亚临床甲状腺功能减退症孕妇左旋甲状腺素治疗剂量及影响因素探讨

目的 探讨亚临床甲状腺功能减退症孕妇患者行L-T4替代治疗的剂量以及影响因素.方法 选取我院收治的62例亚临床甲状腺功能减退症孕妇患者进行L-T4替代治疗,根据TSH值分为A组(TSH＞ 5.0mIU/L)和B组(2.5 mIU/L≤TSH≤5.0mIU/L),治疗过程中根据患者的TSH水平对L-T4的治疗剂量进行调整直至治疗达标,其中妊娠中晚期(0.3mIU/L＜ TSH＜ 3.0mIU/L),妊娠早期(0.3mIU/L＜ TSH＜ 2.5mIU/L).结果 亚临床甲状腺功能减退症患者TSH基线水平与L-T4替代治疗达标剂量呈正相关性(r=0.543,P＜0.01);TSH治疗达标时,A组L-T4替代治疗的剂量显著高于B组(P＜0.01);甲状腺自身抗体阳性组L-T4替代治疗的剂量显著高于阴性组(P＜0.05).结论 TSH基线水平以及甲状腺自身抗体状况可能会对亚临床甲状腺功能减退症孕妇行L-T4治疗的达标剂量产生影响.     

自身免疫甲状腺疾病患者甲状腺自身抗体和淋巴细胞亚群临床免疫相关性比较

报告120例Graves 病(GD)和30例桥本氏甲状腺炎(HT)患者甲状腺自身抗体和淋巴细胞亚群的实验结果。GD 未治组TRAb、TMA 和TGA 阳性率分别为88.9%、61.1%和57.8%;HT 未治组阳性率分别为20.0%.80.0%和70.0%。GD 和HT 未治组CD_3~+、CD_(?)~+明显下降,CD_4~+/CD_(?)~+比值和CD_(20)~+显著上升(P<0.01)。GD 缓解组以上各指标恢复正常。GD 未治组TRAb 含量与CD_(8)~+的负相关性强于TRAb 与CD_(20)~+的正相关性。提示CD_8~+和TRAb 的测定是确定Graves 病及其治疗效果和预后的重要指标。     

甲状腺自身抗体对131I治疗青少年Graves病后甲减的影响

研究青少年Graves病(GD)患者治疗前促甲状腺激素受体抗体(TRAb)和甲状腺过氧化物酶抗体(TPOAb)水平对131I治疗后甲状腺功能减退症(甲减)发生率的影响.131I治疗青少年GD患者 264例,治疗前依TRAb和TPOAb分为TRAb阳性、阴性组及TPOAb强阳性、阳性和阴性组;依两抗体不同阳性组合分为A[...     

不同功能状态的桥本氏甲状腺炎患者甲状腺球蛋白抗体糖基化修饰的差异研究

目的:探讨甲状腺功能正常,亚临床甲状腺功能减退和甲状腺功能减退三种不同状态的桥本氏甲状腺炎(Hashimoto's thyroiditis ,HT)患者血清中甲状腺球蛋白抗体(thyroglobulin antibody ,TgAb)免疫球蛋白(immunoglobulin,Ig) G糖基化修饰水平的差异。方法:收集天...     

Graves'病和桥本氏甲减患者外周血Th1、Th2、Th17、Treg细胞的变化

目的:探讨Graves'病和桥本氏甲减患者外周血中Th1、Th2、Th17细胞和CD4+CD25+FOXP3+调节性T细胞(Treg)的比例及其意义.方法:选择新诊断但未治疗的Graves'病(GD)患者25例、桥本氏甲减25例和正常对照者25例,通过流式细胞技术测定其外周血中Th1、Th2、Th17和CD4+CD25...     

