术前TSH水平与甲状腺结节良恶性关系

目的：探讨血清促甲状腺激素（TSH）浓度与甲状腺结节良恶性的关系。 方法：回顾性分析近3年间收治的421例甲状腺结节患者的临床资料,其中结节性甲状腺肿347例,甲状腺癌74例。比较良恶性甲状腺结节患者血清TSH浓度差异,并分析TSH浓度与甲状腺结节的恶性风险以及甲状腺癌不同病理类型与血清TSH浓度的关系。 结果：甲状腺癌患者血清TSH浓度明显高于结节性甲状腺肿患者[（2.57±3.32）mIU/L vs. （1.67±2.90）mIU/L]（P<0.05）;甲状腺结节的恶性风险随血清TSH浓度的升高而逐渐升高,当TSH>5 mIU/L时,恶性率为50.0%;甲状腺癌不同病理类型间血清TSH浓度无统计学差异（P>0.05）。 结论：甲状腺结节恶性风险随血清TSH浓度的升高而增加,术前血清TSH测定可以作为甲状腺结节良恶性判断的一个辅助性指标。     

结节性甲状腺肿合并甲状腺癌82例

目的:探讨结节性甲状腺肿合并甲状腺癌的诊治方法。方法:回顾分析82例结节性甲状腺肿合并甲状腺癌临床资料。结果:657例患者中合并甲状腺癌82例,占12.5%;结节性甲状腺肿合并甲状腺癌质地较硬占11.0%(9/82),T3、T4升高占2.4%(2/82);男性合并甲状腺癌为9.8%(11/112)、女性合并甲状腺癌为13.0%(71/545);术前影像学检查,657例患者钙化灶发生率为31.3%(206/657),82例结节性甲状腺肿合并甲状腺癌钙化灶发生率为82.9%(68/82),其微钙化占97.1%(64/68);在≥45岁和<45岁年龄间,结节性甲状腺肿合并甲状腺癌的发生率分别为7.2%(39/542)和37.4%(43/115)。结论:结节性甲状腺肿钙化灶,尤其是微钙化灶的出现,对结节性甲状腺肿合并甲状腺癌的诊断有重要意义;年轻患者出现结节性甲状腺肿合并结节的钙化,应警惕甲状腺癌的可能。     

促甲状腺激素水平对新鲜IVF/ICSI周期妊娠结局的影响

目的探讨控制性促排卵前血清促甲状腺激素(TSH)水平高于4.0 mU/L,对IVF/ICSI新鲜周期妊娠结局的影响。方法回顾性分析2017年6月1日至2018年12月31日在本院进行IVF/ICSI助孕的患者资料,共4 457个周期。根据血清TSH水平,分为TSH≤4.0 mU/L组(n=4 107)和TSH4.0 mU/L组(n=350),比较两组患者的一般资料以及妊娠结局。同时又对TSH4.0 mU/L组内的患者按照4.0 mU/LTSH≤5.0 mU/L(n=280)和TSH5.0 mU/L(n=70)再分组,进行助孕结局的比较。结果以4.0 mU/L为分割点的两组患者年龄、不孕年限、体重指数(BMI)、血清抗苗勒管激素(AMH)、基础FSH、基础E_2、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平均无显著性差异(P0.05);两组间的促排卵结局及临床妊娠率、异位妊娠率、活产率均无显著性差异(P0.05);TSH4.0 mU/L组的流产率(15.12%)略高于TSH≤4.0 mU/L组(12.80%),但无显著性差异(P0.05)。TSH4.0 mU/L的患者再分组后统计分析表明,各项助孕指标及妊娠结局均无显著性差异(P0.05)。结论在甲状腺功能其他指标正常的情况下,患者控制性促排卵前的血清TSH水平高于4.0 mU/L不影响IVF/ICSI新鲜周期的妊娠结局。     

绝经后2型糖尿病女性患者骨密度与血清促甲状腺激素水平的关系

目的 通过测定甲状腺功能正常的绝经后2型糖尿病妇女的骨密度,探讨正常范围内促甲状腺激素（TSH）的水平与骨密度的关系。方法 选取在我院内分泌科住院治疗的甲功正常的绝经后T2DM女性患者220例,根据血清TSH水平,以1.60 mU/L和2.90 mU/L为界,将入选患者分为3组,即A组(0.27mU/L~1.60mU/L)、B组（1.60mU/L~2.90mU/L）、C组（2.90mU/L~4.20mU/L）。比较各组的一般情况、生化指标、骨密度（BMD）的差异。结果 ①与B组相比,A组患者左股骨颈、转子和全髋部BMD降低,差异有统计学意义（P<0.05）,而AC、BC两两比较差异无统计学意义（P>0.05,P>0.05）;②对于甲功正常的绝经后T2DM女性患者,血清FT3与全髋部BMD呈正相关（r=0.292,P=0.039）,TSH、FT4与全髋部BMD无相关（r=0.078,P=0.594;r=-0.043,P=0.771）;③校正年龄、绝经年限、BMI后,FT3与全髋部BMD仍呈正相关（r=0.401,P=0.006）,TSH、FT4与全髋部BMD仍无相关（r=0.013,P=0.929;r=0.039,P=0.797）;④在多元线性回归中,FT3仍与全髋部BMD独立相关（B=0.114,P=0.006）。结论 在甲功正常的绝经后T2DM妇女中,低TSH会降低全髋BMD;血清FT3与全髋BMD呈正相关,而TSH、FT4与全髋部BMD无相关。     

