广州成人碘营养与甲状腺结节疾病临床特征分析

目的分析广州市居民碘营养状态与甲状腺结节疾病临床特征的关联。方法收集自2018年1月1日至2019年2月1日在广州医科大学附属第二医院就诊的成人人群,且同期行甲状腺B超、尿碘以及甲状腺功能相关检查者;根据尿碘水平进行评判分组,尿碘100μg/L为碘营养不足组;尿碘100～199μg/L为碘营养适宜组;尿碘200～299μg/L为碘营养超适宜量组;尿碘300μg/L为碘营养过量组。观察尿碘与甲状腺疾病患病率和甲状腺功能的关系。结果研究共入组观察1107例,尿碘中位数93.40μg/L,其中甲状腺结节患者309例,与碘适量组甲状腺结节患病率比较,其他不同的碘营养组甲状腺结节患病率无显著性差异,碘营养水平对甲状腺结节合并甲亢或自身免疫性甲状腺炎的患病率亦无显著影响;与碘适量组人群相比,碘营养不足和碘过量组FT3和FT4显著增高,而对应TSH水平显著下降。结论广州市居民成人碘营养偏低,碘营养水平不足或过量均可能导致甲状腺功能异常。     

威海市区碘摄入与甲状腺良性结节的相关研究

目的:了解威海市区人群甲状腺良性结节与尿碘的相关性,指导甲状腺良性结节患者的饮食结构。方法:用砷铈催化分光光度法测定328例甲状腺良性结节患者及315例健康成年人的尿碘含量,对两组数据进行统计分析。结果:甲状腺良性结节组尿碘为141±4μg/L,正常对照组为265±3μg/L,两组比较差异无统计学意义(P>0.05)。尿碘水平与性别、甲状腺良性结节直径均无相关性(P>0.05)。结论:尿碘与有无甲状腺良性结节、结节大小及性别均无关,男女甲状腺良性结节患者无需限制碘摄入量。     

张家口市区1200例孕妇尿碘分析

目的:了解张家口市区内孕12～37周妇女的尿碘水平,分析孕妇碘营养状况,为有效预防因缺碘所致的新生儿出生缺陷疾病提供参考.方法:选择2007年6月～2009年12月在张家口市妇幼保健院参加孕期保健的1,200名孕妇,取其晨尿,采用过氧乙酸氧化四甲基联苯胺显色法进行碘检测.结果:张家口市区孕妇尿碘中位数为179.2μg/L.其中265例碘摄入量不足,占所调查样本的18.9%;62例碘摄入过量,占所调查样本的5.2%.结论:张家口市区近1/5的孕妇碘摄入量不足,少数孕妇碘摄入过量.     

单侧腺叶切除术后甲状腺功能变化的研究

探讨甲状腺良性结节行单侧腺叶切除术后甲状腺功能的变化情况及影响因素。回顾性分析2014年3月—2015年12月因甲状腺良性结节行单侧腺叶切除术的98例患者的临床资料,根据患者年龄不同分为中青年组(60岁69例和老年组(≥60岁29例;根据患者术前促甲状腺激素(TSH水平分为TSH较高组(TSH2.5 u IU/m L34例和TSH较低组(TSH≤2.5 u IU/m L64例;根据抗甲状腺过氧化物酶抗体(TPOAb水平分为TPOAb阴性组75例和TPOAb阳性组23例。各组患者分别在术前、术后1个月及3个月检测游离三碘甲状腺原氨酸(FT3、游离甲状腺素(FT4及TSH。老年组患者术前的TSH水平明显高于中青年组(P0.05。术后FT3、FT4较术前明显下降,TSH明显升高(P0.05。TSH较高组患者术后FT3、FT4明显下降,TSH明显升高(P0.05。TPOAb阳性组患者术前的TSH水平明显高于TPOAb阴性组(P0.05;术后FT3、FT4较术前明显下降,TSH明显升高(P0.05。老年患者、术前TSH水平高、TPOAb阳性与甲状腺功能减退的发生密切相关。不同人群行单侧腺叶切除术后甲状腺功能变化情况不同,老年患者、术前TSH水平高、TPOAb阳性可能是甲状腺功能减退的危险因素,对术后甲状腺功能减退的发生有一定预测价值。     

