补碘对缺碘机体甲状腺自身免疫的影响

目的 探讨补碘对缺碘机体甲状腺自身免疫的影响。方法 动态观察缺碘地区居民口服碘油补碘前后、血清免疫球蛋白（IgA、IgG、IgM）、补体C3、甲状腺过氧化物酶抗体（TPOAb)、甲状腺球蛋白抗体（TGAb)、促甲状腺激素受体抗体（TRAb)和甲状腺刺激抗体（TSAb)水平变化及其异常值检出率。结果 补碘3个月后IgA、IgG、补体C3水平明显高于补碘前的水平，IgG和C3高于正常值上限的比例分别高达38．9％、62．0％，6个月时IgA和IgG水平则明显下降。补碘之后的TPOAb、TGAb水平及其阳性检率均明显高于补碘前，且以3个月和6个月时增高较为显著并分别在79和64例受试者中出现7例双抗体阳性病例；这些抗体阳性者全为成年女性，平均年龄27．6岁，均无明显临床症状。TRAb和TSAb水平也均明显高于补碘前，12个月时TRAb的阳性检出率高达24.4%。结论 补碘可诱发缺碘机体免疫反应使免疫功能增强，存在产生自身抗体的倾向，导致甲状腺自身抗体水平明显升高、抗体阳性检出率增加，而易于产生亚临床性自身免疫性甲状腺疾病。     

补碘剂量对自身免疫性甲状腺疾病的影响

总结国内外碘与自身免疫性甲状腺疾病（AITD）发病的临床与基础研究资料,探讨碘在AITD发病中的作用,研究证明碘可以增加AITD的发病率,碘在AITD的发病中起重要作用。     

Graves病多发家系成员甲状腺自身免疫状况及碘摄入量对其发病率的影响

目的：确定在Graves病（GD）多发家系成员中,甲状腺自身免疫及甲状腺功能异常的发生情况,并研究碘摄入量对GD发病率的影响。方法：对全部家系成员做甲状腺疾病病史询问,体格检查,甲状腺功能及甲状腺自身抗体测定,并测定空腹尿碘含量。结果：GD患者一级亲属的亚临床甲亢,临床甲状,亚临床甲状的患病率分别为5．2％,1．0％和1．4％,这三种疾病患者的甲状腺自身抗体均为阳性,甲状腺功能正常一级亲属的甲状腺自身抗体阳性率为68．6％,尿碘水平500－599ug/L时,GD的发病率显著增高（P＜0．05）,。结论：在GD多发家系中,GD患者一级亲属发生甲状腺功能异常的原因均为自身免疫甲状腺病,尿碘水平500－599ug/L是GD发病率增高的危险因素。     

甲状腺体积与格雷夫斯病药物治疗预后的关系

格雷夫斯病（Graves’disease，GD）是一类常见的自身免疫性甲状腺疾病，是导致甲状腺功能亢进症（甲亢）的最主要的原因。目前，治疗GD仍以抗甲状腺药物（ATD）为主．此类药物对大多数患者具有良好的疗效．但疗程长、复发率高。由于服药方案、从食物中摄取碘量以及个体遗传特征的不同．治疗的缓解率差异较大。为此，作者前瞻性地观察了特异性甲状腺受体抗体（TRAb）、甲状腺体积大小与GD复发和缓解的关系．旨在探索预测GD治疗缓解的指标。     

补碘对缺碘人群促甲状腺激素受体抗体的影响

为探讨补碘对缺碘机体甲状腺自身免疫的影响，采用酶联免疫分析方法测定了缺碘地区人群口服碘油前后的促甲状腺激素受体抗体(TRAb)和甲状腺刺激抗体(TSAb)水平变化。结果发现，缺碘机体补碘后的TRAb和TSAb水平均明显高于补碘前;TRAb从阳性检出率增高，12个月时其阳性检出率高达24．44％。表明缺碘地区人群补碘后其自身抗体水平增高且抗体阳性率增多。提示补碘可诱导缺碘机体发生甲状腺自身免疫反应，易产生自身免疫性甲状腺疾病。     