1例轻微甲减病人的T3自身抗体与替代治疗观察

轻微甲减病人在使用左旋甲状腺素（L-T4）治疗一定时间后，体内产生了内生抗三碘甲状腺原氨酸（T3）抗体。血清中存在的T3自身抗体干扰血清T3和游离三碘甲状腺原氨酸（FT3）的放射免疫分析结果，使T3、FT3假性升高，给临床判断结果带来一定困难。本文采用抗体替换试验证实了血清内生抗体的存在，并结合检验结果讨论临床替代治疗原则。另外，在临床治疗过程中，该抗体的存在是否会导致L-T4的用药量增加，还需要进一步观察。     

自身免疫性甲状腺病伴甲状腺功能亢进的临床治疗分析

目的探讨分析自身免疫性甲状腺病(AITD)合并甲状腺功能亢进(简称甲亢)患者给予丙硫氧嘧啶片与泼尼松龙片联合治疗的临床效果。方法将我院近两年来收治的210例AITD合并甲亢患者按照随机数字表法分为观察组(给予丙硫氧嘧啶片与泼尼松龙片联合治疗)和对照组(单独给予丙硫氧嘧啶治疗),对比观察两组患者治疗前后游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、血清促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、血清甲状腺过氧化酶抗体(TPOAb)等各项指标变化情况。结果两组患者治疗后FT3、FT4、TGAb、TPOAb等指标水平均有所下降,而TSH水平均有所上升,但观察组患者各项指标改善幅度显著优于对照组患者,差异性显著,具有统计学意义(P<0.05)。结论采用丙硫氧嘧啶与泼尼松龙联合治疗自身免疫性甲状腺病合并甲亢患者临床疗效佳,可显著改善患者功能相关指标,抑制免疫反应,促进患者甲状腺功能尽早恢复,值得在临床上进一步推广、应用。     

消瘿化结汤治疗230例桥本氏病患者的临床疗效分析

桥本氏病是慢性淋巴细胞性甲状腺炎的简称,它是以甲状腺组织中大量淋巴细胞浸润和血清中出现大量抗甲状腺抗体为主要病理特征的自身免疫性疾病.桥本氏病常见于中年女性,很多患者病程早期临床症状不明显,多以甲状腺弥漫性肿大而就诊,可有颈部紧束感,部分患者可有短时间甲亢症状出现,但最终绝大部分患者会出现甲状腺功能减退.     

Graves病中IgG亚型水平的变化

目的 Graves病(Graves′ disease, GD)作为一种自身免疫性甲状腺疾病,其发生存在免疫调节因素的参与,目前对IgG亚类在自身免疫性甲状腺疾病(autoimmune thyroid disease, AITD)中的研究主要集中于针对血清中特定自身抗原的IgG亚型的研究,并无血清整体IgG亚型变化的相关性研究.本研究观察GD患者血清整体IgG亚型水平的变化,并对于IgG亚型与甲状腺自身抗体变化的相关性进行分析,期望通过该研究进一步了解自身抗体介导AITD的机制.方法 随机收集哈尔滨医科大学附属第二医院就诊的初发GD(n=14)作为观察组,观察对象均为女性,排除其他可能影响甲状腺功能和机体免疫状态的因素.随机选取年龄、性别与观察组相匹配非甲状腺疾病健康者15例作为对照组.于清晨空腹采集患者血清,测定甲状腺功能、甲状腺自身抗体、IgG各亚型.结果 GD组血清中IgG1水平较对照组升高(P<0.05);IgG2 水平也较对照组升高,但与对照组相比差异无统计学意义(P>0.05);IgG3和IgG4水平下降明显(P<0.01).GD亚组血清IgG亚型与甲状腺自身抗体、甲状腺功能相关性分析显示各指标间无相关性(P>0.05).结论 Graves病中存在IgG亚型水平的变化.     

桥本甲状腺炎伴不典型细胞与乳头状癌的鉴别诊断

目的：探讨桥本甲状腺炎伴不典型细胞与甲状腺乳头状癌( papillary thyroid carcinoma,PTC)的鉴别诊断。方法收集桥本甲状腺炎153例,分为桥本甲状腺炎伴不典型细胞组(32例)、桥本甲状腺炎伴PTC组(49例)、桥本甲状腺炎对照组(72例)。采用HE及免疫组化法分析各组间的差异。结果桥本甲状腺炎伴不典型细胞与PTC有形态学差异。伴PTC组Galec-tin-3、CK19阳性率高于伴不典型细胞组,CD56阳性率低于伴不典型细胞组,差异均有统计学意义。 Ki-67阳性率在伴不典型细胞组与伴PTC组之间差异无显著性,但与对照组之间差异有统计学意义。结论以组织形态学特征为基础,联合应用CD56、CK19、Galectin-3、Ki-67可有效鉴别桥本甲状腺炎伴不典型细胞与PTC。     