超声引导下微波消融术治疗甲状腺良性结节对患者甲状腺功能及并发症的影响

目的 对甲状腺良性结节患者实施超声引导下微波消融术治疗,分析其临床疗效及对患者甲状腺功能及并发症的影响。方法选取义乌復元第一医院及浙江大学医学院附属第四医院2021年2月至2023年2月医院收治的甲状腺良性结节患者74例,分为观察组37例与对照组37例,对照组实施常规甲状腺结节切除术治疗,观察组实施超声引导下微波消融术治疗,对两组临床疗效及对患者甲状腺功能及并发症的影响进行比较。结果 临床疗效方面,观察组治疗总有效率97.3%与对照组81.1%比较显著提高（P<0.05）;围术期指标方面,观察组手术时间、住院时间较对照组显著缩短,切口长度、术中出血量较对照组显著降低（P<0.05）;甲状腺功能方面,术前,两组促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）水平比较差异无显著性,术后,两组TSH水平均较术前明显提高,FT4、FT3水平均明显降低,其中观察组TSH水平较对照组显著降低,FT4、FT3水平显著提高（P<0.05）;术后,观察组并发症总发生率5.4%与对照组24.3%比较显著降低（P<0.05）。结论 对甲状腺良性结节患者实...     

碘过剩对甲状腺的病理生理效应

目的　探讨碘过剩与甲状腺疾病的关系。方法　观察不同浓度的高碘对大鼠甲状腺的影响 ,以及对人类甲状腺滤泡上皮细胞的作用。结果　实验动物组均出现弥漫性胶质性甲状腺肿 ,随着投碘量的增加 ,甲状腺绝对与相对重量与正常对照组比均见明显增加 (P <0 .0 0 5 ) ;不典型增生区域增多 ;甲状腺滤泡上皮高度降低 ,甲状腺滤泡腔面积扩大 ,核仁组成区嗜银蛋白 (AgNOR )计数增加 ,与正常对照组比较均有明显差异 (均P <0 .0 0 1)。培养的人甲状腺滤泡上皮细胞在碘浓度 0 .75 μg/ml中 6 %～ 2 5 %的细胞出现变形 ,线粒体、粗面内织网及绒毛增多 ;碘浓度 3.75 μg/ml时 ,30 %～ 40 %细胞表现为线粒体肿胀 ,粗面内织网扩张 ;碘浓度 18.75 μg/ml时 90 %细胞溶解 ,可见层状小体。 结论　过量摄碘与甲状腺机能亢进症 ,甲状腺机能减退症 ,甲状腺炎及甲状腺癌等疾病的发生可能有密切关系。     

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自 1996年我国实行全民食盐加碘法规以来 ,居民平均尿碘中位数 (ＭＯＩ)已达到 330 2 μｇ/Ｌ( 1997) ,超过了ＷＨＯ和ＩＣＣＩＤＤ公布的尿碘过量标准 ( 30 0 μｇ/Ｌ)而处于碘过剩状态[1] 。由此带来了甲状腺疾病的巨大变迁 ,患病率明显增加 ,疾病谱也改变了。据调查 ,甲状腺功能减退症 (甲减 )发病率因此而升高 3 2～ 7 4倍 ,自身免疫性甲状腺炎是引起甲减的主要原因。临床上甲状腺炎已是常见病。碘致甲亢是因过量摄碘造成促甲状腺素 (ＴＳＨ)升高的结果。乳头状甲状腺癌的平均发病率也高达 13 12 / 10万 ,与欧美低摄碘量的国家相比 ,大…     

十堰市人群碘营养状况分析

目的:了解和掌握目前本地区人群碘营养状况.方法:检测批发及销售点、居民用户家中食用盐碘含量,8～10岁儿童尿碘水平.结果:共检测食用盐2860份,合格率97.06％；儿童尿1336份,尿碘中位数为324ug/L.结论:我市碘盐合格率达到了碘缺乏病消除标准的要求,儿童尿碘水平较高,说明我市碘营养状况良好.     

