介入血管栓塞治疗甲状腺功能亢进症34例分析

目的:探讨甲状腺功能亢进症(甲亢)介入血管栓塞术后症状、甲功控制、并发症及其防治对策.方法:右侧股动脉穿刺插管后对甲状腺供应动脉行DSA检查,明确其位置、粗细、动脉交通支及甲状腺染色情况;根据以上情况选择动脉并进行栓塞.结果:本组共34例,其中栓塞右侧甲状腺上动脉31例,左侧甲状腺上动脉25例,右侧甲状腺下动脉7例,左侧甲状腺下动脉8例;栓塞4支者5例,3支者9例,2支者13例,1支者7例;术后出现颈部疼痛、体温增高、声音嘶哑、肢体无力、恶心呕吐、小脑梗死、胆道梗阻及梗阻性脑积水合并甲亢危象、暂时性房颤,无视物模糊、吞咽困难、突眼加重;所有患者均于介入术后7～15 d循环甲状腺激素达高峰,后逐渐回落,术后半年左右甲功正常;随访1～5年,发生甲减1例、甲亢复发4例、低剂量药物维持者4例,余甲功正常后停药.结论:介入血管栓塞仍为治疗甲亢的可选方法,但需系统研究、远期观察、慎重开展.     

动脉栓塞治疗甲状腺机能亢进症

目的：探讨动脉栓塞治疗甲状腺机能亢进症（甲亢）的临床应用价值。材料与方法：16例甲亢患者行双侧甲状腺上动脉超选择插管,用褐藻胶微球栓塞。结果：16例甲状腺上动脉栓塞成功,成功率100%,一次成功率88%。栓塞后甲状腺机能逐渐恢复至正常水平。续集：甲状腺上动脉栓塞治疗甲亢是一种有效的方法。     

彩色多普勒超声对甲状腺动脉栓塞治疗甲亢的疗效评价

目的探讨彩色多普勒超声在甲状腺动脉栓塞治疗甲亢疗效评价中的价值.方法 16例甲亢患者行甲状腺动脉栓塞治疗,分别于术前及术后1、3个月用彩色多普勒超声观察甲状腺体积、腺体回声、血供及各血流参数变化情况.结果术前甲状腺弥漫性肿大,血供丰富.术后1～3个月腺体体积缩小,血供明显减少.血流参数各项监测值栓塞前、后比较有显著性差异(P<0.05).结论彩色多普勒超声对甲状腺动脉栓塞治疗甲亢的疗效评价具有重要价值.     

甲状腺功能亢进症介入治疗的临床应用

目的 研究甲状腺功能亢进症（甲亢）介入治疗的安全性和有效性.方法 筛选甲亢病例70例,经甲状腺动脉栓塞治疗后观察疗效、并发症.结果 70例患者有效60例,无效1例,复发9例,2例发生甲亢危象,1例发生甲状旁腺功能降低,2例发生甲状腺功能减退.结论 甲亢介入治疗具有疗效好、安全、微创、并发症少、康复迅速等优点.     

一例甲亢患者甲状腺介入栓塞术后并发Graves眼病的护理

对难治性甲亢采用甲状腺动脉介入栓塞治疗，近期副作用一般为发热、声嘶、可忍受的颈前疼痛等，出现Graves眼病国内尚属罕见。2001年5月我科收治一名确诊甲亢5年，一直行甲亢治疗，停药2月余病情加重的患者。并对其行甲状腺动脉介入栓塞治疗后并发Graves眼病后治愈出院。现将有关护理报告如下。     

甲状腺动脉栓塞治疗甲亢的临床研究

目的研究甲状腺动脉栓塞治疗甲亢的临床应用。方法15例甲亢患者均进行甲状腺动脉造影后，用聚乙稀醇微球（PVA）对相应血管进行栓塞。结果两上甲状腺动脉栓塞5例，两上＋左下5例，两上＋右下2例，左上＋右下1例，左上＋两下＋部分右上及最下1例，两下1例。FT3 2．91～18．52pmol／L（t=5．91，P〈0．01）；FT4 4．71～25．3pmol／L（t=5．88，P〈0．01）。停药9例（60％），少量抗甲状腺药物维持6例。结论甲状腺动脉栓塞治疗甲亢是行之有效的方法，特别对常规治疗有困难的患者提供了新的治疗途径。     

