Effects of growth hormone treatment on thyroid function in pediatric patients with Prader–Willi syndrome

It is unclear whether hypothyroidism is present in patients with Prader–Willi syndrome (PWS). This study aimed to clarify the state of the hypothalamic–pituitary–thyroid axis and the effects of growth hormone (GH) treatment on thyroid function in pediatric patients with PWS. We retrospectively evaluated thyroid function in 51 patients with PWS before GH treatment using a thyroid‐releasing hormone (TRH) stimulation test (29 males and 22 females; median age, 22 months). We also evaluated the effect of GH therapy on thyroid function by comparing serum free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) levels at baseline, 1 year, and 2 years after GH therapy. TSH, fT4, and fT3 levels were 2.28 μU/ml (interquartile range [IQR]; 1.19–3.61), 1.18 ng/dl (IQR; 1.02–1.24), and 4.02 pg/dl (IQR; 3.54–4.40) at baseline, respectively. In 49 of 51 patients, the TSH response to TRH administration showed a physiologically normal pattern; in two patients (4.0%), the pattern suggested hypothalamic hypothyroidism (delayed and prolonged TSH peak after TRH administration). TSH, fT4, and fT3 levels did not change significantly during 1 or 2 years after GH treatment. The TSH response to TRH showed a normal pattern in most patients, and thyroid function did not change significantly during the 2 years after initiating GH treatment.     

TPO-Ab在甲状腺自身免疫性疾病中的应用

目的：探讨甲状腺过氧化物酶抗体（TPO-Ab）在甲状腺功能亢进（甲亢）、甲状腺功能减退（甲减）、单纯性甲状腺肿大患者的临床价值。方法：采用放射免疫分析检测甲状腺疾病患者血清TGA、TMA、TPO-Ab浓度及血清FL、FT4、TSH水平,分析TPO-Ab在69例甲亢、53例甲减及45例单纯性甲状腺肿的阳性率。结果：TPO-Ab的阳性率（82％-92．5％）明显高于同组的TGA（44．2％）、TMA（69．8％）,甲减组TPO-Ab的阳性值（平均57．4％）明显高于甲亢组（31．2％）和单纯甲状腺肿组（17．6％）,差异有显著意义（P〈0．01）。结诊!TPO-Ab对自身角癌件甲状腺疾病的诊断、治疗和预后评估具右一定的临床价值．     

2型糖尿病患者血清TGA、TPO-Ab及甲状腺激素检测的评价

目的:探讨检测2型糖尿病(DM2)患者血清TGA、TPO-Ab及甲状腺激素含量的临床意义.方法:采用化学发光免疫分析(CLIA)测定82例DM2患者血清中甲状腺球蛋白抗体(TGA)、甲状腺过氧化物酶抗体(TPO-Ab)及游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺素(TSH)水平.结果:与68例正常...     

TPO-Ab及TGA与淋巴细胞亚群联检在AITD中的临床价值

目的:探讨自身免疫性甲状腺疾病(AITD)发病与甲状腺自身抗体之间存在的作用关系.方法:分别采用电化学发光法(ECL)检测了甲状腺过氧化物酶抗体(TPO-Ab)水平,采用放射免疫分析检测了89例男性及81例女性AITD患者和相应正常对照组的甲状腺球蛋白抗体(TGA),并采用免疫荧光标记单克隆抗体和流式细胞仪联检T淋巴细胞亚群(CD4 /CD8 )的活性.结果:AITD患者TPO-Ab以及TGA的水平均显著高于对照组(P＜0.01),相关分析显示,抗体水平与淋巴细胞T细胞亚群(CD4 /CD8 )活性变化没有明显相关(P＞0.05).结论:甲状腺自身抗体的水平变化可作为AITD部分病因的推测和提示.     

