Diagnostic value of thyrotrophin releasing hormone tests in elderly patients with atrial fibrillation

A prospective study was carried out to compare clinical and biochemical thyroid states with responses of thyroid stimulating hormone (TSH) to thyrotrophin releasing hormone (TRH) in elderly patients with either atrial fibrillation (n = 75; mean age (SD) 79.3 (6.0) years) or sinus rhythm (n = 73; mean age 78.4 (5.6) years) admitted consecutively to the department of geriatric medicine. No patient in either group had symptoms or signs of hyperthyroidism. Overall, the TSH responses to TRH did not differ significantly between the two groups. Ten (13%) of the patients with atrial fibrillation (of whom four had raised thyroid hormone concentrations) and five (7%) of the patients with sinus rhythm showed no TSH response to TRH while 26% of each group (20 and 19 patients, respectively) showed a much reduced response. Only one of 13 patients with apparently isolated atrial fibrillation showed no TSH response to TRH, and none of these 13 patients was hyperthyroid. In particular, three patients (two with atrial fibrillation and one with sinus rhythm) who showed no TSH response to TRH at presentation exhibited a return of TSH response to TRH at follow up six weeks later. In conclusion, reduced or absent TSH responses to TRH are common in sick elderly patients whether they have atrial fibrillation or sinus rhythm and whether they are euthyroid or hyperthyroid biochemically. An absence of response is therefore an uncertain marker of hyperthyroidism in these groups of patients, and diagnosis and ablative treatment should be based at least on the presence of raised circulating free triiodothyronine or free thyroxine concentrations, or both.     

第三代超敏TSH与TRH兴奋试验的相关性探讨

目的 探讨甲状腺疾病功能诊断中,第三代超敏TSH与TRH兴奋试验在诊断意义上相关性。方法 应用第三代超敏TSH化学发光法测定121例患者的TRH兴奋试验的TSH值,了解基础TSH值与TRH兴奋试验符合情况。结果 基础TSH值正常组57例中有56例TRH兴奋试验是正常反应。基础TSH值低于正常组36例中有34例无反应,2例弱反应。基础TSH值高于正常组28例中有23例强反应。结论 单次第三代超敏TSH测定可以替代TRH兴奋试验。     

Normal thyrotrophin response to intravenous thyrotrophin releasing hormone administration: the best index of optimal L-thyroxine therapy in primary hypothyroidism

Normalization of basal thyrotrophin (TSH) level is used as the endpoint in L-thyroxine (L-T4) therapy of primary hypothyroidism. However, several reports have questioned the reliability of this index because of seasonal variation of TSH. Therefore, we studied 85 consecutive patients with primary hypothyroidism over a period of 3.5 y. In these patients, TSH response (delta TSH) to intravenous thyrotrophin releasing hormone (TRH) administration was examined when basal TSH was normalized with L-T4 therapy. Eight patients showed a blunted response (delta TSH less than 5 microU), whereas 27 patients demonstrated an exaggerated response (delta TSH greater than 25 microU). Thus, 42% of patients were apparently on inappropriate L-T4 dosage. These abnormal TSH responses normalized on adjusting the L-T4 dosage alone; prolonged therapy with the same dose failed to normalize TSH responses. Minor seasonal variations of basal TSH were observed in 30% of patients. However, TSH response to TRH remained normal. Hence, no adjustment of L-thyroxine dose was required. This study, therefore, demonstrates that normalization of TSH response to TRH administration rather than basal TSH may be the best index of adequate L-thyroxine therapy in primary hypothyroidism.     

Altered serum levels of thyroxine, triiodothyroinine and thyroid stimulating hormone in patients with depression.

Objective: To assess serum level of Thyroxine (T4), Triiodothyronine(T3) and thyroid stimulating hormone(TSH) in patient with depression. Methods: Thirty one clinically diagnosed depressed patients and equal number of healthy, age and sex matched control subjects were included in this study. Ham-D scale was used to classify the degree of depression into mild, moderate and severe grades. The biochemical parameters (T3, T4 and TSH) were estimated using commercially available kits. The data were analyzed by using (SPSS-10 software), one way ANOVA and chi2 test. Result: Female depressed (n = 17) cases outnumber the male depressed cases. The distributions of patients in mild, moderate and severe categories were similar. The T3 and T4 level were found to be significantly raised in the moderate depression as compared to the healthy controls. ANOVA with multiple comparisons testing among the patient group showed a significant high TSH level (F> 3.17) at 5% level of significance. A total of six depressive patients were found to have thyroid abnormalities. Conclusion: This study therefore points towards presence of thyroid dysfunction among the depressive which most often characterized as a "Lower Thyroid Syndrome". Thus inclusion of thyroid screening test among depressive patients may be helpful in proper management of cases.     

