Graves病初诊肝功能异常的临床研究

 目的 了解Graves病初诊患者中合并肝功能异常的发病率,探讨其相关因素及内科疗效.方法 对135例Graves病初诊患者进行甲状腺功能、甲状腺自身抗体及肝功能等检查.抗甲状腺功能亢进症(甲亢)及保肝治疗2个月后,对上述患者进行随访.结果 (1) Graves病初诊患者合并肝功能异常的发生率为37.8%,肝功能指标多为轻度升高,且以ALP升高者最多(28.9%).(2)合并肝功能异常者的FT3、FT4水平均高于肝功能正常者.(3)治疗2个月后,甲状腺功能已恢复正常的77例中,90.9%肝功能正常;转归为亚临床甲亢或仍为临床甲亢患者中,肝功能异常率分别为43.2%和60.0%.结论 初诊甲亢患者合并肝功能异常发病率高,但多预后良好,肝功能轻中度异常不应成为ATD治疗的禁忌.     

131I治疗Graves病合并精神障碍36例临床分析

Graves病合并精神障碍是甲状腺功能亢进症(简称甲亢)的一种特殊类型,临床上较少见.笔者于2001年3月-2006年10月应用131 I治疗36例Graves病合并精神障碍患者,现分析报道如下.     

飞行员甲状腺功能亢进症的治疗效果与医学鉴定

目的总结飞行员甲状腺功能亢进症(甲亢)治疗和医学鉴定的经验，为不断完善飞行员体格检查标准提供参考。方法回顾性分析1983年1月～2003年1月间13例飞行员甲亢的临床治疗效果及其飞行鉴定结论。结果①口服抗甲状腺药物治疗12例，其中9例甲状腺功能恢复正常，恢复飞行，3例于2年后复发而手术治疗；②手术治疗3例，均出现甲状腺功能减退，2例经甲状腺激素替代治疗后飞行合格；③1例恶性突眼病例用同位素治疗后停飞。结论①飞行员甲亢患者，以口服抗甲状腺药物治疗作为首选，达到临床治愈标准，可恢复飞行；②甲亢手术治疗愈后合并甲减的运输机或轰炸机飞行员，经甲状腺激素替代治疗而使甲状腺功能正常者，也可恢复飞行。     

~(131)Ⅰ治疗甲状腺功能亢进性心脏病心功能的改变

甲状腺功能亢进性心脏病(甲亢心)的治疗方法最常用的主要有抗甲状腺药物(ATD)治疗、131I治疗。近年来,131Ⅰ已成为治疗甲状腺功能亢进症及甲亢心的主要方法之一[1]。笔者运用多普勒超声心动图对甲亢心患者应用131Ⅰ治疗及ATD治疗前后心功能改善及左室心功能参数的变化进行了对比研究,以探讨131Ⅰ对甲亢心的治疗的临床应用价值。一、材料和方法1.研究对象:1998年5月至2003年5月间来我院确诊的患者随机分成两组,其中131Ⅰ治疗组119例,男28例,女91例,平均年龄(40±8)岁,同时合并有Ⅰ～Ⅴ度突眼。对照组甲状腺药物(ATD)治疗100例,男15例,女8…     

131I治疗老年功能自主性甲状腺腺瘤的远期随访

功能自主性甲状腺腺瘤多发生于中老年患者 ,治疗以手术和放射性1 3 1 I为主。但有报道放射性1 3 1 I治疗可导致甲状腺功能减低和恶性肿瘤 ,为此 ,我们对 1 2例资料完整的1 3 1 I治疗老年功能自主性甲状腺腺瘤患者进行了临床评价和远期随访 ,以了解1 3 1 I治疗的长期效果。1　资料和方法1 .1　临床资料患者 1 2例 ,男 2例 ,女 1 0例 ,年龄 6 2～ 79岁 ,以甲亢为首发症状就诊的 8例。甲亢的主要表现为心慌、多汗、怕热、乏力、易饥、消瘦、手抖、大便次数增多 ,症状多较轻。应用过抗甲状腺药物治疗的 6例。甲亢并甲状腺结节的 3例 ,单纯性甲…     

131碘治疗甲状腺功能亢进的有效半衰期分析

影响13 1碘( 13 1I)治疗甲状腺功能亢进症(简称甲亢)疗效的重要因素之一是其在甲状腺内的有效半衰期。本文对13 1I治疗的42 8例甲亢患者有效半衰期进行观察分析报道如下。材料与方法42 8例住院患者中男10 0例,女3 2 8例,年龄2 0～61岁,平均3 6岁,病程2个月～2 0年。根据有效半衰期不同分为3组:Ⅰ组( <3d) ,Ⅱ组( 3～6d) ,Ⅲ组( >6d)。先行13 1I 6h、2 4h甲状腺摄13 1I功能测定,2 4h后测有效半衰期[1] 等参数评估甲状腺功能。所有患者均经临床确诊为甲亢,并有13 1I治疗适应证。甲亢13 1I治疗辐射剂量控制在60～10 0Gy ,根据公式[2 ] 计算…     

