High serum thyroxine-binding globulin--an important cause of hyperthyroxinaemia.

Four patients are described who had a significant elevation of serum thyroxine-binding globulin (TBG). Review of these patients indicated that inappropriate therapy for thyrotoxicosis had been given in three cases. A study of our laboratory records revealed that significant TBG elevation was a relatively common phenomenon which occurred in approximately 0.45% of our hospital population. Patients with this abnormality have serum thyroxine levels which are comparable to those with clinical thyrotoxicosis. Tri-iodothyronine is frequently elevated though less so than in patients with clinical thyrotoxicosis. Measurement of TBG is indicated in all cases of hyperthyroxinaemia in which the clinical features of thyrotoxicosis are doubtful. The TRH test was found to be most useful in evaluating the thyroid status of these patients.     

低钾性周期性麻痹临床特点分析

目的：探讨低钾性周期性麻痹的临床特点, 比较原发性低钾周期性麻痹与甲状腺毒症继发周期性麻痹两组患者的异同点。方法: 北京大学第一医院1996年12月至2008年12月住院治疗的低钾性周期性麻痹患者44例, 回顾性分析其临床资料。结果: 原发组和甲状腺毒症继发组各22例, 两组患者共同的特点: (1)均好发于青壮年男性; (2)主要临床表现均为肢体活动障碍和乏力, 大部分病例以反复多次发作为主; (3)部分病例（40.9% ~ 68.2%）发病有明显诱因, 诱因以饱餐、喝甜饮料和剧烈运动最常见; (4)发病时, 两组患者血钾水平均明显低于正常水平; (5)原发组与甲状腺毒症继发组分别有20%和25%的患者肌酸激酶明显升高, 补钾治疗后较快恢复正常, 乳酸脱氢酶及α羟基丁酸脱氢酶均正常; (6)补钾剂量与发病时血钾水平无相关性。两组患者的不同点主要表现为: (1) 甲状腺毒症继发组患者有高代谢症状, 甲状腺功能提示T3、T4升高和促甲状腺激素（TSH）降低, 原发组患者无此类症状, 其甲状腺功能正常; (2)甲状腺毒症继发组血钾水平显著低于原发组［(2.25±0.67) vs (2.78±0.49)mmol/L, P=0.007］; (3)甲状腺毒症继发周期性麻痹较原发性低钾性周期性麻痹在补钾治疗过程中更容易出现反跳性高钾血症。结论: 低钾性周期性麻痹有其临床特点, 早期诊断及时补钾治疗预后较好。补钾时不能仅根据发病时血钾水平决定补钾剂量, 应密切监测血钾水平。甲状腺毒症继发周期性麻痹在补钾治疗过程中更容易出现反跳性高钾血症, 在补钾治疗时应当密切监测血钾, 并积极根治甲状腺毒症。     

血清T3/T4值对甲状腺毒症的诊断价值分析

目的:探讨血清T3 T4值对甲状腺毒症的诊断价值,从甲状腺毒症的发病机制分析提供参考。方法:采用电化学发光免疫学方法检测40例甲状腺毒症、60例良性甲状腺病变和40例正常人对照血清甲状腺激素水平,并把甲状腺激素水平与甲状腺毒症临床病理参数进行对比分析。结果:T3、FT4在甲状腺毒症组、甲状腺良性病变组和对照组表达的差异有统计学意义(P<0.05),其中甲状腺毒症组FT3、FT4水平处于较低水平,二者均明显低于甲状腺良性病变组和对照组(P<0.05)。而T3和T4水平在三组之间比较无统计学意义(P>0.05)。甲状腺毒症组血清FT3水平与肿瘤病理分期和淋巴结转移呈负相关(P<0.05),与肿瘤大小无关(P>0.05)。而甲状腺毒症患者血清FT4水平与性肿瘤大小、肿瘤病理分期和淋巴结转移均无关(P>0.05)。结论:甲状腺激素T3水平低下与甲状腺毒症相关,有可能参与了甲状腺毒症的发生发展。而T4不足可能是甲状腺毒症T3水平低下的一个机制。     

Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes

In a clinic population of 509 type 1 diabetic patients aged 16-45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and Addison's disease was present in four patients (0.8%, one male). In all patients, type 1 diabetes preceded the diagnosis of the other autoimmune disorder. The clinical presentation of hypothyroidism was usually insidious with few symptoms, although an increased frequency of hypoglycaemic symptoms and/or raised serum cholesterol levels often prompted thyroid function testing. In contrast, the patients with thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg), palpable goitres, increasing insulin requirements, and low cholesterol levels. Six patients did not achieve remission or had recurrent thyrotoxicosis after oral antithyroid treatment and required 131I or thyroid surgery. A family history of autoimmune disease was present in 25% of patients with thyroid disorders (seven thyrotoxic and one hypothyroid) and in three of the four patients with Addison's disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and Addison's disease should be carried out if there is clinical suspicion and/or unexplained changes in diabetic metabolic control or serum cholesterol. Careful follow-up of patients with a family history of these conditions is recommended.     

Remission of hyperthyroidims and oral contraceptive therapy. [Answer to question

There is no endocrine contraindication to the use of oral contraceptives (OCs) in a 31-year-old nulliparous woman who presumably is in remission from hyperthyroidism. Yet, several important physiological and pathophysiological alterations must be appreciated to evaluate properly thyroid function in persons taking estrogen-containing preparations. Estrogens induce increased hepatic synthesis and release of thyroxine binding globulins (TBGs). Increased serum TBG concentrations result in a new thyroid hormone equilibrium characterized by an elevated serum thyroxine (T4) level and a reduced resin triiodothyronine (T3 uptake) level but a persistently normal serum-free T4 (FT4) level if the patient is euthyroid. When a patient with an increased serum TBG concentration becomes thyrotoxic, the T4 level rises further and the resin T3 uptake increases from low into the normal range. The calculated FT4 level increases into the thyrotoxic range. Thus, in patients with increased serum TBG levels, the calculated FT4 level is the critical serum determinant for laboratory assessment of thyroid function. If the FT4 level is equivocal in evaluating thyrotoxicosis in the presence of increased serum TBG values, then other clinical and laboratory parameters should be used. A thyroid suppression test or a thyrotropin-releasing hormone test might be useful when the serum parameters are not definitive. It is unnecessary to stop the use of OC preparations to evaluate thyroid function. At this time it is unclear whether the use of estrogen-containing medications influences the nature and extent of an autoimmune remission in Graves' disease. There is some evidence that autoimmune thyrotoxicosis is ameliorated or modified by factors in pregnancy.     

甲状腺激素对糖化白蛋白作用的研究

目的 评价甲状腺激素对糖化白蛋白（GA）的影响.方法 选择32例甲状腺功能亢进初发病患者作为甲亢组,7例甲状腺功能减退初发病患者作为甲减组,17例健康体检者作为对照组,采用酶法检测GA、餐后2h血糖（2hBG）,采用化学发光酶免疫分析法检测促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）,统计分析TSH、FT4、FT3与GA的相互关系.结果 甲亢组GA水平[（10.4±1.82）%]较对照组[（12.0±1.13）%]低,甲减组GA水平[（14.6±3.01）%]较对照组[（12.0±1.13）%]高,差异均有统计学意义（均P＜0.01）.血清GA水平与TSH水平正相关（r=0.39,P＜0.01）;与FT3、FT4水平负相关（r =-0.512,P＜0.01;r =-0.619,P＜0.01）.结论 甲状腺激素负调节GA水平;GA检测应考虑甲状腺激素的影响.     