不同剂量左甲状腺素治疗甲状腺良性结节的疗效分析

分析甲状腺良性结节患者应用不同剂量左甲状腺素治疗的疗效及体内内分泌代谢的变化情况。选取我院206例甲状腺良性结节患者为研究对象,采用随机数字表法分为小剂量组及常规剂量组,每组各103例。常规剂量组给予左甲状腺素50μg/d口服;小剂量组给予25μg/d口服。记录两组临床疗效及治疗期间不良反应发生情况,并比较两组治疗前及治疗1年后甲状腺最大结节直径、最大结节体积和内分泌代谢指标[促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)]差异。两组患者临床疗效比较差异无统计学意义(P>0.05)。小剂量组治疗期间不良反应总发生率明显低于常规剂量组(P<0.05)。治疗1年后,两组甲状腺最大结节直径、最大结节体积及血清TSH水平均较治疗前降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。两组治疗前后血清FT3、FT3水平比较,差异无统计学意义(P>0.05)。小剂量左甲状腺素治疗甲状腺良性结节的疗效等同于常规剂量,但不良反应更少,安全性更高。     

碘和甲状腺球蛋白诱导大鼠自身免疫性甲状腺炎的研究

目的　研究碘与自身免疫性甲状腺炎 (EAT)的关系。方法　用碘和甲状腺球蛋白 (TG)诱导SD大鼠建立甲状腺炎模型 ,随机分为 5组 ,每组 10只。正常对照组 (NC组 ) ;少量碘组 (LI组 ) :饮 5 0 0 μg/L碘化钠水 ;大量碘组 (HI组 ) :饮 5 0 0mg/L碘化钠水 ;TG组 :于实验第 15天大鼠接受皮内多点注射完全福氏佐剂乳化的TG各 10 0 μg作为初次免疫 ,2周后以不完全福氏佐剂乳化的TG加强免疫 ,以后每周加强免疫 1次至第 6周末实验结束 ;TG HI组 :TG及HI给药方法同上。至第 6周末实验结束处死所有动物 ,用放免法检测血清TG抗体 (TGAb)及甲状腺过氧化物酶抗体 (TPOAb)效价 ,并于光镜下观察甲状腺组织淋巴细胞浸润程度。结果　TG HI组、HI组及TG组甲状腺滤泡破坏及淋巴细胞浸润均较明显 ,TG HI组及HI组与NC组比较 ,P<0 .0 5 ,TG组与NC组比较有增高趋势 ,但无统计学意义。 3组TGAb、TPOAb均明显高于NC组及LI组 (P<0 .0 1;仅HI组TPOAbP<0 .0 5 )。各组TGAb及TPOAb水平与甲状腺病理分级呈正相关关系 (r =0 .9,P<0 .0 5 )。结论　高碘可诱发SD鼠EAT发生 ,TG与高碘结合诱导SD大鼠EAT的作用更明显     

Urinary Iodine Concentrations Should Be Monitored to Diagnose Some Thyroid Gland Diseases in Heart Transplant Recipients

Background

According to the World Health Organization, iodine excreted in urine is a measure of its supply. According to the International Council for Control of Iodine Deficiency Disorders (ICCIDD), the urinary iodine (UI) should be >100 μg I per 1 liter of urine. Severe deficiency (SID) is diagnosed when UI is <50 μg/L and a moderate deficiency (MID) when UI is <100 μg/L.

Materials and Methods

UI analysis among 32 heart transplant recipients (26 men and 6 women); of overall mean age of 50.4 ± 12.6 years was performed using the modified Program Against Micronutrient Malnutrition method, a spectrophotometric measurement based on the Sandell-Kolthoff reaction. Results were compared with those of thyroid stimulating hormone (TSH; μIU/mL), of free tri-iodothyronine (FT3; pg/mL), and thyroxine (FT4; ng/dL).