Clinical significance of multiple hypothalamic-pituitary functions assessment in patients with Turner’s syndrome

Summary Hypothalamic-pituitary functions in 26 cases of Turner syndrome were assessed with a combined stimulation test. The results showed that the peak GH levels of 12 cases were less than 10 μg/L; 3 patients were demonstrated as having an even TSH response, while another one with a delayed TSH peak, and other 4 had high basal values and consistent exaggerated TSH responses to TRH; all patients showed increased basal and peak LH and FSH levels but 5, whose LH and FSH secretion patterns were similar to normal. 12 cases have been treated with individualized protocols and followed up for 12 months or more, of them the growth velocity all increased, especially those with hypothyroidism or with a BA less than 13. It is suggested that multiple functions of hypothalamic-pituitary axis in Turner patients be evaluated as early as possible, in order that proper treatment could be adopted and their growth and development improved.     

A sensitive immunoradiometric assay for serum thyroid stimulating hormone: a replacement for the thyrotrophin releasing hormone test?

The value as a thyroid function test of a new, rapid, and highly sensitive immunoradiometric assay for thyroid stimulating hormone (TSH) was assessed in 188 consecutive new patients with suspected hyperthyroidism. The diagnosis was made on clinical grounds and on the basis of serum total triiodothyronine and thyroxine concentrations and the response of TSH to thyrotrophin releasing hormone (TRH) as measured by radioimmunoassay. In all except one patient the basal TSH concentration by immunoradiometric assay predicted the response of TSH by radioimmunoassay to TRH, an undetectable value being recorded in patients with a subnormal response and a measurable value in those with a normal test result. This clear relation was not observed for basal TSH concentrations as measured by radioimmunoassay. In a series of 39 hospital inpatients with acute or chronic non-thyroidal illness, of whom 11 had low concentrations of total thyroxine or triiodothyronine, or both, basal TSH concentrations were detectable by both radioimmunoassay and immunoradiometric assay in all cases and were associated with normal responses to TRH. The immunoradiometric assay for TSH, which is commercially available, may therefore obviate the need for the more time consuming TRH test and simplify the approach to thyroid function testing in patients with suspected hyperthyroidism.     

Effect of somatostatin on thyrotropin, prolactin, growth hormone and insulin responses to thyrotropin releasing hormone and arginine in healthy, hypothyroid and acromegalic subjects.

The effect of somatostatin on the thyrotropin (TSH), prolactin, growth hormone (GH) and insulin responses to the combined administration of thyrotropin releasing hormone (TRH) and arginine was studied in six healthy subjects, three hypothyroid patients and three acromegalic patients. Similar inhibition by somatostatin of the TSH and insulin responses was observed in the three groups. While the tetradecapeptide had no significant effect on the prolactin response in the healthy and acromegalic subjects, it caused an unexpected inhibition of the prolactin response in two of the hypothyroid subjects. Contrary to the findings in the healthy and hypothyroid subjects, somatostatin did not inhibit the GH response in the acromegalic patients. Normal inhibition by somatostatin of the insulin response, followed by a rebound in insulin secretion, was observed in all subjects. These preliminary data indicate increased sensitivity of the prolactin-secreting cells to somatostatin in hypothyroidism and suggest that decreased responsiveness of the somatotrophs to somatostatin could play a role in the pathogenesis of acromegaly.     

Response to thyrotrophin-releasing hormone in atrial dysrhythmias.