白细胞亚型和甲状腺功能检测在甲状腺毒症鉴别诊断中的意义

目的：探讨不同甲状腺毒症患者血白细胞亚型和甲状腺功能的差异,阐明血白细胞亚型和甲状腺功能检测鉴别诊断Graves病甲状腺毒症和破坏性甲状腺毒症的实用意义。方法：回顾性分析经临床和实验室检查确诊的33例Graves病患者和30例破坏性甲状腺毒症患者的中性粒细胞（Ne）、淋巴细胞（Ly）、嗜碱性粒细胞（Ba）、嗜酸性粒细胞（Eo）、单核细胞（Mo）、血清游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）和甲状腺刺激激素（TSH）值;采用受试者工作曲线（ROC）评价有统计学意义的检查指标对Graves病和破坏性甲状腺毒症的鉴别诊断价值。结果：Graves病组患者血清Eo、FT4与FT3值和改良后的数据Eo/Mo、Eo×FT3/Mo均明显高于破坏性甲状腺毒症组（P < 0.05）,而TSH和Mo值低于破坏性甲状腺毒症组（P < 0.05）。ROC曲线分析,Eo、Eo/Mo、Eo×FT3/Mo在2种疾病鉴别诊断中的灵敏度和特异度良好,最佳诊断界点分别为1.54、0.34和3.94。结论：Eo、Mo、TSH、FT3、FT4、Eo/Mo和Eo×FT3/Mo均可作为鉴别诊断2种疾病的依据,其中Eo、Eo/Mo和Eo×FT3/Mo对于Graves病与破坏性甲状腺毒症的鉴别诊断实用意义较大。     

血清促甲状腺素水平与甲状腺癌的相关性研究

目的研究血清促甲状腺素水平与甲状腺癌的相关性。方法回顾性分析300例甲状腺肿瘤患者临床资料,其中甲状腺癌87例,良性甲状腺肿瘤213例。结果甲状腺癌与良性肿瘤患者年龄和性别比较无显著差异(P>0.05),甲状腺癌患者血清TSH水平显著高于良性肿瘤患者(P<0.05),不同血清TSH水平良性甲状腺肿瘤患者和甲状腺癌患者构成比有显著差异(P<0.05),在正常值范围内随血清TSH水平增加甲状腺癌呈正相关(P<0.05)。单因素分析,血清TSH与肿瘤分期、肿瘤直径、淋巴结转移、包膜侵犯有关(P<0.05);多因素Logistic回归分析,血清TSH与甲状腺癌患者的肿瘤分期、淋巴结转移密切相关(P均<0.05)。结论血清TSH水平与肿瘤分期、淋巴结转移密切相关,较高的血清TSH水平使甲状腺癌患病风险增高。     

桥本甲状腺炎合并原发性甲状腺淋巴瘤4例的临床病理分析

目的:观察桥本甲状腺炎（HT）合并原发性甲状腺淋巴瘤（PTL）的临床病理特征及免疫表型,探讨PTL的诊断、鉴别诊断、治疗及预后。方法:按WHO（2008）淋巴瘤分类标准,收集4例HT合并PTL,分析其临床病理特征、免疫组化分型并随访。结果:4例中女3例,男1例,年龄56～62岁。单侧甲状腺无痛性肿块常为首发症状。镜下表现为中等或较大的肿瘤性淋巴细胞弥漫浸润,可见残存的甲状腺腺体,腺体萎缩,并可见淋巴上皮病变。结论:甲状腺原发性淋巴瘤少见,与HT的发生密切相关,免疫组化标记有助于确诊,治疗以手术治疗辅助联合化疗、放疗等方案为宜。     

Hyperthyroidism after propranolol withdrawal

Classic features of thyrotoxicosis developed in three patients with no prior history of thyroid disease shortly after the discontinuation of therapy with or decrease in doseage of propranolol hydrochloride. Graves' disease probably developed fortuitously after propranolol therapy was instituted, but the beta-adrenergic blockade masked the clinical features of hyperthyroidism. On discontinuation of propranolol therapy or decrease in propranolol dosage, previously latent thyrotoxicosis became manifest. If hyperthyroidism masked by beta-blockade is not recognized before withdrawal of propranolol therapy in patients with ischemic heart disease, the sudden appearance of thyrotoxicosis may lead to symptoms of increased myocardial ischemia.     