Influence of thyroid autoimmunity and maternal age on the risk of miscarriage

OBJECTIVES: Recently, studies have shown an association between antiperoxidase for the detection of thyroid autoimmunity (TAI) and abortion. Another point to be considered is the association of high risk of abortion and maternal age. The aim of the present study was to evaluate if the association between TAI and miscarriage could also be verified whether a population of unselected pregnant young women who normally present a low risk of miscarriage. MATERIALS AND METHODS: We studied 534 pregnant women, by determining their serum thyroid antiperoxidase antibodies (TPO-Abs), thyrotropin (TSH) and free thyroxine (fT4) levels. Our end point was the pregnancy loss or live birth. RESULTS: Age ranged from 12 to 49 years (mean +/- S.D.; 23.5 +/- 5.9). Of 534 women, 29 (5.4%) were TPO-Ab positive. TSH levels were significantly higher in TPO-Ab-positive women compared with TPO-Ab negative women (median; 1.9 versus 1.1; P = 0.001). Elevated TSH levels were found in 13.8% (4 of 29) of the TPO-Ab-positive women compared with only 2.4% (12 of 505) in the TPO-Ab-negative women. There were no significant differences in fT4 levels in relation with autoimmunity and risk of miscarriage. The overall risk of miscarriage was 2.4% (13 of 534). Risk of miscarriage was significantly higher among women older than 35 years (7.7%), TPO-Ab positive (10.3%) and presenting high levels of TSH (12.5%). These factors remained independently associated with the risk of miscarriage in full multivariate analysis. CONCLUSIONS: We conclude that TAI is independently associated with is a higher risk of miscarriage in a population of unselected pregnant presenting a low risk of miscarriage.     

Thyroid antoantibodies and the response to thyrotropin releasing hormone in patients with subclinical hypothyroidism.

AIM--To evaluate the clinical usefulness of the thyrotropin releasing hormone (TRH) test and estimation of thyroid autoantibody concentrations in patients with borderline raised thyroid stimulating hormone (TSH). METHODS--The records of 34 consecutive patients with persistent borderline increased TSH (4.4-9.9 mU/l) referred to the Medical Investigation Unit were reviewed. The response of patients with thyroid autoantibodies to the TRH test was compared with that of patients with a negative antibody screen. RESULTS--Eleven (44%) of 25 patients with positive anti-thyroid microsomal and/or thyroglobulin antibody tests and three (33%) of nine patients with a negative antibody screen had hypothyroid responses to TRH. Neither age nor sex affected the response to TRH. Basal TSH alone was poorly correlated with these indices. Twelve (35%) patients who had elevated basal TSH had a normal response to the TRH test. CONCLUSION--Patients with positive or negative thyroid autoantibodies and an exaggerated response to the TRH test should be regarded as hypothyroid and treated with thyroxine. Patients with positive thyroid autoantibodies and normal TSH response may subsequently develop hypothyroidism and should be given long term follow up.     

Asymptomatic seminal infection of herpes simplex virus:impact on male infertility

In more than half of infertile men,the cause of their infertility is unknown.Several studies revealed the role of viral infections in male infertility.The aim of the present study was to determine the prevalence of herpes simplex virus-1 (HSV-1) and HSV-2 in semen from asymptomatic infertile male patients,and its association with altered semen parameters.A total of 70 semen samples were collected from infertile men who attended the Research and Clinical Center for Infertility in Yazd,Iran.Semen analysis and diagnostic real-time PCR using specific primers and probes for HSV-1 and HSV-2 DNA were performed.Comparison of semen parameters between virally infected and non-infected samples were performed with independent t-test and Mann-Whitney test.Semen analysis showed that infertile men fell into two groups,the male factor group and the unexplained group.HSV-1 and HSV-2 DNA was detected in 16 (22.9%) and 10 (14.3%) of 70 semen samples,respectively.All HSV-positive samples had abnormal semen parameters (the male factor group).Although HSV infection was not associated with sperm motility and morphological defects,it was correlated with lower sperm count in the seminal fluid.The findings suggest that asymptomatic seminal infection of HSV plays an important role in male infertility by adversely affecting sperm count.     

Economical and rational in vivo and in vitro diagnosis in Basedow hyperthyroidism

Immunogenic hyperthyroidism (Graves' disease) is a life-long ailment. A widespread diagnostic evaluation is essential for unbiased initial values prior to therapy. The major goals of initial investigation are to determine a functional disturbance of the organ, its pathogenesis and morphology. Even a suppressed ultrasensitive bTSH value represents no evidence of overt hyperthyroidism; a positive diagnosis can only be established by the additional presence of increased parameters of circulating free thyroid hormones (fT3, fT4). Evidence of any immunogenic pathogenesis is given by positive thyroid antibody values (TRAK, MAK, TAK). Moreover, the use of sonography (with poor diffuse echo and increased thyroid depth) as well as Tc-99m scan indicating primary autonomy, thyroxine induced hyperthyroidism or painless thyroiditis) may both prove rather useful in a rational and economical diagnosis of Graves' disease.     

运用ROC曲线方法评价TRAb、TPO-Ab和TGA在Graves'病和HT鉴别诊断中的意义

目的:应用临床诊断性能(ROC)曲线方法评价TSH受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPO-Ab)和甲状腺球蛋白抗体(TGA)在Graves'病(格雷夫斯病)和桥本甲状腺炎鉴别诊断中的意义.方法:以甲状腺细针穿刺细胞学检查结果作为诊断金标准,以采用化学发光法测定63例自身免疫性甲状腺病患者血清的TRAb、TP...     