术前TSH水平与甲状腺结节恶性风险的相关性

目的探究术前TSH水平与甲状腺结节恶性风险的相关性。方法回顾性分析959例甲状腺结节患者的病例资料,通过SPSS 17.0软件进行统计学分析。结果 959例患者中,良性结节组746例,甲状腺乳头状癌(PTC)组213例。PTC患者术前的血清TSH水平高于良性结节患者[(2.32±1.65)mU/L比(1.76±1.20)mU/L,P0.001],并随TSH水平上升,PTC的患病风险增加。术前TSH水平与PTC肿瘤直径、病灶数量和淋巴结转移情况无相关性(P0.05)。logistic回归分析结果显示,术前TSH水平是PTC发生的独立影响因素[OR=1.315,95%CI为(1.171,1.477),P0.001]。TSH诊断PTC的最佳临界值为1.575 mU/L,此时灵敏度为62.0%,特异度为53.4%,受试者工作特征(ROC)曲线下面积为0.602(P0.001)。结论术前TSH水平与甲状腺结节恶性风险有一定的相关性,随TSH水平的上升PTC的患病风险增加。     

血清促甲状腺激素水平与分化型甲状腺癌致病风险关系研究

目的 探讨甲状腺结节患者术前血清促甲状腺激素（TSH）水平与分化型甲状腺癌（DTC）的关系.方法 回顾性分析2004 年1 月至2010 年12 月我科收治的6170 例符合条件的各类甲状腺手术治疗患者临床资料,检测患者术前血清TSH 水平并与术后病理组织结果 进行对照分析.结果 6170 例手术患者中389 例术后病理证实为DTC（6.3%）.5781 例良性组甲状腺结节患者血清TSH 浓度为（1.1 ± 0.5）mU/L,389 例恶性组患者为（2.8 ± 0.3）mU/L,两组间比较差异有统计学意义（P 〈 0.01）.高于TSH 参考值范围与低于此范围的患者中患DTC 的比例分别为9.1%、4.9%,二者差异有统计学意义（P 〈 0.001）.并随血清中TSH 水平的增高,患甲状腺癌的机会增加.DTC 患者中颈淋巴结转移组患者平均TSH 水平高于无转移组（P 〈 0.05）.结论 随着血清中TSH 水平的增高,甲状腺结节患者患DTC 的概率增加,血清TSH 水平与DTC 颈淋巴结转移相关.     

结节性甲状腺肿合并甲状腺癌的诊断和治疗

目的：总结结节性甲状腺肿并存甲状腺癌的诊断和治疗的经验。 方法：回顾性分析2007年1月—2012年12月手术治疗并经病理证实的185例结节性甲状腺肿并存甲状腺癌患者的临床资料。 结果：同期手术治疗的结节性甲状腺肿患者共1 657例,185例（11.16%）合并甲状腺癌,其中乳头状癌158例（85.4%）,滤泡状癌17例（9.2%）,混合型癌9例（4.9%）,未分化癌1例（0.5%）。结节性甲状腺肿合并甲状腺癌患者钙化发生率（42.8%,74/173）明显高于单纯结节性甲状腺肿患者（10.8%,159/1472）（χ2=130.16,P=0.00）;砂砾钙化患者癌变率（100%,36/36）明显高于非砂砾样钙化者（19.3%,38/197）（χ2=91.49,P=0.00）。患者均行术中快速病理检查（除12例近期外院已确诊）,并根据不同情况均采取了不同范围的手术方式,术后均终生服用甲状腺素片。 结论：结节性甲状腺肿并存甲状腺癌时,多为分化好的乳头状癌。对于合并钙化,特别是砂砾样钙化的结节性甲状腺肿应积极手术治疗。结节性甲状腺肿的手术中应行快速病理检查帮助诊断,从而有利于术中选择正确的手术方式。     

女性促甲状腺激素水平与IVF/ICSI早期胚胎丢失率相关性研究

目的探讨甲状腺功能正常的女性中血清促甲状腺激素(TSH)水平和IVF/ICSI早期胚胎丢失的相关性。方法回顾性分析2016年9月至2017年2月本中心拟行IVF/ICSI中甲状腺功能正常女性患者的临床资料,根据血清TSH水平,分为TSH≤2.5mU/L组(830例)和TSH2.5mU/L组(355例),对所有患者的甲状腺功能、早期临床妊娠结局及早期胚胎丢失率进行了随访和分析。结果本研究共纳入1 185例进行IVF/ICSI助孕、且甲状腺功能正常的女性患者。830例TSH≤2.5mU/L组患者中,48例(5.8%)发生早期胚胎丢失,441例(53.1%)获得临床妊娠,12例(1.4%)发生异位妊娠;355例TSH2.5mU/L组患者中,21例(5.9%)发生早期胚胎丢失,175例(49.3%)获得临床妊娠,3例(0.8%)发生异位妊娠,两组数据差异均无统计学意义(P0.05)。结论在行IVF/ICSI的控制性促排卵(COH)前,患者TSH水平高于2.5mU/L并不造成早期胚胎丢失率增高。     