肝癌患者肝动脉化学栓塞术后的并发症及护理对策

目的探讨肝癌患者经肝动脉化学栓塞治疗术后出现的副作用及护理对策。方法回顾分析49例肝癌患者经化学栓塞术治疗后出现的并发症。常见的有右上腹剧烈疼痛、发热、恶心、呕吐、寒颤、黄疸加重。结果肝动脉化学栓塞治疗肝癌临床效果较好,但病人术后都会出现轻重不一的并发症。结论肝动脉化学栓塞介入治疗术后会出现各种并发症,要求术后做好病人心理护理,使病人对治疗有所了解,积极配合治疗。护士加强术后观察及人文关怀,可减少介入治疗后的恐惧心理及并发症的发生。     

介入栓塞治疗甲状腺机能亢进症的护理

为发展和完善甲状腺机能亢进症 (以下简称甲亢 )的治疗 ,减少手术创伤和长期服药给患者带来的痛苦及药物的副作用 ,我科与介入放射科自 2 0 0 0年3月～ 8月 ,对 2 0例甲亢病人采取了以甲状腺动脉为靶血管的介入栓塞治疗均取得了满意的效果 ,现将护理体会介绍如下。1　临床资料2 0例甲亢患者中 ,男 6例 ,女 12例 ,年龄 2 0～ 50岁 ,平均 35岁 ,其中弥漫性毒性甲状腺肿 13例 ,结节性甲状腺肿 3例 ,淋巴细胞性甲状腺肿 3例 ,甲状腺机能亢进并发心脏病 1例。甲状腺肿大Ⅲ°者 16例 ,Ⅱ°者 4例 ,病史 2～ 6年 ,16例经内科正规治疗后复发 ,4例因…     

4例甲状腺动脉栓塞术患者的护理

目的：探讨应用介入栓塞术治疗甲状腺机能亢进症(简称甲亢)的临床护理。方法：对4例甲状腺动脉栓塞术的有关护理措施进行归纳总结。结果：4例甲亢患者术后随访1—6个月，临床症状完全缓解，T3、T4、FT3、FT4值明显下降，TSH正常。结论：做好术前、术中及术后护理，对保证手术安全有效及促进患者术后康复至关重要。     

介入栓塞术治疗甲亢并发症的观察及护理

介入栓塞术治疗甲状腺功能亢进症是近年采用的新方法,通常采用seldinger法行股动脉穿刺插管至甲状腺上动脉,先行碘造影确定甲状腺上动脉各细小分支及血供面积,然后注入无水酒精及明胶海绵阻断血供,使大部分甲状腺组织逐渐缺血、坏死、萎缩,丧失功能,从而达到治疗甲亢的目的.我们从1999年7月至2000年6月共行甲亢介入栓塞术18例,其中男13例,女5例,19～48岁,病程1～12年.该项技术治疗甲亢具有创伤小、无疤痕、无痛苦、价廉、效果佳、方便等优点,但如操作不当,术中术后护理不及时,少数病例可出现并发症,影响疗效,并给患者带来严重的心理负担.因此,术中、术后需要密切观察病情,采取必要的护理措施,现将可能出现的并发症及护理要点报告如下.……     

Transient hyperthyroidism in patients with lymphocytic thyroiditis

We have studied seven episodes of transient hyperthyroidism in three men and one woman, aged 19 to 38 years. No patient had fever or neck tenderness. All had palpable thyroid glands. Elevated serum thyroxine values persisted for 1 to 3 months. Thyroid131I uptake at 6 and 24 hours was low (1 to 3%). Erythrocyte sedimentation rates were normal or only slightly increased. Needle biopsy in four patients and a thyroidectomy specimen in one patient, all taken during the hyperthyroid phase, showed lymphocyte infiltration and extensive follicular disruption without oxyphilia. There was no evidence of granulomatous thyroiditis. Thyroglobulin antibodies were normal in all. In three patients, transient hypothyroidism followed the hyperthyroid episode. In two patients, the condition was recurrent. The findings are compatible with transient unregulated discharge of thyroid follicle content in some patients with lymphocytic thyroiditis. Recognition permits avoidance of unnecessary treatment with surgery, radioiodine, or antithyroid drugs.     