Undetectable serum IgA and low IgM concentration in children with congenital hypothyroidism

Some studies suggest thyroid hormones may regulate the human immune system. In order to evaluate the effect of thyroid hormone deficiency on antibody production, we evaluated serum IgA and IgM concentrations in 83 children with congenital hypothyroidism (CH), diagnosed by neonatal screening. Patients were compared to two healthy, age-matched control groups. Patients with permanent CH had a significantly higher frequency of undetectable IgA concentrations (thyroid agenesis, P<10(-5); thyroid ectopy, P=0.013) and lower concentrations of IgA (thyroid agenesis, P<10(-6); thyroid ectopy, P<10(-5); dyshormonogenesis, P=0.0002) and IgM (thyroid agenesis, P=0.0002; thyroid ectopy, P<10(-6); dyshormonogenesis, P=0.0017) compared to control group. No difference was observed between patients with transient hypothyroidism and controls. A significant correlation was observed between serum IgA and IgM concentrations and fT4 levels. IgA and IgM deficiency is correlated with the severity of congenital hypothyroidism and may help to evaluate the duration and severity of thyroid hormone deficiency during prenatal life.     

Die Rolle des TSH für Psychische VerÄnderungen und BefindlichkeitsverÄnderungen bei Schilddrüsenfunktionsstörungen

Summary The characteristic psychic and somatic features found in patients with overt hyper- or hypothyroidism are usually attributed to elevated or diminished levels, respectively, of thyroid hormones. This concept does not sufficiently explain our previous investigations in which the same symptoms, albeit attenuated, were also seen in patients suffering from so-called latent disturbances of thyroid function. This state of disorder, however, exhibits normal concentrations of peripheral thyroid hormones. Only the response of thyroid-stimulating hormone (TSH) to thyrotropin-releasing hormone (TRH) stimulation is in accordance with the behaviour of the overt thyroid dysfunction and enables its differentiation from the euthyroid state. In this context, we investigated the question as to whether pathologic signs in thyroid disorders are correlated to alterations of peripheral thyroid hormones or to changes in the hypothalamus pituitary axis. Therefore, we investigated two groups of ten patients each who suffered from latent hyper- or hypothyroidism, respectively, and ten euthyroid controls. All were matched from sex and age. Endocrine function was estimated by TRH testing, TT3, TT4 and thyroxine binding globuline (TBG). Psychologic testing was performed by questionnaires concerning subjective somatic symptoms, emotional disturbances, psychomotoric performance, cognitive impairment and personality. Patients with latent hyperthyroidism were more subject to somatic symptoms and affective complaints than were those who had latent hypothyroidism. As compared with controls, there were significant differences in exhaustion and pain in the limbs and heart. In terms of affective complaints, patients were more depressive, anxious, touchy and irritable; their personalities showed a higher degree of emotional lability, excitement and irritability. Many symptoms described in overt thyroid dysfunction could be found in latent metabolic disturbances. Therefore, we conclude that the alterations of health in thyroid disorders are more likely to be caused by hypothalamic pituitary impairment than by changes in peripheral hormone levels. The stronger symptoms occurring in overt thyroid dysfunction as compared with latent metabolic disturbances may reflect the degree of hypothalamic pituitary dysfunction.

Diese Arbeit wurde erstellt im Rahmen des Sonderforschungsbereichs 258 der UniversitÄt Heidelberg, gefördert von der DFG     

No evidence of deteriorating semen quality among men in infertile relationships during the last decade: a study of males from Southern Sweden

The aim of this study was to investigate whether the quality of semen has deteriorated during the last decade. Laboratory records containing semen analysis results were reviewed. The records, arranged according to date of birth, are kept in shelves. Every fifth record for analyses performed between 1985 and 1995, and only those of men in infertile relationships, were included. The data were abstracted in a data base, and time-related changes in semen characteristics were studied using linear regression analyses. During the study period, there was a slight, but significant increase in sperm concentration, percentage of motile spermatozoa, percentage of spermatozoa with normal morphology, and the base-value of the penetration test. The seminal volumes decreased slightly, but significantly. Sperm characteristics were not associated with age or date of birth of the men. In conclusion, these data show no evidence of deterioration in sperm quality during the last decade among men in infertile relationships.      

