甲状腺功能亢进患者的手术前药物治疗

目的 观察甲状腺功能亢进患术前用药效果。方法 对48例中度以上甲状腺功能亢进患者给予联合用药作为术前准备，观察其对手术过程及术后并发症的影响。结果 本组患者术前均达到理想的准备程度，手术中及手术后经过顺利，无出血、甲状腺危象等并发症。结论 联合用药，作用互补，减小各用药剂量，缩短用药时间，经济适用，疗效可靠。     

甲状腺功能亢进及抗甲状腺药物与肝损害

甲状腺功能亢进(甲亢)、抗甲状腺药物均可引起肝损害。甲亢引起肝损害比较常见,可分为肝酶的升高和黄疸,其对肝功能损害的原因是多方面的,与甲状腺激素的直接毒性作用、高代谢、心力衰竭及免疫等因素有关;治疗原则以控制甲亢为主,甲亢治愈后,肝功能大多数可恢复正常。抗甲状腺药物引起肝损害的诊断通常采用排除法,其发病机制目前主要认为与机体的异质性反应有关;亚临床肝损害时不需停用抗甲状腺药物,如果肝损害显著,立即停药是治疗的关键。     

原发性甲状腺功能减退转变为甲状腺功能亢进五例

临床上,甲状腺功能亢进（甲亢）转变为甲状腺功能减退（甲减）较常见,例如桥本病（HT）患者早期因炎症破坏滤泡、甲状腺激素漏出而引起一过性甲状腺毒症,随着病程的延长,后期可以发生甲减。但是,在排除甲状腺激素替代治疗的影响因素之后,原发性甲减转变为甲亢则比较罕见,甲减-甲亢-甲减的转变就更为罕见。我们曾发现5例原发性甲减,在经过一段时间之后,自行转变为原发性甲亢,现将资料报告如下。     

儿童及青少年甲状腺功能亢进的治疗

近年来，儿童及青少年甲状腺功能亢进(甲亢)的发病率有增长趋势。目前，儿童甲亢的治疗首选仍以口服药为主，疗效并不理想，缓解率为50％～66％，对他巴唑疗效差者换用赛治(甲亢平)也可取得较好的疗效。桥本甲亢不应选用^131I或手术治疗，因为它本身引起甲状腺功能减低机会多，故抗甲亢药物剂量应小些，疗程应短些。欧洲与我国多数医生拒用^131I疗法，但该疗法在美国推崇之至，而手术疗法与医生经验有关，各有优缺点。     

甲状腺功能亢进致肝损害

甲状腺功能亢进致肝损害在临床上较为多见,但大多数表现为非特异性损害,容易误诊。本文从临床表现、肝脏病理改变、发病机制、鉴别诊断、治疗措施等方面总结了甲状腺功能亢进致肝损害的研究概况,为临床有效治疗提供参考。     

甲状腺功能亢进合并急性心肌梗死一例

患者,男性,47岁。因“胸闷憋气4～5天,心前区疼痛5小时”于2009年10月15日入院。患者4～5天来无明显诱因出现胸闷憋气,但未介意。入院前5小时突然左侧胸痛及上腹部剧烈疼痛,不扩散,持续约两小时,来我院外科,考虑“胆囊炎”,     

甲状腺功能亢进患者为何血糖升高？

我的朋友患有甲状腺功能亢进，但最近他发现血糖有些高，他根担心会不会得糖尿病，烦请专家给予回答。     

糖尿病合并甲状腺功能亢进的临床诊治分析

糖尿病与甲状腺疾病均是常见的内分泌代谢性疾病,二者并存并非少见,有时症状叠加互相影响,甲状腺疾病可加速糖尿病的进程,促进某些慢性并发症的发生;糖尿病患者,尤其当血糖高、病情不稳定时,可使甲状腺疾病病情加重,因此对于糖尿病合并甲状腺机能亢进的患者目前已逐渐被重视,并积极研究防治。     

甲状腺功能亢进性心脏病3例误诊分析

甲状腺功能亢进性心脏病 (甲亢性心脏病 )如缺乏甲亢的典型表现 ,易被误诊。我们曾收治 3例甲亢性心脏病被误诊者 ,现报告如下并回顾性分析其误诊原因。例 1:女 ,5 9岁 ,因劳累性呼吸困难 3个月伴心悸 ,并有夜间阵发性呼吸困难而就诊。曾在外院诊断为风湿性心脏病 ,房颤。服用地高辛、氢氯噻嗪等药物 ,症状无改善。查体 :Bpl4 0 /60 mm Hg( 1mm Hg≈ 0 .13 3 k Pa) ,肥胖体型 ,甲状腺无肿大。双肺检查无异常发现 ;心界向左下扩大 ,心室率 10 2次 /分 ,,心律绝对不齐 ,第 1心音强弱不等 ,心尖部可闻及隆隆样舒张期杂音。心电图示房颤。 X线…     