胃癌血清CEA和CA19-9的表达及临床意义

目的:分析胃癌血清CEA、CA19-9水平与临床病理特点的关系,为临床应用提供依据.方法:检测51例胃癌患者血清CEA、CA19-9表达水平,同时留取胃癌患者组织病理学标本,分析血清CEA、CA19-9的表达水平与临床病理特点的关系.结果:血清CEA在胃低分化腺癌及黏液性腺癌中的表达阳性率高于其他病理类型;有肝转移及腹腔转移患者血清CEA、CA19-9表达阳性率高于无肝转移及无腹腔转移患者.结论:血清CEA、CA19-9水平的升高对判断胃癌有无肝及腹腔转移具有重要的临床意义.     

原发性甲状腺恶性淋巴瘤10例临床分析

目的 总结原发性甲状腺恶性淋巴瘤(PTL)的诊断和治疗经验.方法 10 例PLT患者采用甲状腺全切除术、CHOP方案(环磷酰胺,阿霉素,长春新碱)化疗及术后放疗,回顾性分析其临床特点及疗效.结果 术前9例患者被误诊为甲状腺癌,1例误诊为结节性甲状腺肿.10例患者均行甲状腺全切除术,4例颈部淋巴结有转移的患者行甲状腺全切...     

American Thyroid Association guidelines for use of laboratory tests in thyroid disorders

Selection of appropriate laboratory determinations will enable the clinician to diagnose thyroid dysfunction readily in the majority of patients. At the present time, estimation of free thyroxine and a "sensitive" thyrotropin assay are recommended as the principal laboratory tests for thyroid disease. A decrease in serum free thyroxine estimate and a raised level of serum thyrotropin confirm the diagnosis of hypothyroidism caused by thyroid gland failure. An increase in free thyroxine estimate combined with a serum sensitive thyrotropin level suppressed to less than 0.1 mU/L establishes the diagnosis of thyrotoxicosis. In sick patients, a normal or raised serum free thyroxine estimate together with a normal level of serum thyrotropin suggests that the patient has neither hypothyroidism nor thyrotoxicosis. Patients with severe illnesses, generally in the intensive care unit, and those treated with certain drugs, as well as individuals with unusual thyroid disorders, may present with confusing laboratory findings. An understanding of the regulation of the thyroid hormone system and/or judicious consultation with an endocrinologist should enable the clinician to diagnose thyroid disease, if present, in such patients.     

带血管蒂甲状腺甲状旁腺胸腺联合移植术

目的探讨联合移植甲状腺甲状旁腺及胸腺治疗甲状腺癌根治术后甲状旁腺功能低下症及预防甲状腺癌复发.方法将带血管蒂甲状腺甲状旁腺及胸腺整块移植给甲状腺癌根治术后继发甲状旁腺功能低下症的患者,观察移植物存活、临床效果及T细胞亚群变化.结果移植后患者的钙剂用量有所减少,临床症状有所改善.移植物血流良好.血钙及甲状旁腺素水平有所变化,但未恢复正常.CD3,CD4/CD8比值升高.结论带血管蒂甲状腺甲状旁腺胸腺联合移植近期可以改善甲状旁腺功能低下症患者的临床症状,远期疗效及抑制甲状腺癌复发的作用尚需长期观察.     

