间较术前均无明显变化（P>0.05）;TSH水平在术后1周,1、3个月时较术前比明显升高（均P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）。中年组术后各时间点FT3、FT4、TSH与术前比较均无统计学差异（P>0.05）。老年组患者FT3水平在术后1周,1、3个月时较术前明显降低（P>0.05）,后期各时间点则术前无统计学差异（P>0.05）;FT4水平在术后1、3、6个月时较术前明显降低（P<0.05）,其余各时间点则与术前无统计学差异（P>0.05）;TSH水平在术后1周,1、3、6个月时均较术前比升高（P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）。3组患者均未出现临床甲状腺功能减退症状。 结论：不同年龄甲状腺良性肿瘤患者行单侧腺叶切除术后甲状腺功能恢复情况不同。中年患者术后代偿能力强,可不予激素替代治疗;青年对甲状腺激素需求量相对较大而老年患者代偿能力较差,故青年患者术后半年内、老年患者术后1年内给予激素替代治疗较合适。     

二氧化碳气腹对术中血浆甲状腺素影响的观察

目的：探讨腹腔镜胆囊切除术（LC）中CO2气腹对甲状腺功能的影响。方法：全麻下胆囊切除术60例随机分为LC组（30例）和非腹腔镜组（30例）,于术前1日及术中不同时期抽取静脉血标本,用放射免疫法检测血浆甲状腺（TT3,TT4,FT3,FT4,rTs,TSH)的变化,结果：60例患者术前甲腺素水平均为正常。LC气腹后TT3,TT4,TSH升高（P＜0．01,与术前相比）,非腹腔镜者术中TT3有所一降。结论：LC术中甲状腺功能增强可能与CO2气腹有关。     

Altered hormonal activity in severely ill patients after injury or sepsis

We studied the hormonal millieu and possibility of altered thyroid function in 25 patients in a surgical intensive care unit (ICU) who had severe life-threatening illnesses. Sixteen patients had septic complications and nine patients had multiple-system injuries. On admission to the ICU, serial measurements were begun of thyroxine (T4), triiodothyronine (T3), T4-binding globulin, thyrotropin (thyroid-stimulating hormone [TSH]), corticotropin (adrenocorticotropic hormone [ACTH]), cortisol, prolactin, human growth hormone, catecholamine, insulin and glucose, lactate, retinol-binding protein, prealbumin, and transferrin levels. All patients initially had low normal levels of T4 (4.5 +/- 2 micrograms/dL) and T3 (55 +/- 26 ng/dL), with normal TSH levels (2.3 +/- 2.3 microU/mL) (the "low T3 syndrome"). The 11 surviving patients had their levels increase to normal before leaving the ICU (T4, 7.0 +/- 2.1 micrograms/dL; T3, 110 +/- 48 ng/dL; and TSH, no change). The 14 patients who died showed further decreases before death (T4, 2.6 +/- 2.1 micrograms/dL; T3, 30.6 +/- 23.5 ng/dL; and TSH, 0.9 +/- 0.7 microU/mL). The corticotropin, cortisol, prolactin, and growth hormone levels were normal throughout the study. Catecholamine levels were high initially and decreased in surviving patients. Epinephrine levels increased greatly in nonsurvivors before death, and the norepinephrine-epinephrine ratio decreased from 5.7:1 to 2:1. After protirelin (thyroid-releasing hormone [TRH]) stimulation, the TSH level increased either minimally or not at all in six patients who eventually died. This indicates hypothalamic-pituitary dysregulation or suppression, and altered release and/or peripheral metabolism of T4. Whether this represents a deficiency of thyroid hormone for cell and organ function remains to be established.     

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目的 探讨辅助检查在诊断亚急性甲状腺炎中的作用。方法 回顾分析372例亚急性甲状腺炎病人所做的各项辅助检查结果。结果 血沉，B超，彩色多普勒，甲状腺核素扫描，甲状腺吸^131I率测定，细针穿刺细胞学，TMA，TGA等项检查诊断本病的阳性率分别为93.75%,81.63%,95.62%,89.66%,69.70%,89.41%,13.46%和9.62%。T3，T4，TSH检查结果随着病程的进展变化较大。结论 血沉检查对诊断本病缺乏特异性；彩色多普勒，细针穿刺细胞学检查诊断率高，特异性强，是首选的检查手段；甲状腺核素扫描可以准确地反映甲状腺功能状态；检测血清中T3，T4，TSH水平可以协助诊断本病，判断疾病所处时期。     

Effect of anesthesia and surgery on immunity in patients with benign and malignant diseases

The effect of anesthesia and surgery in patients with benign and malignant diseases was investigated applying two color analysis for the classification of functional lymphocyte subpopulation. Eight patients with benign diseases and twelve patients with malignancies were studied. Peripheral lymphocyte subsets were measured before, during and after operation using monoclonal antibodies; OKT3 (Leu4), OKT4 (Leu3a), OKT8 (Leu2a), Leu11, OKT11 (Leu5b), Leu12, HLA-Dr. Decrease in OKT4, OKT4/OKT8 ratio, Leu12 and HLA-Dr, and increase in OKT8 were observed during the operation. In addition to these measurements, two color analysis utilizing two kinds of monoclonal antibody, such as Leu3a and Leu8, or Leu2a and Leu15 was performed. Inducer T cells decreased and suppressor T cells increased during the operation. These changes suggest immuno-suppression throughout the operation. These changes returned to control levels in three days after the operation.