Results

The average UI among the whole group was 126.4 ± 109.6 μg/L. SID occurred in 12 patients (37.5%) and MID in 4 (12.5%); namely, mean UI of 17.0 ± 9.6 and 79.5 ± 5.6, respectively. In the other 16 patients (50%), the average UI was high, namely, 220.1 ± 72.1 IU/mL. TSH, FT3, and FT4 in the whole group were within normal ranges. However, FT4 values significantly differed when SID and MID patients were compared with those displaying the recommended UI: 0.8 ± 0.2 and 0.9 ± 0.1 versus 1.1 ± 0.2 respectively (P < .05). We noted decreased values of TSH in 5 patients (15.6%) and of FT3 or FT4 in 6 subjects (18.8%).

Conclusion

There exists significant iodine deficiency among heart transplant recipients. Measurements of urinary iodine together with thyroid gland hormones may be essential to prevent thyroid gland disturbances in these patients.     

髋关节置换术中碘伏冲洗对患者甲状腺功能的影响

目的探讨髋关节置换术术中使用碘伏冲洗消毒对患者术后甲状腺功能的影响。 方法2017年1月至2017年9月将诊于上海长海医院关节外科拟行髋关节置换术的50名患者(无甲状腺疾病及髋关节感染患者),随机分为两组：实验组(术中于假体置入后应用碘伏冲洗、浸泡消毒5 min)25例,对照组(使用生理盐水冲洗、浸泡5 min)25例。两组术后采用相同的康复训练方案。采集所有患者术前、术后第1天,第1周以及第1个月促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT₃)、游离甲状腺素(FT₄)以及尿碘的结果,评估术后以及术后1 d、1周及1个月与术前相比变化的程度。各时间点的组间差异采用配对样本t检验。 结果50名患者均顺利完成手术,且术后至少随访1个月。实验组FT₃术前为(4.4±0.8)pmol/L,术后第1天、1周、1个月分别为(1.7±0.3)、(4.7±0.7)、(4.3±1.0)pmol/L,对照组术前为(4.2±0.7)pmol/L,术后1 d,1周、1个月分别为(2.9±0.5)、(3.8±0.8)、(4.5±0.9)pmol/L;实验组FT₄术前为(15.4±3.6)pmol/L,术后第1天、1周、1个月分别为(10.7±2.5)、(12.1±2.7)、(15.3±3.5)pmol/L,对照组术前为(15.1±3.8)pmol/L,术后1 d,1周、1个月分别为(13.9±2.7)、(14.6±2.3)、(15.7±3.1)pmol/L;实验组TSH术前为(2.6±1.3)mIU/L,术后1 d、1周、1个月分别为(1.3±0.3)、(3.1±1.0)、(2.36±1.9)mIU/L,对照组术前为(2.6±1.0)mIU/L,术后1 d,1周、1个月分别为(1.3±0.3)、(2.0±1.1)、(2.5±1.5)mIU/L;实验组术前尿碘(251±97)μg/L,术后1 d、1周、1个月为(919± 224)、(453± 106)、(253±112)μg/L,对照组术前为(254±98)μg/L,术后1 d,1周、1个月分别为(262±215)、(255±107)、(244±94)μg/L。两组组间相比术后1 d及1周TSH、FT₃、FT₄以及尿碘值比较差异有统计学意义(术后1 d TSH：t＝0. 892,术后1 d FT₃：t＝7.165,术后1 d FT₄：t＝3.296,术后1 d尿碘值：t＝8.184,均为P <0.05;术后1周TSH：t＝2.691,术后1周FT₃：t＝3.339,术后1周FT₄：t＝2.754,术后1周尿碘值：t＝5.092;均为P <0.05),而术后1个月TSH、FT₃、FT₄以及尿碘值比较差异无统计学意义(均为P>0.05)。 结论术中使用碘伏冲洗对患者甲状腺功能有一过性影响,在术后第1天影响最大,1周后逐渐恢复,1个月后几无影响。     

Thyroid hormone metabolism in pediatric cardiac patients treated by continuous povidone–iodine irrigation for deep sternal wound infection