口服碘油丸对甲状腺自身抗体的影响

观察了山东省重度缺碘病区人群服用４００ｍｇ碘油前后的甲状腺自身抗体水平。服药前甲状腺自身抗体ＴｍＡｂ和ＴｇＡｂ均阴性，而服药一年、一年半和二年后分别出现５、６、１０例抗体阳性患者；服药后的ＴｍＡｂ、ＴｇＡｂ水平均明显高于服药前。提示服用碘油丸很可能会影响甲状腺自身抗体而诱发甲状腺自身免疫性疾病，应引起重视。     

血清甲状腺自身抗体、碘摄入量与Graves病发病及临床转归的关系

目的探讨血清甲状腺刺激性抗体（TSAb）、甲状腺刺激阻断性抗体（TSBAb）等甲状腺自身抗体、碘摄入量与Graves病（GD）甲状腺功能亢进症（甲亢）发病和转归的关系。方法测定3个不同碘摄入量地区63例临床甲亢患者的血清TSAb、TSBAb、促甲状腺激素结合抑制免疫球蛋白（TBⅡ）、甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGAb）,2年后随访。TSAb和TSBAb采用转染了重组人促甲状腺素受体的中国仓鼠卵巢细胞（rhTSHR—CHO细胞）生物法测定。结果初访GD甲亢患者TSAb、TBⅡ和TSBAb的阳性率分别为80．9％、61．7％和6．4％,TSAb和TBⅡ任-抗体阳性率为91．5％,显著高于对照组。TSAb和TBⅡ的一致率为59．6％。GD甲亢患者TSAb与TBⅡ（r=0．407）、甲状腺球蛋白（r=0、301）、甲状腺体积（r=0．317）正相关。初访碘过量地区GD甲亢患者TSAb阳性率（91．7％）显著高于轻度碘缺乏地区（66．7％）,3个地区GD患者TBⅡ、TPOAb、TGAb阳性率、活性和甲状腺体积无统计学差异。随访时患者分为甲状腺功能恢复组（G1）和未恢复组（G2）。G1组TSAb活性和甲状腺体积显著下降。当TPOAb滴度显著增高,且随访时继续保持高滴度时,甲状腺功能不易恢复。此时TSAb对甲状腺功能的影响降为次要因素。结论TSAb对GD甲亢的诊断和判断临床转归的意义大于TBⅡ,联合应用二者能提高GD甲亢患者促甲状腺激素受体抗体的检出率;GD甲亢的转归与TSAb、TPOAb浓度和甲状腺体积有关。     

格雷夫斯病的药物治疗进展

格雷夫斯病(Graves GD)是一种能引起甲状腺机能亢进症的自身免疫性疾病，随着对GD基础和临床研究。近年发现新的疗法及药物的应用较传统的抗甲亢药物(ATD)治疗具有更好的疗效，更低的复发率，更少的副作用，为些，现结合有关文献综述如下。     

再论碘摄入量增加对甲状腺疾病的影响

我国实行普遍食盐碘化 (ｕｎｉｖｅｒｓａｌｓａｌｔｉｏｄｉｎａ ｔｉｏｎ ,ＵＳＩ)已经 4年。内分泌学界和地方病学界关于碘摄入量增加对甲状腺疾病影响的争论持续不断 ,日趋激烈。最近 ,中国医科大学附属第一医院历时 1年 2个月完成了对 3个不同碘摄入量地区〔尿碘中位数 (ＭＵＩ)分别为 10 3μｇ/Ｌ、374 μｇ/Ｌ、6 14μｇ/Ｌ〕的大规模流行病学横断面对比研究。血清激素和抗体测定均采用固相化学发光酶免疫测定法。他们认为 :碘摄入量增加的主要影响是低碘地区临床甲状腺功能亢进症 (甲亢 )发病率的一过性增加及过度补碘地区的甲状腺…     