Seventy-eight clinically euthyroid patients with atrial dysrhythmias, either established or paroxysmal, and sixty-three patients in sinus rhythm with coronary disease were screened for hyperthyroidism using thyroid function tests including the thyroid-stimulating hormone (TSH) response to thyrotrophin-releasing hormone (TRH). All had normal levels of serum thyroxine (T4) apart from three with dysrhythmias who were found to have hyperthyroidism. Twenty per cent of patients with atrial dysrhythmias and 10% of those in sinus rhythm had exaggerated TSH response to TRH. Thirty-six per cent of patients with an exaggerated response of TSH to TRH had significant titres of thyroid auto-antibodies compared with 15% with positive antibodies in those with normal TSH response to TRH. Auto-immune thyroid disease may be more closely related to heart disease than has previously been recognized. Rapid atrial dysrhythmias may occur in the presence of a normal serum thyroxine, high levels of TSH and positive thyroid antibodies.     

神经系统疾病伴发抑郁障碍与单纯抑郁障碍临床表现比较

目的 比较综合医院门诊中神经系统疾病伴发抑郁障碍和单纯抑郁障碍的患者临床表现的差异,探讨神经系统疾病伴发抑郁障碍患者的临床特点.方法 使用美国精神障碍诊断和统计手册第Ⅳ版(DSM-Ⅳ)作为诊断依据,连续纳入就诊于综合医院神经内科和心理卫生科门诊的抑郁障碍患者94例,使用Hamilton抑郁量表17项版本(HAMD-17)作为严重程度评定量表,比较神经系统疾病伴发抑郁障碍患者和单纯的抑郁障碍患者临床特点和差异.结果 连续纳入患者共94例,平均年龄为(48±18)岁.其中,神经系统疾病伴发抑郁障碍者45例,单纯的抑郁障碍患者共49例,两组患者的抑郁严重程度均以中度为主,差异无统计学意义.神经系统疾病伴发抑郁障碍患者平均年龄为(62±15)岁,以中老年人居多,有较多的躯体疾病(3个),HAMD-17量表评分中迟滞因子分数为10.9±3.2,提示抑郁的迟滞症状明显;而单纯的抑郁障碍患者平均年龄(35±10)岁,以中青年人居多,很少伴有躯体疾病(0个),量表中核心因子分数为8.9±2.0,说明这类患者的核心症状突出.结论 在综合医院门诊就诊的神经系统疾病伴发的抑郁障碍患者和单纯的抑郁障碍患者在临床特点上有显著不同,正确的认识这种差异有助于提高诊断的识别率,并决定恰当治疗方案.     

Reciprocal change in ST segment in acute myocardial infarction: correlation with findings on exercise electrocardiography and coronary angiography

The clinical relevance of reciprocal changes in the ST segment occurring at the time of acute myocardial infarction was studied prospectively in 85 consecutive uncomplicated cases. Reciprocal depression of the ST segment was defined as depression of 1 mm or more in electrocardiogram leads other than those reflecting the infarct. All patients underwent maximal, symptom limited treadmill stress testing two weeks after the infarct and coronary angiography six weeks after infarction. Forty six patients had inferior, 34 anterior, and five true posterior infarction. Of the 51 patients with reciprocal changes, 45 (88%) developed exercise induced ST segment depression in areas remote from the infarction zone. At angiography all 45 patients were shown to have stenoses greater than 70% in at least two major vessels. Four patients had negative exercise electrocardiograms and were sequently shown to have single vessel disease subtending their infarct, and the remaining two patients had a false negative treadmill test result. Of the 27 patients without reciprocal changes, 21 (78%) had negative treadmill stress test results associated with single vessel coronary disease. Five had positive stress test results and multivessel coronary disease, and one had a false negative stress test result. The remaining seven patients had ST segment elevation without Q wave formation in the reciprocal areas and were assessed separately. Of these, six had positive stress test results and multivessel coronary disease and one had a negative stress test result and single vessel coronary disease to the infarct area. Twenty one patients with anterior infarcts (62%) and 27 with inferior infarcts (59%) had reciprocal changes. No differences emerged in the relation between infarct site, reciprocal change, and presence of additional coronary disease. At follow up of the 51 patients with reciprocal changes in the ST segment 36 had become symptomatic, of whom 29 had undergone coronary artery bypass surgery. By contrast, only four of the 27 patients without reciprocal changes in the ST segment had developed symptoms, and two of these had undergone coronary revascularisation. Reciprocal ST segment depression at the time of acute myocardial infarction may identify patients with severe coronary disease who are at risk of subsequent cardiac events and appears to be as reliable as results of early postinfarction treadmill stress testing in predicting the underlying coronary anatomy. When the electrocardiogram does not show reciprocal changes treadmill testing provides valuable additional information.     