Evaluation of Chronic Urticaria in Patients with Hashimoto Thyroiditis

The coincidence of Hashimoto thyroiditis (HT) and chronic idiopathic urticaria (CIU) is a commonly observed phenomenon in western New York. Previous literature suggested that there may be a direct relationship between them. We undertook these studies to determine whether humoral or cell-mediated mechanisms might link HT and CIU.Skin biopsies from patients with CIU, with or without HT, were indistinguishable by light microscopy. No immune complex deposition was observed, although only the skin from patients with CIU and HT contained perivascular fibrin deposits. Similarly, immunohistochemical studies evaluating cellular expression of CD3, CD4, CD8, CD20, and CD68 failed to differentiate between CIU with or without HT. Analysis of V restriction in thyroid tissue of patients with HT and the skin of patients with CIU and HT by in situ polymerase chain reaction failed to reveal any oligoclonal T-lymphocyte subpopulations. In contrast, only patients with CIU and HT had anti-FcRI antibodies in their sera that could induce degranulation of normal basophils. Some sera from patients with CIU and HT caused degranulation of normal basophils in the absence of anti-FceRI. The factor causing basophil degranulation in these sera was not determined. Patients with CIU and HT failed to improve clinically with thyroid replacement therapy. All CIU patients were equally well managed with symptomatic therapies.In conclusion, HT likely represents a marker of other autoimmunity, rather than being a direct causative agent in CIU. Management of CIU, with or without HT and with or without anti-FceRI antibodies, should be the same. Future studies will have to examine whether cell-mediated responses participate in CIU, especially in association with HT.     

Diagnostic usefulness of fragments of crushed cells in autoimmune thyroiditis

Fine-needle aspiration cytology has emerged as an important diagnostic tool in cases of autoimmune thyroiditis. However, the patchy nature of this disease and its coexistence with other thyroid pathologies, with only subtle demonstrable cytologic features in many cases can lead to misdiagnosis. Of 313 thyroid aspirates, 62 were diagnosed as autoimmune thyroiditis. Fragments of crushed cells were observed in 51 (82.11%) of autoimmune thyroiditis (P < 0.001). The presence of "crush artifact" that can be easily picked up on low magnification should be used as an important criterion for the diagnosis of thyroiditis. It is particularly helpful in cellular smears from thyroiditis to avoid misdiagnosis of neoplasia.     

Expression of bcl-2, Bax and Fas in oxyphil cells of Hashimoto thyroiditis

Immunoreactivity for bcl-2, Bax and Fas was analysed in 16 cases with Hashimoto thyroiditis. Bcl-2-expression was constantly seen in regular thyrocytes and in the mantle-zone of lymphofollicular infiltrates. However, thyrocytes in the vicinity of lymphoid infiltrates and, especially, mitochondria-rich oxyphil cells exhibited reduced staining or none at all for bcl-2. Bax was found to be weakly reactive or negative in normal thyrocytes and was not up-regulated in bcl-2-deficient epithelial cells. In contrast, expression of Fas was markedly increased both in typical thyrocytes and in oxyphil cells within areas of lymphocytic infiltration. In conclusion, focal lack of bcl-2 expression together with up-regulation of Fas is a constant feature of Hashimoto thyroiditis. The reaction pattern of oxyphil cells is identical to that of affected typical thyrocytes without proliferation of mitochondria. Loss of bcl-2 with up-regulation of Fas is therefore likely to precede oncocytic change. Whether these alterations are involved in the process of oncocytic transformation remains to be clarified, however. Received: 25 June 1999 / Accepted: 14 January 1999     

Role of fine needle aspiration cytology in thyroiditis

Fine needle aspiration (FNA) of thyroid is a cost-effective, simple, diagnostic tool in the initial screening of patients with thyroid lesions. Its role in a minimally enlarged thyroid in a symptomatic patient suspected of thyroid dysfunction is now well known. It plays an important role in the medical management of all nonpalpable/minimally enlarged thyroid (goiter) in patients suspect for thyroid pathology and/or in combination with thyroid-stimulating hormone, T3 and T4 levels by diagnosing early cases of thyroiditis. FNA may be of assistance in the early detection of subclinical hypothyroidism, which is of utmost importance in pregnant women, and further makes possible the availability of baseline values for future reference. With the implementation of this protocol of FNA thyroid with/without imaging, we affirm that the practice of cytology has differed in different geographic areas and from country to country, depending on economy and availability of infrastructure.     