缺碘病区补碘后人群亚克汀病诊断标准的探讨

自1983年Hetzel首先提出了碘缺乏病的概念,提高了人们对缺碘的认识,使碘缺乏病的防治提高到新阶段。1986年我国科学工作者制定了亚临床型克汀病(简称亚克汀病)诊断标准草案,对亚克汀病诊断起到了推动和指导作用。近几年来,在执行该标准中,人们逐渐认识到还有一些问题需要修正与补充,并提出一些新的看法和建议。作者在1990～1991年对吉林省缺碘病区学龄期儿童进行了调查,结合吉林省缺碘病区补碘后3137～3157名儿童调查结果,对亚克汀病诊断标准提出些建议,供修订中参考。     

Comparison of standardized initial doses of two antithyroid drugs in the treatment of Graves' disease

Objectives. To obtain a simple standard regimen, suitable for general practice, and based upon the addition of antithyroid drug plus thyroxine for attaining euthyroidism in patients with Graves' disease. Design. Prospective, randomized trial of patients with Graves' disease followed for 3 months after the initiation of therapy with an antithyroid drug and combined with the later addition of triiodothyronine to keep the patient euthyroid. The patients were randomized, according to birth date, between methimazole and propylthiouracil. Three dose schemes were tested for each antithyroid drug. Setting. The study was performed at the thyroid outpatient units of two general hospitals, with the patients having been referred from primary care. Subjects. Ninety-four patients with Graves' disease who were suitable for treatment with antithyroid drugs. Interventions. The patients were allocated into six groups. Three groups received methimazole (10 mg every 6th, 8th or 12th h) and three received propylthiouracil (100 mg every 6th, 8th or 12th h). Twenty micrograms of triiodothyronine was added when the patients were euthyroid to avoid hypothyroidism. Main outcome measures. The lowest serum free thyroxine level within 3 months of the initiation of the antithyroid treatment. Results. Fourteen per cent of the patients on methimazole 10 mg every 12th h and 29% on propylthiouracil 100 mg every 12th h did not achieve euthyroidism within the 3-month observation period. All but one patient on methimazole 10 mg every 8th h or propylthiouracil 100 mg every 8th h reduced the free serum thyroxine levels to the normal or hypothyroid range within the observation period. All of the patients on methimazole 10 mg every 6th h and 56% on propylthiouracil 100 mg every 6th h reduced the serum T4 values into the hypothyroid range within the period. Conclusion. A standard regimen, based upon the addition of methimazole 10 mg every 8th or 6th h or propylthiouracil 100 mg every 8th or 6th h and followed by the addition of thyroxine or triiodothyronine when euthyroid to avoid hypothyroidism, seems to be suitable for attaining euthyroidism within 3 months in patients with Graves' disease. A dose scheme based on methimazole 10 mg every 12th h or propylthiouracil 100 mg every 12th h were found to be unsuitable due to an unacceptably high incidence of failure to attain euthyroidism or hypothyroidism within 3 months.     

三种不同方法治疗Graves病的疗效和预后分析

目的 研究药物、手术、放射性碘治疗三种方法对Ｇｒａｖｅｓ病（ＧＤ）的有效率、复发率及其相关性。方法 采用回顾性调查方法,分析２１２例ＧＤ患者的治疗情况及预后。结果 治疗停止半年后治愈率分别为药物组７８．６％、手术组９１．９％、放疗组９５．２％,治疗后５年治愈率分别为药物组５４．５％、手术组９０．６％、放疗组８１．８％。结论 治疗后半年及５年药物组治愈率均低于手术组和放疗组,而复发率则相反。药物组有     

为我们的儿童而安全补碘

补碘预防碘缺乏性疾病的益处已不言而喻，但也发生甲状腺毒症和引起甲状腺功能减退症（甲减）的甲状腺炎等不良反应。碘致甲状腺炎以前的证据仅来自实验性研究、病理学检查和横断面流行病学调查。本期发表的滕卫平等在中国轻度碘缺乏、超足量碘补充和碘过量摄取地区的3个人群的研究已证实随着较高的碘摄取，甲状腺自身免疫和亚临床甲减的发病率呈轻度、但已有统计学意义的上升。然而，临床甲减的发病率并未见升高。这些发现再次从临床和公共卫生方面消除了人们的疑虑，证实了补碘方案对人类健康会产生巨大的效益而风险甚小。     

沙利度胺对Graves病甲状腺功能的影响18例临床观察

选择2006年8月至2009年3月宁波市第二医院内分泌科收治的Graves病患者18例,随机分为抗甲状腺药物单药组10例(单药组)及沙利度胺与抗甲状腺药联合组(联合组)8例。比较治疗前及治疗3、6周后患者甲状腺功能。     

Three patients who spontaneously developed persistent hypothyroidism during or following treatment with antithyroid drugs for Graves' hyperthyroidism.