Objective: The purpose of this study was to assess the influence of povidone–iodine mediastinal irrigation used for the treatment of deep sternal wound infection (DSWI) on thyroid function. Methods: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone–iodine irrigation for DSWI. The median age of patients was 8 months (18 days–5.3 years). Serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), reverse triiodothyronine (rT3) and thyroxine-binding globulin (TBG) were measured at three time points: (a) prior to mediastinal reexploration (before povidone–iodine exposure); (b) immediately after discontinuation of povidone–iodine irrigation; (c) 2 weeks after discontinuation of mediastinal irrigation. Urinary iodine excretion was examined on the last day of povidone–iodine exposure. Results: Prior to the mediastinal reexploration, the median TT3 and TT4 levels were below the normal range, then increased significantly to concentrations within the normal range. The median serum FT3 levels were within the normal range throughout the observation period, though a significant increase of FT3 levels was observed after discontinuation of irrigation. The median serum FT4 concentrations were within the normal range prior to irrigation and did not change significantly. The median rT3 levels were within the normal range, close to upper normal limit. The median TBG levels were within the normal range throughout the observation period, though a significant increase of TBG levels was observed during the period of mediastinal irrigation. The median TSH level was within the normal range prior to mediastinal irrigation and did not change significantly. Urinary iodine concentrations in infants with povidone–iodine irrigation were significantly higher 6700 μg/l (range, 1600–15 000 μg/l) than in the group of 53 healthy infants 200 μg/l (range, 20–780 μg/l, P<0,001). Conclusions: Our data showed that the use of povidone–iodine irrigation in the patients with DSWI has not lead to any significant alteration in thyroid function within the study period.     

Thyroid disorders in hemodialysis patients in an iodine-deficient community

There are various changes in the thyroid gland and its function in chronic renal failure (CRF). These changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland. This study is designed to investigate the prevalence of goiter and thyroid dysfunction in patients with end-stage renal disease (ESRD) on hemodialysis (HD) in an iodine-deficient community. Eighty-seven (40 females and 47 males) HD patients and 169 (79 females and 90 males) healthy individuals as controls are included. Sex ratios for the patient and control groups are 0.85 and 0.88, respectively. Mean ages for the patient and control groups are 42.94 +/- 11.88 and 40.20 +/- 10.72 years, respectively. Examination of the thyroid gland using ultrasonography along with simultaneous measurement of blood levels of free-T4 (FT4), free-T3 (FT3), and thyrotropin (TSH) are made for every individual. The presence of goiter demonstrable by ultrasonography is found in 32.2% of the uremic patients and in 23.5% of the controls and its prevalence increases with age (P = 0.01). In 32 (36.8%) of the patients and 29 (17.1%) of the controls at least one thyroid nodule is found in ultrasonography. Between patients with or without a nodular goiter the authors could not observe any difference for duration of dialysis and serum levels of TSH, FT4, FT3, calcium, and albumin. In ESRD patients the prevalence of nodular goiter is higher for females (47.5% vs. 27.7%, P = 0.045) and increases with age (P = 0.04). Though incidence of hyperthyroidism is found to be similar for the two groups (1.14% in ESRD patients vs. 1.10% in controls), hypothyroidism is observed in 3.4% of ESRD patients but only 0.6% of controls. This high incidence of hypothyroidism and nodular goiter in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests and ultrasonography, should be considered in evaluation of every ESRD patient.     

The use of povidone iodine in neonatal bowel surgery

The ostomy sites of four premature infants undergoing bowel reanastomosis were lavaged with a 10% solution of povidone iodine to reduce local bacterial contamination and the risk of anastomosis dehiscence. There was a significant decrease in serum thyroxin from 112 (+/- 11) mumol/L to 90 (+/- 33) mumol/L 24 hours following surgery (P less than .05), but no change in serum thyroid stimulating hormone (TSH). The total serum iodine rose from 1.5 (+/- 0.05) mumol/L before surgery to 61.6 (+/- 46.4) mumol/L 24 hours later and urinary iodine excretion was 60 times the preoperative value in the second 24 hours following surgery. Both the hormonal and biochemical indices returned to normal 2 weeks following surgery except for total serum iodine, which remained slightly elevated. Povidone iodine is a safe and effective antiseptic agent. However, as it may cause transient suppression of thyroid function in neonates, thyroid status should be tested in all such infants at approximately 2 weeks following repeated or widespread use.     