低吸131I率甲亢患者131I治疗疗效评价

笔者探讨了低吸1 31 I率甲状腺功能亢进症患者 (简称甲亢 ) 1 31 I治疗的疗效 ,现报道如下。一、资料与方法1 研究对象。甲亢患者 31例 ,男 11例 ,女 2 0例 ,平均年龄 (38 1± 14 5 )岁。其中 3例为初诊患者 ,7例为第 2次1 31 I治疗患者 ,17例为抗甲状腺药物 (ATD)治疗无效者 ,2例用过碘油治疗 ,1例服用过海藻多元片 ,1例曾给予质量分数95 %酒精甲状腺内多点注射治疗。入选标准以吸1 31 I率低于 4 0 %。考虑到放射性测量统计涨落 ,1例吸1 31 I率为 4 0 2 %也纳入本研究。其中 3例吸1 31 I率 <30 % ,平均 (35 9± 5 1) %。有 7例伴吸…     

胺碘酮联合131I治疗Graves甲亢伴房颤

胺碘酮有抗心律失常和抗甲状腺激素作用 ,本研究探讨其联合1 31 Ｉ治疗中、重度甲状腺功能亢进 (简称甲亢 )合并房颤的疗效。一、资料与方法34例有甲亢临床症状和体征者 ,经检查确诊为中、重度Ｇｒａｖｅｓ甲亢伴持续性快速型房颤 ,其中男 11例 ,女 2 3例 ,年龄 2 6～ 5 9岁 ,平均 4 0岁 ,甲状腺质量30～ 6 5ｇ,平均 4 5ｇ。患者随机分为 :①对照组 17例 ,1 31 Ｉ治疗后 2ｄ加用心得安10～ 30ｍｇ,3次 ｄ× 15ｄ。②试验组 17例 ,1 31 Ｉ治疗后 2ｄ加用胺碘酮 2 0 0ｍｇ,3次 ｄ× 5ｄ ,后 2 0 0ｍｇ,2次 ｄ× 5ｄ ,再 2 0 0ｍｇ,1次 ｄ× 5…     

海藻酸钠微球在甲状腺功能亢进介入治疗中的应用

目的探讨海藻酸钠微球栓塞治疗甲状腺功能亢进(甲亢)的方法并观察疗效。方法使用海藻酸钠微球栓塞13例甲亢患者的25支甲状腺动脉,选择的适应证为内科抗甲状腺治疗效果欠佳或有严重不良反应者,作为手术或131Ⅰ治疗的替代疗法。结果12例患者栓塞后1个月血液甲状腺激素水平明显下降,接近或达到正常,临床症状缓解或消失,1例效果不明显。随访超过6个月的病例在停用或间歇少量使用抗甲状腺药物的情况下可有效控制症状。1例效果不明显者拒绝再次介入治疗。所有病例未发生甲状腺功能低下或甲状旁腺功能异常,亦无严重并发症。结论作为手术和131Ⅰ治疗的替代疗法,海藻酸钠微球栓塞是甲亢综合治疗中可供选择的有效手段。     

甲亢患者药物治疗后缓解时间的性别差异分析

甲状腺功能亢进的临床特点中表现出很多的性别差异,男性甲亢的平均年龄高于女性,40～59岁的男性甲亢多于女性,40岁以下女性甲亢多于男性;男性甲亢无甲状腺肿大、突眼征、心律失常、周期性麻痹的发生率高于女性;老年女性及男性甲亢患者易发生骨密度降低;甲亢伴发精神障碍男性患者以类精神分裂症多见,女性则以类躁狂状态为主要表现等。本组观察到甲亢患者在药物治疗后缓解时间上存在性别差异,现报道如下。     

Iodine-131: optimal therapy for hyperthyroidism in children and adolescents?