神经系统疾病伴发抑郁障碍的诊疗特点

目的 比较神经系统疾病伴发抑郁障碍患者和单纯的抑郁障碍患者的生活质量以及疗效的差异,探讨神经系统疾病伴发抑郁障碍患者的临床诊疗特点.方法 用美国精神障碍诊断和统计手册第Ⅳ版(DSM-Ⅳ)作为抑郁障碍诊断依据;用汉密尔顿抑郁量表17项(HAMD-17)评价抑郁障碍严重程度;用简明健康状况调查表(SF-36)评价健康相关的生活质量,分别对2007年1月至2010年3月就诊于综合医院神经内科门诊和心理卫生科门诊的抑郁障碍患者在基线期和研究结束时(6周抗抑郁治疗)进行评估.结果 连续纳入神经系统疾病伴发抑郁障碍的患者共45例,平均年龄62岁,其中39例(86.7%)患者就诊于神经内科门诊;单纯抑郁障碍的患者49例,平均年龄35岁,其中42例(85.7%)就诊于心理卫生门诊.患者的抑郁严重程度和生活质量呈负相关即抑郁越严重生活质量越差,在基线期神经系统疾病伴发抑郁和单纯抑郁障碍的患者相比,生理机能评分(分别为61和83分,P=0.044)更低损害更突出,而精力受损不如单纯抑郁障碍的患者严重(分别为39和29分,P=0.007).经过6周抗抑郁治疗结束时两组患者缓解率和有效率差异无统计学意义.在疗效的评价中神经系统疾病伴发抑郁患者的疼痛(治疗前60分,治疗后65分,P=0.048)的恢复明显好于单纯的抑郁患者.结论 神经系统疾病伴发抑郁障碍的患者更多地就诊于综合医院的神经内科,其健康相关的生活质量的损害有别于单纯的抑郁障碍患者,而在接受抗抑郁治疗后可以获得同样的缓解率和有效率,正确地认识患者的临床特点有助于提高综合医院医师对抑郁障碍的诊治,提高患者的生活质量.     

急性脑卒中患者甲状腺功能改变与卒中后抑郁相关性研究

目的:探讨急性脑卒中患者甲状腺功能改变与情感变化相关性。方法:对62例急性脑卒中患者进行分组(单纯卒中组35例和卒中后抑郁组27例)收集两组入院d2、d7及d14两次空腹血清,采用化学发光法测定甲状腺功能,并与30例正常健康体检者(对照组)进行比较。结果:卒中后抑郁组较单纯卒中组比血清游离三碘甲状腺原氨酸(FT3)水平明显下降,而血清游离甲状腺素(FT4)水平显著增高,且卒中后抑郁组比卒中后无抑郁组的变化程度更显著;单纯卒中组血清促甲状腺素(TSH)水平比对照组显著增高,但卒中后抑郁组TSH水平升高不明显;而在入院d14,单纯卒中组FT3、FT4、TSH均恢复接近正常,与对照组比较无差异,而卒中后抑郁组FT3、FT4虽有恢复但不明显,与对照组比较无显著差异。结论:急性脑卒中患者甲状腺功能发生变化,而FT3、FT4及TSH水平变化与患者并发卒中后抑郁有关。     

国产万拉法新治疗肠易激综合征的初步临床研究

目的 观察国产新药万拉法新对肠易激综合征（IBS）及其伴随的焦虑和抑郁症状的临床治疗效果。方法 选择48例IBS患者,随机分为治疗组和对照组,分别服用万拉法新及硝苯地平进行为期4周的治疗,通过对IBS各项症状的改善率和总体改善率评定观察治疗效果。同时采用Zung编制的抑郁自评量表和焦虑自评量表进行评分观察治疗前后抑郁和焦虑的改善程度。结果 万拉法新对IBS的治疗总体改善率为80％,对照组为52．17％（P＜0．05）。万拉法新治疗前后焦虑和抑郁的改善程度经检验均有统计学意义（P＜0．01）。结论 单独应用万拉法新对IBS的总体治疗效果优于硝苯地平组,对改善伴随的焦虑和抑郁症状有明显的疗效。     