不育男性精子膜表面抗精子抗体水平与精液主要参数及精子功能的相关性

目的探讨男性不育症患者精子膜表面抗精子抗体与精液主要参数的相关性。方法收集男性不育症患者350例,均采用免疫珠法测定精子膜表面抗精子抗体(AsAb,IgA或IgG型),根据结果分为AsAb阳性组(43例)和阴性组(307例)。结果在这350例男性不育症患者中精子膜表面抗精子抗体检出率为14.00%。AsAb阳性组患者的精液主要参数(精液密度、活动率、活动力、精液量)均低于AsAb阴性组患者,两组间比较差异具有显著性(P<0.05)。结论精子膜表面抗精子抗体与精液主要参数及精子功能下降有明显相关性,是导致男性免疫性不育的重要因素之一。     

人精子膜功能完整性与精液参数的关系

目的探讨精子膜功能完整性与精液参数的关系。方法收集503例精液样本,其中对照组149例,不育组354例。根据WHO标准分析精子密度、活率、活力、精液白细胞浓度、精子形态和精子尾部低渗膨胀(HOS)率。结果不育组精子尾部低渗膨胀率显著低于对照组(P<0.05)。与对照组相比,HOS正常不育组和HOS异常不育组形态正常精子率、密度、活力、活率均显著降低(P<0.05),头部异常精子率、精液白细胞浓度显著增高(P<0.05);此外,HOS正常不育组的尾部异常精子率显著高于对照组,其精子活力、活率均显著高于HOS异常不育组(P<0.05)。精子HOS与精子密度、活力、活率呈显著正相关,与精液白细胞浓度呈显著负相关(P<0.05)。结论精子膜功能可能与精液参数密切相关,精子膜功能是评价男性生育力的重要指标。     

Correlation between semen parameters and sperm aneuploidy rates investigated by fluorescence in-situ hybridization in infertile men

Spermatozoa from 32 infertile patients and 13 controls with normal semen parameters were analysed using dual and triple colour fluorescence in-situ hybridization (FISH) techniques, in order to investigate the rates of aneuploidy for chromosomes 13, 18, 21, X and Y. The patients were divided into three groups according to their karyotypes or the karyotypes of their offspring: 15 were infertile men with abnormal semen parameters and normal karyotypes (group 1), 13 were infertile men with abnormal karyotypes and normal or abnormal semen (group 2) and four were infertile men with abnormal semen and normal karyotypes but whose wives conceived a child (or a fetus) with a numerical chromosomal abnormality through an intracytoplasmic sperm injection cycle (group 3). Patients with abnormal semen parameters showed a significantly higher aneuploidy rate for the investigated chromosomes in their spermatozoa compared to controls (P < 0.005). Our data suggest the presence of a correlation between poor semen parameters and an increase in aneuploidy rate of chromosomes 13, 18, 21, X and Y in spermatozoa (r = -0.81071, P < 0.002); therefore the risk of a chromosomal aneuploidy in spermatozoa seems to be inversely correlated to sperm concentration and total progressive motility. Patients with abnormal karyotypes showed a higher incidence of diploidy and chromosomal aneuploidies compared to controls (P < 0.002). This strongly suggests the presence of an interchromosomal effect of the cytogenetic rearrangement. Men who fathered a child with an abnormal karyotype through intracytoplasmic sperm injection did not present a higher aneuploidy rate for the investigated chromosomes in spermatozoa compared to patients with infertility due to a similar male factor but showed higher incidence of chromosomal aneuploidy compared to normal controls.     

Evidence for mutually antagonistic actions of thyroid releasing hormone and inhibin at pituitary-gonadal-prostate-spermatozoal axis

In-vivo as well as in-vitro studies carried out demonstrate for the first time the interaction between thyroid releasing hormone (TRH) and inhibin at the pituitary, testes, prostate and spermatozoa levels. At the pituitary level both peptides act as antagonists to each other and modify the release of pituitary hormones. Further, these peptides act at the prostatic level wherein they modulate ornithine decarboxylase activity as well as 5 alpha-reductase activity. At the testicular level TRH blocks inhibin biosynthesis whereas in semen, it significantly reduces the binding of spermatozoa to specific antibodies directed against inhibin. In conclusion, although TRH and inhibin are widely different in their molecular size and chemical structure, these peptides seems to act antagonistically at multiple sites.     