基础甲状腺功能与IVF-ET妊娠结局的相关性研究

目的研究基础甲状腺功能三项(TSH、FT3、FT4水平)与体外受精-胚胎移植妊娠结局之间的关系。方法以2014年9月至2015年5月在南京大学医学院附属鼓楼医院生殖医学中心行长方案体外受精/卵胞浆内单精子注射-胚胎移植术(IVF/ICSI-ET)并行新鲜胚胎移植的不孕症患者作为研究对象。于IVF前月经第2~4天空腹留血,检测基础甲状腺功能三项:促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)。纳入甲状腺功能三项均正常的患者486例,分析基础甲状腺功能与IVF/ICSI妊娠结局的关系。结果 (1)486例患者中临床妊娠305例,活产249例,早期自然流产23例;(2)临床妊娠组与未妊娠组比较,TSH、FT3、FT4水平均无统计学差异(P0.05),临床妊娠组女方年龄小[(29.4±3.9)vs.(30.7±4.3)岁,P=0.001)]、子宫内膜厚[(11.0±2.2)mm vs.(9.9±1.9)mm,P0.001)];(3)活产组与早期自然流产组相比,基础TSH、FT3、FT4差异均无统计学意义(P0.05);(4)基础TSH≥2.5mIU/L的患者与TSH2.5mIU/L者的临床妊娠率、活产率、早期自然流产率和新生儿出生体重均无统计学差异(P0.05)。结论基础甲状腺功能三项如在正常范围不影响IVF结局,IVF前TSH≥2.5mIU/L但4.2mIU/L时不增加早期自然流产率,也不影响新生儿出生体重。     

分化型甲状腺癌术后sTg、sTg/TSH及sTg×TgAb对131I疗效预测价值研究

目的 分析分化型甲状腺癌（DTC）术后首次131I治疗前血清刺激性甲状腺球蛋白（sTg）、sTg与促甲状腺激素（TSH）的比值以及sTg与抗甲状腺球蛋白抗体（TgAb）的乘积对131I疗效的预测价值。方法 回顾性分析2019—2020年郑州大学第一附属医院302例DTC病人的临床特征资料,根据131I疗效反应的分类将疗效满意的病人纳入疗效满意组（176例）,将疗效不确切、生化疗效不佳及结构性疗效不佳的病人纳入疗效不佳组（126例）。采用受试者工作特征（ROC）曲线模型分析并比较sTg、sTg/TSH及sTg×TgAb对131I疗效的预测价值。采用单因素及多因素Logistic回归分析明确131I疗效不佳的独立危险因素。结果 sTg、sTg/TSH和sTg×TgAb预测131I疗效的曲线下面积（AUC）分别为0.809、0.789、0.870,最佳临界值分别为2.735mg/L、0.038、28.364,敏感度分别为72.2%、60.3%、88.1%,特异度分别为86.4%、92.0%、72.2%。三者ROC曲线两两之间差异有统计学意义（P＜0.05）。单因素及多因素Logisic回归分析示侧区淋巴结转移、服碘剂量、TgAb、sTg＞2.735 mg/L和sTg×TgAb＞28.364是131I疗效不佳的独立危险因素。结论 sTg、sTg/TSH和sTg×TgAb均可在一定程度上预测131I的疗效,且sTg×TgAb的预测能力优于sTg和sTg/TSH,其中sTg＞2.735 mg/L及sTg×TgAb＞28.364是131I疗效不佳的独立危险因素。临床可将sTg×TgAb作为预测DTC病人术后131I疗效的参考指标。     