First observation of an Hashimoto thyroiditis-like disease in horses from Eastern Europe: histopathological and immunological findings

Among 622 slaughtered horses from eastern Europe, 156 thyroid glands were selected on the basis of macroscopic alterations (e.g., determination of volume and weight). In the 80% of these thyroids, microscopic alterations consistent with a diagnosis of Hashimoto thyroiditis-like disease were found. In particular, a subverted architecture of the thyroid gland with colloid rarefaction, lymphocytic infiltration, and fibrosis was noted. The confirmation of the histopathological diagnosis of an equine Hashimoto thyroiditis-like disease was provided by the increased serum concentration of thyroglobulin, of antithyroglobulin, and of antithyroid peroxidase autoantibodies. Despite evidence consistent with an Hashimoto thyroiditis-like disease in eastern European horses, the etiopathogenesis of this autoimmune disorder deserves further investigation. In this respect, in some horses histopathological alterations in the pituitary gland may suggest an as-yet-unidentified disorder within the hypothalamus-pituitary adrenal axis associated with Hashimoto thyroiditis.     

Postpartum silent thyroiditis simulating a malignant lymphoma of the thyroid

A case of postpartum silent thyroiditis simulating a malignant lymphoma of the thyroid is reported. The patient was a 30-yr-old female who had received irradiation thearapy to the neck for malignant lymphoma of the thyroid 9 yr previously. She was referred to our department because of a struma associated with acute aggravation of chronic thyroiditis after parturition. In this case, the mechanism of the disease was explained by the “immune rebound hypothesis”. It was difficult to differentiate postpartum silent thyroiditis from malignant lymphoma of the thyroid, either clinically or cytologically, when the immune-rebound phenomenon with lymphocytic infiltration and the appearance of lymphoid follicles were prominent. The immunological status of patients with chronic thyroiditis accompanied by morphological changes should be taken into consideration before establishing the diagnosis of malignant lymphoma of the thyroid.     

桥本甲状腺炎伴甲状腺癌临床病理分析

目的　探讨桥本甲状腺炎 (Hashimoto’sthyroiditis,HT)与甲状腺癌的关系。 方法　对 80例HT和其中 14例并发甲状腺癌的HE片进行形态学观察 ,部分病例进行PCNA、p5 3免疫组化标记。结果　HT及甲状腺癌旁组织有滤泡上皮细胞增生、乳头状增生、不典型增生至癌变移行 (过渡 )的形态 ,其PCNA表达逐渐增强 (P <0 0 1) ,p5 3在少数不典型增生及癌变区呈低度阳性表达 (P <0 0 5 )。结论　HT与甲状腺癌发生关系密切 ,HT中甲状腺滤泡上皮增殖活跃 ,易于癌变。HT是一种具有恶变潜能的病变 ,应引起高度重视。     

Oxidative stress and antioxidant enzyme activities in patients with Hashimoto’s thyroiditis

We investigated the parameters of oxidative stress in 71 Hashimoto’s thyroiditis patients. They were divided into three sub-groups according to the thyroid function: group I—euthyroid subjects; group II—hypothyroid subjects; and group III—subjects treated with Levothyroxin. Thirty healthy subjects were studied as controls. The level of lipid peroxidation (malondialdehyde, MDA) in the plasma and the antioxidant defences such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) activities in erythrocytes were measured. Concentrations of MDA and SOD activity were not different in sub-groups of patients and controls. CAT activity was significantly lower in group II in comparison with both controls (p = 0.01) and group III (p = 0.02) as well as in group I compared to the controls (p = 0.04). Activity of GPX in erythrocytes in hypothyroidism was significantly higher compared to controls (p = 0.02). GPX activity in both groups I and III tended to be lower in comparison with controls. Our results indicate a deficiency of cellular antioxidative defense in Hashimoto’s thyroiditis patients in all stages of disease. Accordingly, we suppose that the supplementation with antioxidants from an early stage of the disease, in addition to thyroid hormone replacement, may have a positive benefit in the treatment.