3533例男性不育症患者精液标本的支原体检测与耐药性分析

目的了解我院近三年来男性不育症患者精液标本衣原体、支原体的感染情况和支原体对抗生素的耐药性,为临床治疗用药提供依据。方法对2004～2006年间来我院生殖中心就诊的不同病因的3533例男性不育症患者的精液标本进行支原体和衣原体的检测,同时对支原体检测阳性的标本进行了菌落计数和抗生素敏感性检测,分析其耐药情况。结果2004、2005、2006年的413、1303、1817份男性不育症患者的精液标本中分别有18、124、66份精液标本衣原体金标试验阳性,分别有119、304、408份精液标本检到支原体,检到的支原体以解脲支原体为主,解脲支原体对氧氟沙星耐药率最高、交沙霉素耐药率最低。结论我院近三年男性不育症患者的精液标本中支原体和衣原体是主要的病原,检测支原体的耐药性对合理用药、指导临床治疗和提高不育症患者的生育率具有重要意义。     

Semen analysis profile in male infertility: an experience with 100 cases

In the assessment of unexplained infertility the evaluation of seminal characteristics is primary and paramount, as far as the male is concerned. We present in this article our experience with semen analyses of 100 infertile males. The collection and examination were according to standardized and well accepted methodology. We found that majority of infertile men were within the age interval of 26-30 years, and had been married for 1-3 years, when they first submitted themselves for fertility assessment. The physical parameters were found to be important, in that they in many patients pointed towards a specific physical cause; depletion in semen volume, altered colour, and pH changes were found especially informative. We also found the microscopic arm of semen analyses very useful in pin-pointing existing deficits in the male. Some significant correlations were also observed between abnormal microscopic parameters and clinical conditions. The results are discussed.     

Possible association between thyroid autoimmunity and Menière's disease

Various aetiopathological mechanisms have been postulated to be at the root of Menière's disease (MD), and some data suggest that there may be also an underlying autoimmune factor. In fact, Menière patients manifest certain characteristics that are typical of autoimmune involvement association of particular human leucocyte antigen haplotypes, the presence of antibodies against internal ear antigens. In this study, we evaluated the association between thyroid autoimmunity and MD in a non-selected group of patients. We recruited 50 consecutive MD patients and two groups as controls: group A, 82 healthy volunteers; and group B, 50 subjects suffering from acute unilateral peripheral vestibulopathy. All subjects were submitted to instrumental assessment of cochlear-vestibular function and analysis of thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-TSH receptor antibody (TR-Ab), anti-thyroperoxidase antibody (TPO-Ab) and anti-thyroglobulin antibody (Tg-Ab) in the blood. The prevalence of autoimmune thyroiditis in group B [6/50 (12%); 66.7% TPO-Ab and 33.3% Tg-Ab] was superimposable with the healthy controls [6/82 (7%); 66.7% TPO-Ab and 33.3% Tg-Ab]. In contrast, 38% of the MD patients (P = 0.0001 versus group A and group B) had significant autoantibody levels (68.4% TPO-Ab; 15.8% TPO-Ab + TR-Ab; 10.5% Tg-Ab; 5.2% TPO-Ab + Tg-Ab). Furthermore, 14% of the MD patients were hyperthyroid under l-thyroxine therapy, while no dysfunction was seen in the control groups. Overall, our data demonstrate a significant association between MD and thyroid autoimmunity, which suggests that an autoimmune factor is involved in the aetiopathogenesis of this disease. These findings suggest that it should be useful to submit MD patients to multi-disciplinary clinical investigation.     

The impact of cigarette smoking on human semen parameters and hormones

BACKGROUND: In this prospective study, semen parameters and hormone concentrations of infertile smokers were compared with infertile non- and ex-smokers. We also determined how many men with idiopathic infertility would stop smoking in an attempt to improve their fertility. METHODS: 1104 men (517 non-smokers, 109 ex-smokers and 478 smokers) with infertility for at least 1 year were evaluated. Evaluation included medical history, physical examination, hormone analysis and two semen analyses. Prior to the second semen analysis, smokers were urged to quit smoking. RESULTS: Smokers were significantly younger (P < 0.001), had significantly more round cells in their ejaculates (P = 0.003), and the percentage of ejaculates with > 1 x 10(6)/ml leukocytes was higher in smokers (P < 0.001). Increased free and total serum testosterone (P < 0.001) and decreased prolactin levels (P < 0.001) were found in smokers. No differences were found between non-smokers and ex-smokers. Only 23.1% of the smokers versus 46% non-smokers (P < 0.001) returned for a second semen analysis, 14 of whom reduced and 15 of whom quit smoking completely. Testosterone levels were significantly lower in those who were able to stop or reduce smoking (P < 0.001). CONCLUSIONS: Smoking does not affect conventional semen parameters, but significantly increases round cells and leukocytes. Only a few idiopathic infertile smokers were able to quit smoking.