Thyroid hormone and the cardiovascular system

Thyroid hormone has many effects on the heart and vascular system. Many of the clinical manifestations of hyperthyroidism are due to the ability of thyroid hormone to alter cardiovascular hemodynamics. The hemodynamic effects of hypothyroidism are opposite to those of hyperthyroidism, although the clinical manifestations are less obvious. This review will integrate what is known about the mechanisms of thyroid hormone action on the heart with recent observations from both experimental and clinical studies of hyperthyroidism and hypothyroidism. Thyroid hormone has both direct and indirect actions on the cardiovascular system. Patients with thyroid disease, especially those with hyperthyroidism, often have symptoms and signs indicating changes in cardiovascular hemodynamics. Indeed, symptoms and signs referable to the cardiovascular system may be the only manifestations of thyroid dysfunction, and thyroid function should therefore be assessed by the measurement of serum thyrotropin concentrations in all patients with cardiovascular disease. Some suggest that the administration of triiodothyronine may benefit some patients with cardiovascular disease.     

伊曲康唑三日疗法治疗复发性外阴阴道念珠菌病47例疗效观察

目的观察并评价口服伊曲康唑三日疗法对复发性外阴阴道念珠菌病(VVC)患者的疗效。方法采用开放性研究,对47例VVC患者应用口服伊曲康唑,200 mg,1次/d,共3 d,观察疗效及副反应,选择同期47例患者口服伊曲康唑200 mg,2次/d,每次200 mg,共1 d为对照组。结果(1)第1次复诊时(停药7～14 d)观察组的念珠菌镜检转阴率为87.2%,第2次复诊时(停药1个月)观察组镜检转阴率为72.3%;第1次复诊对照组的念珠菌镜检转阴率为59.5%,第2次复诊对照组的镜检转阴率为51.1%。(2)无严重不良反应发生,1例患者出现腹泻。结论口服伊曲康唑200 mg顿服,连服3 d治疗VVC有效、安全、依从性好,局部刺激症状轻。     

Transient hyperthyroidism after total parathyroidectomy for tertiary hyperparathyroidism: A report of two cases

Surgical removal of enlarged parathyroid glands is the treatment of choice in most cases of tertiary renal hyperparathyroidism. Complications of this surgical procedure are rare. We report two cases of patients who developed acute hyperthyroidism after total parathyroidectomy with parathyroid autotransplantation for refractory tertiary hyperparathyroidism. The patients had no history or biochemical or radiologic evidence of thyroid disease. They were not taking drugs affecting thyroid function. Thyroid function (thyroid stimulating hormone, free T(3) and free T(4)) was measured preoperatively, immediately after surgery and again three months later. Total parathyroidectomy was successful in both patients. Circulating levels of parathyroid hormone were at the lower limit of normal values. Postoperative thyroid function tests demonstrated acute hyperthyroidism with a rapid increase in free T(3) and T(4) levels above normal and a drop in thyroid stimulating hormone below normal in both patients. The course of hyperthyroidism was short (normalization of fT(3) and fT(4) values within 14-21 days). Neither patient had symptoms of thyrotoxicosis. Transient hyperthyroidism may be an under-recognized complication of total parathyroidectomy for tertiary hyperparathyroidism. These patients should be monitored with thyroid function tests and assessed for clinical signs attributable to thyrotoxicosis.     

HYPERTHYROIDISM ASSOCIATED WITH HYPEREMESIS GRAVIDARUM

SUMMARY Hyperemesis gravidarum is an uncommon presentation of hyperthyroidism in pregnancy which is usually attributable to autoimmune (Graves') disease. While this condition necessitates treatment with antithyroid drugs, a syndrome of transient hyperthyroidism associated with hyperemesis gravidarum that resolves spontaneously is also recognised. Differentiation between these two conditions may prove problematic in practice. We report two cases of hyperthyroidism associated with severe hyperemesis gravidarum. Intractable hyperemesis continued in one patient despite normalisation of circulating free thyroid hormone concentrations with carbimazole. Neither patient exhibited clinical or immunological features of autoimmune thyroid disease, suggesting in retrospect that they had the syndrome of transient hyperthyroxinaemia associated with hyperemesis gravidarum rather than Graves' disease. The role of antithyroid drugs in the treatment of self-limiting transient hyperthyroidism associated with hyperemesis gravidarum requires clarification.     