甲亢与糖尿病合并症临床治疗分析

目的将甲状腺功能亢进症(甲亢)与糖尿病合并治疗进行临床效果分析,对该方法所起到的临床医效进行探讨从而降低患者的危险。方法选择近2年内该院收治的甲亢糖尿病患者64例,在对患者全部实施甲亢常规治疗方案的基础上,再选取一定规模的其他药物加以配合使用,如胰岛素、瑞格列奈片、甲巯咪唑片等药物,经过一段时间的治疗之后,对比观察治疗前后患者的血糖、甲状腺等其他身体部位病理变化状况。结果接受2~3个月的治疗之后,相关数据显示这64例甲亢糖尿病患者的血糖参数远远小于进行医治之前,FT3及FT4水平也都比治疗之前低,相关差异有统计学意义(P0.05)。结论在面对甲亢与糖尿病合并的患者时,临床治疗的过程中应当将2种疾病进行联合考量,取长补短将两者的优势相结合,从而制定出合适有效的治理方法,有效改善患者的血糖、甲状腺等其他的有关临床症状。但是需注意的是在治疗的过程中必须是在治疗甲亢的基础上兼治糖尿病。     

甲状腺功能亢进症156例外科治疗临床分析

目的探讨甲状腺功能亢进症外科手术治疗效果。方法回顾性分析156例甲亢患者临床资料。结果本组无手术死亡病例,发生甲状腺危象1例,无术后出血,窒息及呼吸困难,喉返神经损伤3例,低钙性抽搐4例,给予相应治疗措施后恢复,术后甲亢复发3例。结论外科手术可有效治疗甲亢,术前准备充分,手术操作细致,术后处理妥当可提高疗效,减少并发症。     

Gastrointestinal Tract in Hyperthyroidism before and after Treatment

The state of the upper gastro-intestinal tract in hyperthyroidism was studied in 42 patients before and after treatment. Gastritis was found in 30 patients out of 39. The incidence of gastritis in the control series was 52 per cent. Numerous plasma cells and aggregates of lymphocytes were commonly observed in both gastric and intestinal biopsy specimens. Before treatment the basal secretion of hydrochloric acid was 1.2 mEq/h and after histalog stimulation 4.6 mEq/h. There was usually a fairly good correlation between the secretion values and the gastric morphology, but in 5 patients the maximal stimulation values remained below 1 mEq/h, in spite of a normal or only slightly altered gastric mucosa. The re-examination, performed 4 months after treatment, revealed improvement of gastritis in 7 and progress in 2 of 21 patients. In the 16 patients examined, the average number of eosinophils in gastric mucosa increased from 33 to 47 per 0.1 mm² of tissue. The hydrochloric acid secretion revealed a decreasing trend, in particular in patients who initially had values above 5 mEq/h. In 3 patients with initial values below 5 mEq/h a distinct increase was observed. Faecal fat excretion was definitely increased in 7 out of 30 hyperthyroid patients, in spite of a normal villous structure. Five patients were re-examined after adequate treatment and the fat excretion had returned to normal in all instances.     

67例药物性肝损害的临床分析

药物性肝损害临床不少见,我们收集本院2000年到2007年药物性肝损害的病例,并对其进行分析,以提高对该病的认识,及时作出正确诊断和治疗。     

药物所致的血小板减少症

药物所致的血小板减少症为药物治疗过程中的一种常见副作用。主要分为两型 :一为骨髓被药物毒性作用抑制所致 ,二为药物通过免疫机制破坏血小板所致 ,后者中以肝素、奎宁、奎尼丁、金盐与磺胺类药物发病较高。临床症状极不一致 ,血小板减少至 (1.0～ 80 )× 10 9/L ,轻者无症状 ,重者可因颅内出血或因肝素导致内皮细胞的免疫损害 ,合并危及生命的肺栓塞与动脉血栓形成致死。诊断主要依靠 :①药物治疗期间血小板减少 ;②停药后血小板减少消除。严重患者血清中可检出药物依赖性血小板抗体 ,但敏感性不高而常呈假阴性。治疗之首要是立即停用相关药物 ,严重病例可相机使用输注血小板、激素、丙球甚或血浆置换     

Cost Savings/Benefit Analysis of Drug Abuse Treatment

Ninety-six male alcoholics were tested before and after a 4-week residential rehabilitation program. One-half of the subjects were residents of a VR treatment center which stressed development of internal controls and the attribution of responsibility to self. The other half were patients at a VA hospital which fostered considerable dependency and reliance on external controls. Change in self-concept was assessed by the Tennessee Self-Concept Scale (TSCS). A Locus of Control of Drinking Behavior Scale (LCDB) was also administered. Positive changes occurred across settings on 9 of 17 self-concept variables. However, there were four variables on which a differential change occurred. These setting-by-treatment interactions are discussed in terms of the treatment philosophy of the two programs.     

Methimazole Slows Hepatocyte Streaming in Rats

Hepatocytes are hypothesized to continuallystream from the portal tract to the terminal hepaticvein. By this model, when a cell divides, one of itsprogeny replaces the dividing ancestor and the other is displaced into a more remote location. Thepresent experiment aims to demonstrate thathypothyroidism affects liver cell turnover. Thirty maleadult rats were divided into two groups. One receivedmethimazole for two weeks and the other served as control.Each rat was injected intraperitoneally with 18.5 KBq[³H]thymidine/g body weight. Rats were killedafter 1 hr and two and four weeks. Autoradiography was done. The distance of the labeled cells fromthe portal tract was measured. The mean TSH levels ofthe methimazole-treated group and controls were 1.45 and0.25 mM/liter, respectively (P < 0.01). Hepatocyte streaming was lower in hypothyroid (1.8m/day) than in untreated rats (2.5 m/day) (P< 0.01). The respective labeling indices 1 hr afterlabeling were 0.9% and 1.24% (P < 0.05). We concludethat hypothyroidism diminishes hepatocyte and littoral cellturnover and slows down their streaming.