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甲状腺疾病在不同的年龄阶段呈现不同的演变规律,由于老年人甲状腺激素合成、代谢、下丘脑-垂体调控以及甲状腺自身免疫的特点,使得包括甲状腺功能亢进和减退、结节性甲状腺肿、甲状腺癌在内的各种甲状腺相关疾病在发病机制、临床症状、诊断以及治疗措施方面与年轻人均有明显的差异。因而,熟练掌握老年性甲状腺疾病的规律,对于提高老年患者的甲状腺疾病的诊断治疗水平有着重要的临床意义。     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

Community-based study of the association of subclinical thyroid dysfunction with blood pressure

The relationship between subclinical thyroid dysfunction and blood pressure has been controversial and received unsufficient attention. Thus, we performed a cross-sectional study conducted among 6,992 inhabitants from six districts of Jiangsu Province to investigate the association of subclinical thyroid dysfunction with blood pressure in China. The data from 6,583 subjects (4,115 women and 2,468 men) were included and divided into three groups: euthyroidism (n = 5669, 86.11%), subclinical hyperthyroidism (n = 108, 1.65%), and subclinical hypothyroidism (n = 806, 12.24%). In the groups with subclinical hypothyroidism and hyperthyroidism, systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure were not significantly different from those in the groups with euthyroidism after being adjusted for age, sex, BMI, and smoking status (P > 0.05). More extensively, the SBP and DBP in the group of subclinical hypothyroidism with lower level of TSH (TSH 4.51–10.00 mIU/l, SCH₁) were significantly higher than those of participants with euthyroidism (P < 0.05). Multivariable logistic analysis revealed that subclinical hypothyroidism with lower TSH (TSH 4.51–10.00 mIU/l) was an independent risk factor for increased SBP (OR = 1.28, 95% CI 1.03–1.59, P = 0.028). Similar results could not be found between groups of euthyroid and subclinical hypothyroid with higher level of TSH (TSH > 10 mIU/l, SCH₂). Further subdivision of the euthyroid group on the basis of a TSH cut-off of 2.5 mIU/l, revealed still no significant difference in blood pressure after adjustment regardless of whether the TSH levels were in the lower reference (TSH 0.40–2.50 mIU/l, n = 4093) or in the upper reference ranges (TSH 2.51–4.50 mIU/l, n = 1576) (P > 0.05). We concluded that subclinical thyroid dysfunction was not associated with blood pressure. Neither subclinical hyperthyroidism nor subclinical hypothyroidism independently predicted increased blood pressure.     

亚临床甲状腺功能异常与骨质疏松

亚临床甲状腺功能异常(STD)和骨质疏松是常见的内分泌疾病,主要发生在女性和老年人群中.甲状腺激素和促甲状腺激素可直接或间接影响骨代谢,导致骨密度发生变化.而STD患者体内这两种激素水平异常,提示STD和骨质疏松之间存在一定的联系.此外,外源性甲状腺激素替代治疗亦可影响骨代谢,导致骨密度下降和骨质疏松.因此,明确STD和骨质疏松之间的联系并采取适当干预措施对于预防STD患者发生骨质疏松有重要意义.     

鸢尾素在糖脂代谢相关疾病中的作用研究进展

鸢尾素主要是运动后由肌细胞产生及分泌的肌细胞因子,在脂肪组织、肝脏、胰腺、睾丸、胃等组织中也有表达,其前体物质是Ⅲ型纤维连接蛋白结构域5(FNDC5),经裂解后分泌到外周循环中。鸢尾素通过MAPK、AMPK、PI3K/Akt及STAT3/Snail等信号通路,促进白色脂肪组织棕色样变,增加线粒体代谢及能量消耗,改善胰岛素抵抗,调节炎症因子、神经系统分化及成骨细胞增殖等,有望成为多种糖脂代谢相关疾病的新型治疗靶点。     

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

Background

Subclinical hyperthyroidism (SH yper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear.

Objective

To investigate the association between subclinical thyroid dysfunction and bone loss.

Methods

Individual participant data analysis was performed after a systematic literature search in MEDLINE /EMBASE (1946–2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD ) measurements. We classified thyroid status as euthyroidism (thyroid‐stimulating hormone [TSH ] 0.45–4.49 mIU/L), SH yper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SH ypo, TSH ≥ 4.50–19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X‐ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random‐effects two‐step approach.