甲状腺结节患者临床特征研究

目的　分析甲状腺结节患者的临床资料,为甲状腺结节良恶性的鉴别提供依据。方法　收集2014年1月—2015年2月于昆明医科大学第一附属医院因甲状腺结节行手术切除的646例患者的临床资料,以术后病理检查结果为诊断标准,比较不同基本资料、病史、血脂异常情况、超声影像特点、CT影像特点的甲状腺结节患者恶性结节发生率,检测甲状腺良、恶性结节患者促甲状腺激素（TSH）、甲状腺球蛋白抗体（TGAb）滴度、甲状腺过氧化物酶抗体（TPOAb）滴度。分析术前超声、CT对甲状腺结节性质的鉴别诊断价值及甲状腺结节恶性的危险因素。结果　不同年龄段甲状腺结节患者恶性结节发生率比较,差异有统计学意义（P<0.05）;不同BMI、饮食碘摄入情况、甲状腺癌家族史情况、其他恶性肿瘤家族史情况甲状腺结节患者恶性结节发生率比较,差异有统计学意义（P<0.05）。本研究患者均行甲状腺超声检查,不同性质、低回声情况、边界、形态、结节内血流情况、纵横比、边缘成角情况、内部钙化情况、颈部淋巴结肿大情况的甲状腺结节患者恶性结节发生率比较,差异有统计学意义（P<0.05）。共85例患者行CT增强扫描,不同边界、颈部淋巴结肿大情况甲状腺结节患者恶性结节发生率比较,差异有统计学意义（P<0.05）。本研究患者均行TSH检测,恶性结节患者TSH高于良性结节患者（P=0.006）。行甲状腺自身抗体滴度检测的患者共395例,恶性结节患者TGAb滴度及TPOAb滴度均较良性结节患者高（P<0.001）。与术后病理检查结果比较,术前超声鉴别甲状腺结节性质的灵敏度为97.60%、特异度为82.77%、诊断符合率为89.47%,术前CT鉴别甲状腺结节性质的灵敏度、特异度、诊断符合率依次为95.12%、68.18%、81.18%。多因素Logistic回归分析显示,年龄较小、肥胖、饮食碘摄入多,超声检查甲状腺结节形态不规则、结节内血流丰富、纵横比≥1、边缘成角、内部有钙化,TSH升高及TPOAb滴度升高是甲状腺结节恶性的危险因素（P<0.05）。伴、不伴颈部淋巴结转移的甲状腺恶性结节患者结节内血流、内部有钙化情况比较,差异有统计学意义（P<0.05）。结论　年龄较小（30~49岁）、肥胖、饮食碘摄入多,超声检查甲状腺结节形态不规则、结节内血流丰富、纵横比≥1、边缘成角、内部有钙化,TSH升高及TPOAb滴度升高是甲状腺结节恶性的危险因素;甲状腺结节内血流丰富及内部钙化更多见于伴颈部淋巴结转移的甲状腺癌。     

超声弹性成像参数联合血清MMP-9、HMGB-1、TG诊断甲状腺癌临床价值及与淋巴结转移的关系

目的分析超声弹性成像参数联合血清基质金属蛋白酶-9(MMP-9)、高迁移率族蛋白B1(HMGB-1)、甲状腺球蛋白(TG)在甲状腺癌临床诊断中的价值及与淋巴结转移的关系。方法选取2017年1月-2019年1月皖北煤电集团总医院超声科诊断甲状腺癌患者126例作为甲状腺癌组(腺癌组),甲状腺良性结节患者126例作为甲状腺良性结节组(结节组)。2组均进行超声弹性成像检查及血清MMP-9、HMGB-1、TG水平检测,比较2组患者超声弹性成像参数(蓝色面积比值、弹性比值)及血清各指标水平,应用Logistic回归分析甲状腺癌发生的危险因素,并分析血清各指标及超声弹性成像参数与甲状腺癌患者淋巴结转移的相关性,采用ROC曲线分析超声弹性成像参数、血清各指标对甲状腺癌的诊断价值。结果腺癌组血清MMP-9、HMGB-1、TG水平高于结节组(t=13.022、10.571、12.015,P均<0.001),蓝色面积比值、弹性比值均高于结节组(t=6.537、8.765,P均<0.001);腺癌组有淋巴结转移患者血清MMP-9、HMGB-1、TG水平及蓝色面积比值、弹性比值高于无淋巴结转移患者(t=4.097、3.091、2.528、5.667、6.679,P均<0.05)。Spearman相关性分析,血清MMP-9、HMGB-1、TG水平及蓝色面积比值、弹性比值与甲状腺癌患者淋巴结转移呈显著正相关(r=0.624、0.728、0.709、0.661、0.687,P均<0.001)。超声弹性成像参数及血清指标联合诊断甲状腺癌的AUC为0.919,敏感度为90.48%,特异度为86.51%。Logistic回归分析,血清MMP-9、HMGB-1、TG、蓝色面积比值、弹性比值均为甲状腺癌发生的重要危险因素(P均<0.05)。结论超声弹性成像参数及血清MMP-9、HMGB-1、TG与甲状腺癌患者淋巴结转移密切相关,联合检测可为甲状腺癌临床诊断提供一定依据。     