α-硫辛酸联合替米沙坦治疗早期2型糖尿病肾脏疾病的临床疗效观察

目的 观察应用α-硫辛酸联合替米沙坦治疗早期2型糖尿病肾脏疾病（diabetic kidney disease,DKD）的临床疗效及安全性.方法 选择2012年8月至2013年12月间116例诊断为早期2型糖尿病肾脏病的成人患者,采用随机数字表法将患者分为4组,每组29例.常规治疗组（对照组）：予以控制饮食、降血糖和血压等常规治疗;替米沙坦组：在对照组基础上加用替米沙坦（80 mg/d,连用4周）;α-硫辛酸组：在对照组基础上加用α-硫辛酸（600 mg/d,连用4周）;联合用药组：在对照组的基础上加用替米沙坦和α-硫辛酸（二者用法同前）.监测治疗后各组患者的血糖、尿微量白蛋白排泄率（urinary albumin excretion rate,UAER）及尿β2微球蛋白（β2-Microglobulin,β2-MG）水平,观察治疗期间患者的病情变化及不良反应.结果 治疗前,对照组、替米沙坦组、α-硫辛酸组及联合用药组的UAER分别为（118.5±13.3） μg/min、（122.8±12.1）μg/min、（121.2±11.3）μg/min和（119.2±11.7）μg/min,尿β2MG分别为（331.1±43.3） mg/L、（325.2±41.6） mg/L、（328.7±39.9） mg/L和（330.7±44.0）mg/L,4组间差异均无统计学意义（P＞0.05）.治疗后第4周,替米沙坦组、α硫辛酸组及联合用药组UAER和尿β2-MG较治疗前均呈下降趋势（P＜0.01）,UAER分别为（52.2±6.1） μg/min、（40.2±5.0） μg/min和（22.6±3.8） μg/min,尿β2-MG分别为（231.2±18.7）mg/L、（206.2±19.8）mg/L和（171.7±15.8） mg/L;与对照组[（78.1±7.3）μg/min和（268.1±22.3） mg/L]比较,其他3组UAER和尿β2-MG的下降幅度更大（P＜0.01）;其中联合用药组下降幅度最大（P＜0.05）,α硫辛酸组下降幅度大于替米沙坦组（P＜0.05）.治疗期间,4组患者的血糖和血压控制良好,肾功能未出现明显异常,均未发生严重的药物相关不良反应.结论 α-硫辛酸治疗早期2型糖尿病肾脏病是安全、有效的,能显著降低患者的UAER和尿β2-MG水平;     

Iodine therapy for thyroidectomy patients exhibiting high thyroid-stimulating hormone values: a randomised study.

After thyroidectomy there is an appreciable incidence of hypothyroidism as judged by FT4I estimates. Pharmacological doses of iodine (10-300 mg/day) usually suppress, whereas physiological doses of iodine (< 5 mg/day) have been reported to both decrease and increase thyroid function. The value of iodine supplementation in preventing post-thyroidectomy hypothyroidism was assessed in a prospective randomised trial. A series of 55 patients with a TSH > 6 mU/l 1 month after bilateral subtotal thyroidectomy or unilateral lobectomy for benign disease were randomised to receive either chloroform water 5 ml/day (placebo) or chloroform water 5 ml/day with 1 mg of iodine to be taken for 20 weeks. With placebo, 62% of bilateral subtotal thyroidectomies were euthyroid at 6 months on no thyroid replacement, while with iodine all were hypothyroid as judged by FT4I. After bilateral subtotal thyroidectomy, the recovery of remnant function is delayed by an iodine supplement of 1 mg/day.     

Iodine-induced thyrotoxic hypokalemic paralysis after ingestion of Salicornia herbace

A 56-year-old Korean man visited to emergency room due to paroxysmal flaccid paralysis in his lower extremities. There was no family or personal history of periodic paralysis. His initial potassium levels were 1.8?mmol/L. The patient had been taking Salicornia herbacea for the treatment of diabetes and hypertension. Results of a thyroid function test were as follows: T3?=?130.40?ng/dL, TSH?=?0.06?mIU/L, and free T4?=?1.73?ng/dL. A thyroid scan exhibited a decreased uptake (0.6%). His symptoms clearly improved and serum potassium levels increased to 4.4?mmol/L by intravenous infusion of only 40?mmol of potassium chloride. Eight months after the discontinuation of only Salicornia herbacea, the patient’s thyroid function tests were normalized. Large amounts of iodine can induce hypokalemic thyrotoxic paralysis and it may be necessary to inquire about the ingestion of iatrogenic iodine compounds, such as Salicornia herbacea.