Results

Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SH ypo and 284 (5.2%) had SH yper. During 36 569 person‐years of follow‐up, those with SH yper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = ?0.18 (95% CI: ?0.34, ?0.02; I ² = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = ?0.14 (95% CI: ?0.38, 0.10; I ² = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: ?0.30, 0.36; I ² = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = ?0.59; [95% CI: ?0.99, ?0.19]) and total hip region (%ΔBMD = ?0.46 [95% CI: ?1.05, ?0.13]). In contrast, SH ypo was not associated with bone loss at any site.

Conclusion

Amongst adults, SH yper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.

     

Subclinical thyroid disorders--consequences and implications for treatment

Subclinical hyperthyroidism is characterized by low circulating TSH concentrations, together with normal concentrations of free T4 and free T3. The clinical significance of low but detectable TSH values is likely to be different from undetectable TSH values. The question remains as to whether endogenous and exogenous (iatrogenic) causes of low serum TSH have the same clinical significance. Subclinical hypothyroidism is characterized by high serum TSH concentrations, together with normal free T4 values.     

Screening for thyroid dysfunction in a community population of diabetic patients

In a general practice population of 11 300 patients, 223 were known to have diabetes mellitus. Thirteen diabetic patients (5.8 %) had a previous diagnosis of thyroid disease. The study excluded 17 patients who received sole diabetes care at a secondary referral centre (of whom 5 had a previous diagnosis of thyroid disease), 8 with a previous diagnosis of thyroid disease receiving community care, and 1 patient who declined screening. New thyroid disease was diagnosed in 11 patients (8 female, 3 male): 5 with primary hypothyroidism, 4 with subclinical hypothyroidism, 1 with hyperthyroidism and 1 with subclinical hyperthyroidism. Thus the prevalence of undiagnosed thyroid disease in diabetic patients receiving community diabetes care was 5.5 % (9.5 % of female patients), and the prevalence of thyroid disease (previusly known and diagnosed as a result of screening) in the entire population of diabetic patients registered in the general practice was 10.8 %. These findings suggest that screening for thyroid disease should be considered in patients receiving diabetes care in the community. © 1998 John Wiley & Sons, Ltd.     

青少年甲状腺疾病的特点和管理

青少年甲状腺疾病有其自身的特点,比如甲状腺亢进和甲状腺减退的药物选择、药物剂量、疗程等均与成人不同.药物治疗是青少年甲亢最主要的手段,手术和放疗需要严格掌握适应证.青少年甲状腺相关眼病的病情较轻,常常不需要激素等免疫抑制剂的治疗.青少年甲状腺结节中甲状腺癌的检出率高于成人,青少年分化型甲状腺癌TSH抑制治疗的目标值可以...     

Regulation of cell proliferation and malignant potential by irisin in endometrial,colon, thyroid and esophageal cancer cell lines

Objective

Irisin is a novel hormone that has been proposed to mediate the beneficial effects of exercise on metabolism, including body weight regulation and insulin resistance. No previous studies have evaluated whether irisin may regulate cell proliferation and malignant potential of obesity-related cancer cell lines.

Materials/Methods

Cell proliferation and malignant potential i.e. cell adhesion and colony formation were studied in vitro using human and mouse obesity-related cancer cell lines i.e. endometrial (KLE and RL95-2), colon (HT29 and MCA38), thyroid (SW579 and BHP7) and esophageal (OE13 and OE33).

Results

We observed that, in contrast to metformin, cell proliferation is not regulated by irisin in a dose-dependent manner in human and mouse obesity-related cancer cell lines. Specifically, physiological (5 to 10 nmol/L) and high physiological/pharmacological (50 to 100 nmol/L) concentrations of irisin had no effect on cell proliferation when compared to control in human and mouse endometrial, colon, thyroid and esophageal cancer cell lines. Also, we observed that, in contrast to metformin, neither physiological nor high physiological/pharmacological concentrations of irisin regulate cell adhesion and/or colony formation in human and mouse endometrial, colon, thyroid and esophageal cancer cell lines.

Conclusions

Our data suggest that irisin, in physiological and high physiological/pharmacological concentrations, has no in vitro effect on cell proliferation and malignant potential of obesity-related cancer cell lines. Future work is needed to determine the regulation of irisin levels and any physiological effects it may have on obesity-related cancers in vivo in animals and humans.     