Amiodarone. The dilemma of hyperthyroxinaemia and the treatment of thyrotoxicosis

The use of amiodarone, a drug which is prescribed increasingly as an anti-anginal and anti-arrhythmic agent, necessitates a high index of suspicion for the development of thyroid disorders, especially thyrotoxicosis. Two cases, which illustrate the diagnostic dilemma of hyperthyroxinaemia and the poor response to antithyroid medication, are described. During amiodarone therapy, the clinical features of thyrotoxicosis may be masked or atypical, and the choice of therapy is complicated by a delayed response to thioamide drugs and possible contraindication for beta-blocking agents which necessitates the use of glucocorticoid drugs in some patients.     

原发性甲状腺淋巴瘤的CT表现

目的：探讨原发性甲状腺淋巴瘤(primary thyroid lymphoma,PTL)的CT特征。方法回顾性分析9例经手术病理证实的PTL的CT与临床相关资料。结果弥漫大B细胞淋巴瘤8例,粘膜相关淋巴组织淋巴瘤1例,其中单发结节型2例,多发结节型3例,弥漫肿大型4例。CT平扫7例呈稍低密度,2例呈等密度,8例肿块密度均匀,1例中心见囊变坏死,均无钙化。动态增强：8例呈均匀轻度强化,1例中心伴囊变,囊壁呈环状明显强化,实性区呈不均匀中度强化。3例甲状腺包膜完整,6例病灶甲状腺包膜不完整,侵犯邻近结构,4例伴颈部或上纵膈淋巴结肿大。结论 PTL具有一定CT特征,以弥漫肿大型多见,沿甲状腺轮廓塑形、膨胀生长,多呈均匀低密度,增强扫描呈轻中度均匀强化,确诊仍需结合穿刺活检。     

A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis

Hashimoto thyroiditis (HT) is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis (SAT) is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and an elevated erythrocyte sedimentation rate (ESR). Very rarely, patients with HT can present with painful, tender goiter or fever, a mimic of SAT. We report a case of painful HT in a 68-year-old woman who presented with pain and tenderness in a chronic goiter. Her ESR was definitely elevated and her thyroid laboratory tests suggested subclinical hypothyroidism of autoimmune origin. (99m)Tc pertechnetate uptake was markedly decreased. Fine needle aspiration biopsy revealed reactive and polymorphous lymphoid cells and occasional epithelial cells with Hürthle cell changes. Her clinical symptoms showed a dramatic response to glucocorticoid treatment. She became hypothyroid finally and is now on levothyroxine therapy.     

乳腺癌患者血清甲状腺激素水平检测及其临床意义

目的探讨乳腺癌患者血清甲状腺激素水平的变化及其临床意义。方法回顾性分析30例乳腺癌患者的血清中甲状腺激素水平,并与同期30例健康人群作对比。结果乳腺癌患者血清T3和FT3值均明显降低,与正常对照组相比有统计学意义（P〈0.05）;T4和FT4值轻度降低,但与对照组无显著性差异（P〉0.05）,TSH值无明显变化（P〉0.05）;Ⅲ、Ⅳ期乳腺癌患者T3和FT3值显著低于Ⅰ、Ⅱ期乳腺癌患者（P〈0.05）,而以年龄、肿瘤直径、ER、PR、Her2表达水平分组中血清甲状腺激素水平的变化无显著差异性（P〉0.05）。结论乳腺癌患者血清甲状腺激素水平与患者的病情严重程度相关,监测血清甲状腺激素可有助于评估病情和判断预后。