To assess the medium- to long-term effects of I-131 therapy of hyperthyroidism in children and adolescents, we studied 51 patients (age range 6--18; boys, 43 girls) treated with I-131 for Graves' disease with hyperthyroidism at the University of Michigan Medical Center (1951--1972). Patients received total doses ranging from 3 to 81.6 mCi. The mean followup period was 14.6 +/- 7.9 yr. Hyperthyroidism was effectively treated in 49 within 1 to 12 mo. One patient failed to respond to three treatment doses, and hyperthyroidism recurred in two patients: 2 and 11 yr after initial therapy. Of these three patients, two were treated by thyroidectomy and one was retreated successfully with I-131. There were no cases of thyroid cancer, other malignancies or leukemia. The patients' reproductive histories and the health of their offspring were as in the general population. At the time of study, the prevalence of hypothyroidism was 92%, with no recurrent goiters or thyroid nodules. Iodine-131 is found to be safe and effective treatment of hyperthyroidism in children and adolescents and should be the preferred mode of therapy.     

飞行人员甲状腺功能异常的诊治及医学鉴定

目的 总结甲状腺功能异常飞行人员的临床资料,为规范相关疾病的诊治与鉴定提供依据. 方法 回顾性分析2000年12月至2014年9月间在空军总医院住院的42例甲状腺功能异常的飞行人员病例资料,包括甲状腺功能亢进症和甲状腺功能减退症,总结其疾病特点、诊治过程、治疗效果、医学鉴定结论及随访情况. 结果 ①甲状腺功能亢进症30例（71.43％）,其中26例（86.67％）应用抗甲状腺药物治疗后,医学鉴定结论为飞行合格7例、暂时飞行不合格4例、飞行不合格15例,停飞率57.69％（15/26）.4例（13.33％）应用放射性131I治疗后3例出现甲状腺功能减退;医学鉴定结论为飞行合格2例、暂时飞行不合格2例.②甲状腺功能减退症12例（28.57％）,应用药物替代治疗后,医学鉴定结论为飞行合格9例、飞行不合格3例;3例停飞者中2例为合并心房颤动.结论 飞行人员甲状腺功能亢进症单病种飞行合格率低于甲状腺功能减退症.需要进一步优化飞行人员甲状腺功能亢进症的治疗路径,完善甲状腺功能异常飞行人员的医学鉴定,既最大限度地保存飞行力量又保证飞行安全.     

Radioiodine treatment of solitary functioning thyroid nodules

Forty-eight patients with hyperthyroidism due to a single toxic nodule have been treated with radioiodine (131I). The mean follow-up period is 37 months. All patients were rendered euthyroid and no cases of hyperthyroidism have been observed. Forty patients required only one dose of 131I to render them euthyroid, six patients required more than one dose and two patients initially rendered euthyroid relapsed during follow-up and required further 131I treatment. It is concluded that a single fixed dose of 131I is a simple, effective treatment for a solitary toxic thyroid nodule and does not cause hypothyroidism.     

甲状腺功能亢进症合并胸腺增生CT观察

目的 通过CT追踪观察甲状腺功能亢进症合并胸腺增大患者诊治过程中胸腺的改变,提高对该病的诊断及鉴别诊断水平,以避免不必要的创伤性活组织检查及外科手术.资料与方法 对7例甲状腺功能亢进患者并发胸腺增生的临床表现、诊疗过程及CT追踪观察胸腺病变的变化进行回顾性分析.结果 7例中,2例行胸腺手术治疗(1例因误诊胸腺瘤行胸腺手术,术后症状未改善,短期内复查见胸腺增生).7例行抗甲状腺药物治疗后临床症状好转,复查CT显示6例胸腺较前减小[体积平均减小(9.32±1.60)cm3],CT值密度降低[平均降低(53±11)HU],1例术后未见胸腺增生.结论 部分患者的胸腺增大可能与甲状腺功能亢进相关,通过抗甲状腺药物治疗后,胸部CT可以显示增生胸腺变小及密度减低.甲状腺功能亢进症合并前纵隔的肿块没有必要立即进行穿刺活检及手术切除.通过观察临床表现,完善相关的实验室检查及追踪病变的CT变化可以对甲状腺功能亢进合并胸腺增生进行定性诊断,从而避免创伤性的活组织检查及开胸手术.     

The role of thyroid scanning in hyperthyroidism

Radionuclide thyroid imaging was performed in 872 consecutive patients with hyperthyroidism. Of these, 84% were found to have diffuse toxic hyperplasia (Graves' disease), while 12% had autonomously functioning nodules (Plummer's disease), 3% had Graves' disease developing in a multinodular gland, and in the remaining 1%, either a clear diagnosis could not be established or the hyperthyroidism was due to thyroiditis or the Job-Basedow phenomenon. It was found that a thyroid scan seldom provides additional diagnostic information in patients with Graves' disease when a diffuse goitre is present. However, if patients are to be treated with radioiodine (¹³¹I), thyroid imaging with tracer quantitation can replace a 24-h ¹³¹I uptake measurement, this having the advantages that the patients are required to attend only once, and that the gland size can be measured. In addition, visual confirmation of tracer uptake by the thyroid is obtained and patients with thyroiditis will not receive inappropriate therapy. When single or multiple thyroid nodules are palpated, a thyroid scan is crucial in establishing an accurate diagnosis, as it is not otherwise possible to differentiate between Plummer's disease and Graves' disease developing in a multinodular gland. Indeed, in 20 of our 63 patients (32%) with single autonomously functioning nodules, the initial clinical assessment had been incorrect.     