抑郁症患者甲状腺素水平紊乱与生物节律之间的关系

目的 探讨抑郁症患者甲状腺激素水平紊乱和生物节律紊乱之间的关系,为患者的治疗提供参考依据。方法 连续纳入2020年6月至2022年3月在安徽省精神卫生中心就诊的抑郁症患者90例,同期纳入90例健康对照人群。比较两组对象神经精神生物节律评定晤谈（BRIAN）评定得分、血清甲状腺激素水平的差异,并分析BRIAN评分与甲状腺激素水平的相关性。结果 与对照组相比,抑郁症患者BRIAN总分、睡眠、活动、社交、进食、夜间活动、昼夜节律颠倒评分增高（P<0.05）,早晨活动评分降低（P<0.05）。抑郁症组促甲状腺激素（TSH）水平升高,四碘甲状腺氨酸（TT4）、游离四碘甲状腺氨酸（FT4）、游离三碘甲状腺氨酸（FT3）水平降低（P<0.05）。相关性分析提示,TSH水平与BRIAN总分呈正相关,TT4及FT4水平与BRIAN总分呈负相关,而TT3及FT3与BRIAN评分无相关性。线性回归分析提示,TSH水平升高、FT4水平降低是影响抑郁症患者生物节律紊乱的危险因素。结论 抑郁症患者生物节律紊乱与甲状腺功能密切相关。     

PRE- AND POST-OPERATIVE HYPOTHALAMIC-PITUITARY- THYROIDAL AXIS FUNCTION IN PATIENTS WITH PROLACTINOMA, GROWTH HORMONE TUMOUR AND ACTH TUMOUR

Pre- and postoperative hypothalamic-pituitary-thyroid axis function was studied in 38 patients with pituitary adenomas (PRL, GH and ACTH tumours), of whom 35 were surgically confirmed and three diagnosed by clinical signs, CT scanning and hormone assessments. About ten days after operation, the same study was repeated in 10 patients with prolactinoma and 7 with growth hormone (GH) tumour. The preoperative abnormal serum TSH response to TRH was found in 8/20 patients with prolactinoma, 9/16 with GH tumour, and 2/2 with Cushing's disease due to ACTH microadenoma. The incidence of abnormal TSH response to TRH was not significantly increased in patients with larger adenoma in either PRL or GH tumour group. In 8 cases of prolactinoma, metoclopramide (MCP, 10 mg, P.O.) test was also performed and there was a significant positive correlation between TSH responses to TRH and to MCP. Serum TT3 in the GH tumour group was within normal ranges, but significantly higher than that of the normal and prolactinoma groups. After operation, TT3 was significantly decreased as compared with that before operation and there were marked changes in TSH response to TRH. In conclusion, there were some abnormalities in TSH control in patients with non-TSH pituitary tumour, and in serum TT3 control in patients with GH tumour. The surgical treatment of pituitary adenoma can lead to transient decrease in TSH reserve and serum TT3 level probably resulting from both stress and/or destruction of thyro-trophs by the operation.     

促甲状腺激素降低与脑卒中后抑郁的相关性研究

目的：探讨促甲状腺激素（TSH）降低与脑卒中后抑郁的相关性。方法收集2012年10月至2014年7月该院住院治疗的急性脑梗死患者101例，根据TSH是否小于0．27 uIU／mL分成 TSH降低组和 TSH正常组。入院时两组患者分别进行神经功能缺损（NIHSS）评分，出院后随访3个月分别进行汉密尔顿抑郁量表（HAMD）评分和改良的Rankin量表（mRS）评分。结果 TSH降低组3个月时的HAMD评分（16．04±3．34 vs ．14．03±3．47，P＝0．000）、mRS均明显高于TSH正常组（3．2±1．1 vs ．2．1±1．5，P＝0．000）。TSH降低组预后差的比率（89．3％）高于TSH正常组（38．4％）。结论 TSH浓度降低与脑卒中后抑郁可能存在相关性，TSH浓度低的急性脑梗死患者预后较差。     