Frequency of thyroid disease among Southeast Asian primary care patients

We prospectively assessed 99 Southeast Asians for the presence of thyroid disease who were attending a primary care clinic devoted to the care of refugees. Subjects were undergoing evaluation as new patients and had no previously diagnosed thyroid abnormality. Each patient had a physical examination performed by his or her primary‐care provider, was given a standardized questionnaire that focused on symptoms of thyroid disease and underwent a venipuncture for total thyroxine, triiodothyronine resin uptake and thyrotropin (TSH) concentration. Those who had an abnormal examination, calculated free thyroxine index (FT ₄ I) or TSH level were re‐examined by an endocrinologist and had repeat thyroid studies performed. Although 81% of patients reported ≥1 symptom compatible with thyroid dysfunction, only 17% were found to have laboratory abnormalities. An abnormal FT ₄ I and TSH level was found in 5% and 13% of subjects, respectively, but only one case of clinically significant hyperthyroidism and no cases of hypothyroidism were confirmed. TSH suppression, noted in 12% of subjects, persisted over a median follow‐up of 6 months. Among seven patients with an anatomic abnormality of the thyroid, four had an abnormal FT ₄ I or TSH. We conclude that the clinical prevalence of symptomatic thyroid dysfunction among Southeast Asians is comparable to that reported for non‐Asian populations, but that the frequency of subclinical hyperthyroidism may be higher. Although symptoms suggestive of thyroid disease are common, routine screening for thyroid disease is not indicated in this study.     

Possible hypothyroidism associated with quetiapine

OBJECTIVE: To report a case of hypothyroidism occurring after the addition of quetiapine to an existing drug regimen. CASE SUMMARY: A 46-year-old African-American woman diagnosed with schizoaffective disorder, bipolar type, and a four-year history of successfully treated hyperthyroidism, was suboptimally responsive to olanzapine treatment. Transition from olanzapine to quetiapine was initiated and, approximately two months after adding quetiapine to a standing pharmacotherapeutic regimen, the patient developed an elevated thyroid-stimulating hormone (TSH) concentration of 8.45 microU/L. A diagnosis of hypothyroidism was subsequently made, treatment with levothyroxine was initiated, and the patient's thyroid function became stable. DISCUSSION: Drug induced hypothyroidism is known to occur with several medications. Quetiapine is an atypical antipsychotic with the potential to decrease thyroid hormone concentrations in some patients; this effect may be dose related. Despite this known adverse effect, the manufacturer of quetiapine reports that elevated TSH concentrations and subsequent treatment with thyroid hormone supplementation have occurred only rarely. We report the development of hypothyroidism in a patient who had previously received successful radioactive iodine treatment for hyperthyroidism in 1994, but who had no detected thyroid abnormalities until treatment with quetiapine was started four years later. CONCLUSIONS: Patients with compromised thyroid function who receive treatment with quetiapine may develop hypothyroidism. Appropriate care for these patients may include an increased awareness of possible hypothyroidism and consideration of thyroid function monitoring.     

女性毒性弥漫性甲状腺肿患者骨密度特点

目的观察绝经前后女性毒性弥漫性甲状腺肿(GD)患者骨密度,分析甲状腺激素水平与骨密度之间的相关性。方法使用双能X线骨密度仪测定318例女性(GD患者242例,对照组76例)桡骨全部、腰椎2-4及股骨颈三个部位骨密度。用化学发光法测定GD患者的游离三碘甲腺原氨酸(FT3)、游离甲状腺激素(FT4)及促甲状腺激素(TSH)。结果绝经前GD患者桡骨全部、腰椎2-4、股骨颈的骨密度均显著低于绝经前对照组(P<0.01),而绝经后GD患者仅桡骨全部的骨密度显著低于绝经后对照组(P<0.01)。绝经后GD患者与绝经前GD患者比较,以及绝经后对照组与绝经前对照组比较,三个部位骨密度均明显下降(P<0.01)。结论 GD影响女性的骨健康状况,尤其对前臂骨影响更显著。绝经后GD患者除甲状腺激素对骨量的负性影响外,雌激素的缺乏也是影响骨密度的重要因素,雌激素缺乏可加剧GD对骨代谢的负影响。     

甲状腺功能亢进症并发烟雾病5例临床分析

【目的】分析甲亢合并烟雾病的临床特点和可能的病因学联系。【方法】回顾性分析本院收治的5例甲亢合并烟雾病患者的临床表现和神经影像学特点。5例均行头部磁共振平扫（MRI）和磁共振血管造影（MRA）以及甲状腺功能检测。【结果】5例患者中,男1例,女4例;5例均表现为缺血性卒中。MRA表现：双侧颈内动脉系统狭窄或闭塞4例。1例单侧颈内动脉系统受累。3例可见网状侧枝血管。2例同时合并大脑后动脉狭窄。【结论】对于临床拟诊烟雾病的中青年女性,应常规筛查甲状腺功能。     

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.