Three patients with Graves' disease who spontaneously developed hypothyroidism after treatment with antithyroid drugs are described herein. Patient 1 developed a painful tender thyroid enlargement with a fever and accelerated erythrocyte sedimentation rate when she was receiving maintenance therapy with methimazole, and she progressed to persistent hypothyroidism with increased titers of antithyroglobulin and antimicrosomal antibodies and marked reduction of goiter size within the subsequent 2 months. Thyroid-stimulating hormone-binding inhibitory immunoglobulins (TBIIs) and thyroid stimulation-blocking antibody (TSBAb) were absent when she was hypothyroid. Hypothyroidism probably resulted from autoimmune thyroid destruction due to subacute aggravation of Hashimoto's thyroiditis. During the clinical course of patient 2, accelerated erythrocyte sedimentation rate and later transient increases of antimicrosomal and antithyroglobulin antibody titers were observed repeatedly (four times), and she finally fell into overt hypothyroidism. She also had negative results of tests for TBII and TSBAb. Her hypothyroidism appeared to result from repeated thyroid destruction due to aggravation of Hashimoto's thyroiditis. Patient 3 fell into hypothyroidism when receiving a small dosage of methimazole. The TBII and TSBAb were strongly active when she developed hypothyroidism, which thus seemed to be due to blocking antibody. Patients with Graves' hyperthyroidism may eventually progress to hypothyroidism later by several different mechanisms. Severe and sudden or slowly repeated thyroid destruction due to aggravation of Hashimoto's thyroiditis is one mechanism. Another may be the appearance of a blocking antibody to the TSH receptor.     

青海省四次碘缺乏病监测结果分析

目的了解青海省自1995年以来碘缺乏病防治进展和现状,分析1995、1997、1999和2002年全省碘缺乏病监测结果。方法按照《全国碘缺乏病监测方案》进行调查。结果青海省8～10岁儿童甲状腺肿大率(甲肿率)合计为4.4%,2002年为6.7%,高于1997和1999年(P<0.05),居民合格碘盐食用率2002年为71.6%,加碘盐合格率为93.2%,高于前3次(P<0.01),儿童尿碘中位数在127.5～146.4μg/L,无明显变化。结论青海省居民碘盐合格率和加碘盐质量有明显提高,但非碘盐所占百分比一直在20%左右,应重点加强对销售非碘盐的打击力度。     

不同抗甲状腺药物对^131Ⅰ治疗Graves病近期疗效的比较

目的探讨Graves病患者使用不同抗甲状腺药物后再行^131Ⅰ治疗的疗效比较。方法随访Graves病经抗甲状腺药物治疗后再行^131Ⅰ治疗的患者98例,按治疗前分别使用丙基硫氧嘧啶、他巴唑、碳酸锂分为3组,前两组在^131Ⅰ治疗前停用抗甲亢药物15天,碳酸锂组使用至治疗当日,采用个性化^131Ⅰ治疗后6个月复查并评价治疗效果。结果使用丙基硫氧嘧啶组在^131Ⅰ治疗6月后仍有38％患者甲状腺功能亢进,使用他巴唑组甲亢比例为23％,而碳酸锂组仅为9．6％,3组间比较均有显著性差异（α〈0．05）;3组间发生甲减例数比较无显著性差异（P〉0．05）。结论在^131Ⅰ治疗Graves病前使用丙基硫氧嘧啶会降低^131Ⅰ治疗甲亢的疗效,其影响高于他巴唑组及碳酸锂组,3组中碳酸锂组对^131Ⅰ治疗甲亢的疗效影响最小。