Influence of compensated radioiodine therapy on thyroid volume and incidence of hypothyroidism in Graves' disease

Abstract. Objectives . To investigate the long-term effect of radioactive iodine (¹³¹I) on thyroid function and size in patients with Graves' disease. Setting . Out-patient clinic in Herlev Hospital. Subjects . One hundred and seventeen consecutive patients (104 women) with Graves' disease selected for ¹³¹I treatment and followed for a minimum of 12 months (range 1–10 years, median 5 years). Interventions . ¹³¹I dose was calculated based on thyroid volume and 24-h ¹³¹I uptake. Main outcome measures . Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 0.75, 1.5, 3, 6 and 12 months after treatment, and then once a year were investigated. Results . Seventy-eight patients were cured by one ¹³¹I dose and 30 by two doses, while the remaining nine patients received additional doses (range one to five doses, median one dose). Within one year, 25% developed hypothyroidism, and hereafter, hypothyroidism developed at a constant rate of 3% per year independent of antithyroid pretreatment. The cumulative 10-year risk of hypothyroidism was 60%. Initial median thyroid volume was 33 mL (range 9–106 mL). At 12 months after the last ¹³¹I dose, median thyroid volume was reduced to 14 mL (range 6–36 mL) (P < 0.00001). The median reduction being 58% (range 0–80%,), hereafter no further reduction occurred. A significant reduction in thyroid volume was also noted in patients needing subsequent ¹³¹I doses and in those developing hypothyroidism within the first year. Conclusions . ¹³¹I normalizes thyroid volume in patients with Graves' disease. Hypothyroidism seems an inevitable end result of this treatment. The present study suggests that it will be impossible to modify ¹³¹I therapy in a way to achieve both early control of hyperthyroidism and a low incidence of hypothyroidism.     

成人非老年亚临床甲状腺功能异常的管理

亚临床甲状腺功能异常在人群中普遍常见,其诊断依赖于实验室检查结果,分为亚临床甲状腺功能减退症和亚临床甲状腺功能亢进症.文章仅涉及成人非老年内源性亚临床甲状腺功能异常,结合近年国内外多个临床指南,重点介绍亚临床甲状腺功能减退和亚临床甲亢非妊娠和妊娠人群相关的管理内容.文章管理建议仅针对非老年(70岁以下的亚临床甲减和65...     

Association of the HLA A2-B46-DR9 haplotype with autoimmune thyroid dysfunction after bone marrow transplantation in Chinese patients

Autoimmune thyroid disease (AITD) may occur in patients after bone marrow transplantation (BMT). At a median follow-up of 4 years, among 194 allografts and 28 autografts, four patients (three allografts, one autograft) developed AITD. All carried the human leucocyte antigen (HLA) A2-B46-DR9 haplotype, strongly associated with AITD in the Chinese population. No significant thyroid disorder was detected in 190 patients without this haplotype. The frequency of AITD in BMT patients with the HLA A2-B46-DR9 haplotype was 12.5%, with a relative risk of 7.8 times that of non-carriers (P < 0.001). The risk of AITD should be recognized in recipients with high-risk HLA haplotypes, and regular screening might be warranted.     

Standardized radioiodine therapy in Graves' disease: the persistent effect of thyroid weight and radioiodine uptake on outcome

Abstract. Objective. To assess the incidence of hypothyroidism, euthyroidism, and recurrent hyperthyroidism following a standard dose of Na¹³¹I (3.7 MBq or 100 μCi) per g thyroid tissue, adjusted for radioiodine tracer uptake. Design. A single-centre prospective follow-up study from January 1990 to December 1992. Setting. Academic Hospital in Utrecht, the Netherlands. Subjects. Newly diagnosed patients with Graves' disease (n = 148). Interventions. Radioiodine treatment at a standard dose of 3.7 MBq or 100 μCi per g thyroid tissue. Main outcome measures. Confidence interval testing of resulting thyroid status, defined by biochemical criteria. Results. The overall cure rate was 70% (103 of 148 subjects), confidence interval (CI) 62–77%. A 90% incidence of hypothyroidism was found in patients with a small thyroid (less than 20 g). Recurrent hyperthyroidism was found significantly more often in subjects with a thyroid weight exceeding 60 g compared to those who had a thyroid of 9–59 g. More recurrences were found in subjects in the highest tertile of a 24-h radioiodine uptake test (> 80% uptake) compared to those in the lowest tertile (< 60% uptake). Conclusions. No uniform treatment results expressed per thyroid weight category were obtained, in spite of standardizing the treatment Na¹³¹I dose (3.7 MBq per g thyroid). Graves' patients with a thyroid smaller than 20 g and those with less than 60% 24-h radioiodine uptake have a 50–90% chance of hypothyroidism at the 12-month follow-up.