The role of thyroid scanning in hyperthyroidism

Radionuclide thyroid imaging was performed in 872 consecutive patients with hyperthyroidism. Of these, 84% were found to have diffuse toxic hyperplasia (Graves' disease), while 12% had autonomously functioning nodules (Plummer's disease), 3% had Graves' disease developing in a multinodular gland, and in the remaining 1%, either a clear diagnosis could not be established or the hyperthyroidism was due to thyroiditis or the Jod-Basedow phenomenon. It was found that a thyroid scan seldom provides additional diagnostic information in patients with Graves' disease when a diffuse goitre is present. However, if patients are to be treated with radioiodine (131I), thyroid imaging with tracer quantitation can replace a 24-h 131I uptake measurement, this having the advantages that the patients are required to attend only once, and that the gland size can be measured. In addition, visual confirmation of tracer uptake by the thyroid is obtained and patients with thyroiditis will not receive inappropriate therapy. When single or multiple thyroid nodules are palpated, a thyroid scan is crucial in establishing an accurate diagnosis, as it is not otherwise possible to differentiate between Plummer's disease and Graves' disease developing in a multinodular gland. Indeed, in 20 of our 63 patients (32%) with single autonomously functioning nodules, the initial clinical assessment had been incorrect.     

Long-term follow-up in untreated Plummer's disease (autonomous goiter)

Plummer's disease presents a spectrum of forms and its evolution is often slow. Longitudinal studies have been limited both in number of patients and duration of follow-up. In order to answer the question of whether euthyroid patients with no local symptoms should be treated prophylactically, 70 patients were reexamined 5.2-21.8 years (average, 8.9) after Plummer's disease had been diagnosed. Data are included on four others who developed symptoms that indicated treatment within five years. Gross (clinically relevant) changes were seen in 24 cases. Of these, 16 were progressive, including 12 where hyperthyroidism developed. Gross regressive changes included two cases with complete remission. Minor changes (28 cases) were about as often regressive as progressive. Most patients with a solitary autonomous nodule showed either gross changes or no change, whereas minor changes prevailed in multifocal autonomy. All eight male patients had a solitary nodule, 28 of 66 females had multifocal autonomy. Gross changes were seen in nine of 12 patients under 40 years at presentation, more often than in those over 49 years; seven of these changes were progressive. Six short case reports illustrate the great diversity in evolution. It is concluded that treatment seems wise in teenagers and in elderly patients with borderline (biochemical) hyperthyroidism but others generally may be left untreated, as long as they have few or no complaints.     

131I治疗Graves病后暂发性甲低的临床分析

目的：探讨^131I治疗后暂发性甲低的临床特点和转归。方法：对32例^131I治疗后出现暂发性甲低的患者进行临床分析和随访。结果：暂发性甲低出现在^131I治疗后2～6个月，有甲低症状者19例(59．38％)。甲低缓解后甲状腺功能正常者20例(62．5％)，又甲亢者12例(37．5％)。甲低时，T3和T4明显降低，TSH变化不一。结论：暂发性甲低多发生在低剂量^131I治疗的患者，甲低缓解后部分患者可再次出现甲亢。     

Graves' disease nd toxic nodular goiter--radioiodine therapy

At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany. The diagnosis Graves' hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70-90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1-1.5 years is recommended for 90%. This review describes subgroups of patients with Graves' disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60-70% of the patients with Graves' hyperthyroidism.     

司法精神医学鉴定536例分析

目的　总结分析精神医学司法鉴定案例中精神障碍诊断及责任能力评定现状。方法　运用分类统计法对近 4年本院鉴定的 5 36案例资料进行总结分析。结果　 5 36案例中诊断有各类精神障碍 499例 (93 1% ) ,其中无责任能力 35 4例 (6 6 0 4% )、部分责任能力 85例 (15 86 % )、有责任能力 97例 (18 10 % )。结论　所送鉴定案例中确有精神障碍者比较多 ;三分法的运用 ,对于责任能力评定更趋科学合理。