酶免疫法检测结核分枝杆菌糖脂抗体监测结核患者的体液免疫

目的　探讨用酶免疫实验检测抗结核分枝杆菌糖脂抗原 (TBGL)抗体的方法 ,监测结核病人体液免疫的可能性。方法　用酶免疫EIA法检测 84例活动结核患者及 35例健康对照血清中抗TBGL抗体。结果　结核患者血清中抗TBGL抗体总阳性率达到 5 5 % ,正常人为 17% (P <0 .0 1)。门诊患者和住院患者的阳性率分别为 36 %和74 % (P <0 .0 0 1)。结论　本法可能用于进行结核的血清学诊断及患者体液免疫功能监测。     

Health-related quality of life and depression in patients with chronic hepatitis C

BACKGROUND: Hepatitis C is a major cause of liver disease worldwide. It has been associated with decreased health-related quality of life (HRQL) and psychiatric symptoms. Our aim was to assess HRQL, depression, and illness understanding in patients with chronic hepatitis C without previous interferon therapy. METHODS: Consecutive patients attending a referral center were enrolled. HRQL was measured using SF-36 questionnaire, depression with Zung self-rating depression scale, and illness understanding with self-applied knowledge test. RESULTS: Of 157 patients enrolled, 112 were female (71%) and 45 male (29%). Ninety-seven patients (61.8%) had cirrhosis. HRQL was significantly decreased in chronic hepatitis C patients compared to historical normal controls in all eight domains of the SF-36 (p < 0.001). In hepatitis C cirrhotic patients, HRQL was significantly lower among Child-Pugh class B and C subjects in domains reflecting physical health (p <0.05). Ninety-two patients (58.6%) had depression that resulted in lower HRQL when compared to nondepressed patients (p <0.05). One hundred fourteen patients (72.6%) had poor illness understanding of hepatitis C. These subjects had significantly lower HRQL scores in six of eight SF-36 domains when compared to patients with better understanding of the disease (p <0.05). CONCLUSIONS: Chronic hepatitis C patients attending a tertiary-referral center had significant decrease in HRQL associated with depression (58.6%) and poor illness understanding (72.6%). Educational programs and their impact on HRQL need to be addressed in detail, particularly for the pre-treatment scenario.     

Retrospective audit of the value of the pancreolauryl test in a district general hospital

Objectives: To audit the specificity and value of the pancreolauryl test (PLT) for the diagnosis of pancreatic insufficiency. Design: A retrospective case note review of 47 patients who had a PLT during three consecutive years. Setting: A 650 bedded district general hospital. Main outcome measures: Patient demographics, symptoms, baseline blood, endoscopic and radiological investigations, and alcohol consumption were related to the results of the PLT to determine if the test could be better targeted. Response to therapy and final diagnoses were noted to determine the specificity of the test. Results: Forty seven patients had a PLT during the three years studied. All successfully performed the test as outpatients. Seven inconclusive tests were repeated. Thirty eight patients (81%) had diarrhoea, of whom 10 (21%) described steatorrhoea; 23 (49%) had an abnormal PLT. All with an abnormal test had diarrhoea, more frequently describing watery stools than steatorrhoea. Those treated with pancreatic enzyme supplements had an excellent response, although two of these had a final diagnosis of coeliac disease. Nineteen patients with an abnormal PLT were thought to be suffering from pancreatic insufficiency. All patients with a normal PLT were clinically thought not to have pancreatic insufficiency. Age, sex, and alcohol intake correlated poorly with final diagnosis. Conclusions: The PLT can be used in a district general hospital setting as an outpatient test for pancreatic insufficiency and has a specificity of 83%–91%. Its use should be restricted to thse presenting with diarrhoea, not necessarily steatorrhoea, and not restricted to those with a history of high alcohol consumption.     

原发性慢性每日头痛的临床分析

目的探讨原发性慢性每日头痛的临床特点。方法对73例原发性慢性每日头痛患者进行问卷式调查,并给予Hamilton抑郁量表评分。结果研究组中,男女比为1;2．17,临床上大多同时具有偏头痛和紧张性头痛的特点,52％的患者既往有头痛病史,48％的患者有药物过量服用史,55％的患者合并有抑郁。结论慢性每日头痛有其特殊的临床表现,大多伴有抑郁厦药物滥用。