甲状腺机能亢进合并甲状腺癌

对于甲状腺癌与甲状腺机能亢进相并发曾有不同报道,其发生率为0.76～8.7%,特别是毒性结节性甲状腺肿,其合并甲状腺癌的可能性更大,因此宜首选手术治疗.作者总结了1986～1991年因甲状腺机能亢进行甲状腺切除的138例患者,其中80例(58%)为毒性结节性甲状腺肿,33例(23.9%)为弥漫性甲状腺肿伴机能亢进,25例(18.1%)为高功能腺瘤.全部病例中合并甲状腺癌共8例(5.8%),其在各组发生率分别为:高功能腺瘤组2例(8%),突眼性甲状腺肿组2例(6%),毒性结节性甲状腺肿组4例(5%).临床表现     

血清甲状腺球蛋白及促甲状腺素在分化型甲状腺癌预后判断中的意义

目的探讨血清甲状腺球蛋白(thyroglobulin,Tg)及促甲状腺素(thyrotropin,TSH)在分化型甲状腺癌预后判断中的意义。方法分化型甲状腺癌患者112例,检测112例患者术前血清Tg和TSH水平。采用Kaplan-Meier生存分析和COX多因素回归模型分析不同病理参数与患者平均总生存期和平均无进展生存期的关系。结果血清Tg≥20 ng/ml和TSH≥2.5 mIU/L的患者其T分期为3/4的比例和淋巴转移率较高(P0.05),Tg≥20 ng/ml的患者其肿瘤体积显著大于Tg20 ng/ml的患者(P0.05),不同TSH水平患者之间肿瘤大小比较差异无统计学意义(P0.05)。TNM不同分期患者血清Tg和TSH水平比较差异有统计学意义(P0.05)。Tg≥20 ng/ml和TSH≥2.5 mIU/L的患者5年生存率分别为79.9%和82.8%,无进展生存率分别为71.0%和73.3%,均显著低于Tg20 ng/ml和TSH2.5 mIU/L的患者(P0.05)。肿瘤大小、T分期、淋巴转移、远处转移、Tg水平、TSH水平是分化型甲状腺癌5年生存率的独立危险因素。结论高Tg和TSH水平与分化型甲状腺癌患者不良预后有关。     

Thyroid disorders in hemodialysis patients in an iodine-deficient community

There are various changes in the thyroid gland and its function in chronic renal failure (CRF). These changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland. This study is designed to investigate the prevalence of goiter and thyroid dysfunction in patients with end-stage renal disease (ESRD) on hemodialysis (HD) in an iodine-deficient community. Eighty-seven (40 females and 47 males) HD patients and 169 (79 females and 90 males) healthy individuals as controls are included. Sex ratios for the patient and control groups are 0.85 and 0.88, respectively. Mean ages for the patient and control groups are 42.94 +/- 11.88 and 40.20 +/- 10.72 years, respectively. Examination of the thyroid gland using ultrasonography along with simultaneous measurement of blood levels of free-T4 (FT4), free-T3 (FT3), and thyrotropin (TSH) are made for every individual. The presence of goiter demonstrable by ultrasonography is found in 32.2% of the uremic patients and in 23.5% of the controls and its prevalence increases with age (P = 0.01). In 32 (36.8%) of the patients and 29 (17.1%) of the controls at least one thyroid nodule is found in ultrasonography. Between patients with or without a nodular goiter the authors could not observe any difference for duration of dialysis and serum levels of TSH, FT4, FT3, calcium, and albumin. In ESRD patients the prevalence of nodular goiter is higher for females (47.5% vs. 27.7%, P = 0.045) and increases with age (P = 0.04). Though incidence of hyperthyroidism is found to be similar for the two groups (1.14% in ESRD patients vs. 1.10% in controls), hypothyroidism is observed in 3.4% of ESRD patients but only 0.6% of controls. This high incidence of hypothyroidism and nodular goiter in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests and ultrasonography, should be considered in evaluation of every ESRD patient.     

Incidental thyroid carcinoma in patients with Graves' disease

BACKGROUND: The clinical significance of incidental thyroid carcinoma in patients with Graves' disease is uncertain. METHODS: The prevalence of incidental thyroid carcinoma was determined in patients with Graves' disease who underwent surgery from 1990 to 2007 and was compared with patients with nontoxic nodular goiter or toxic multinodular goiter who underwent surgery during the same time period. RESULTS: Of the 93 patients who underwent thyroidectomy for Graves' disease, 2 patients (2.2%) had an incidental papillary carcinoma: .4 and .5 cm in size. Neither patient developed recurrent disease after 3 and 13 years of follow-up evaluation. The prevalence of incidental thyroid cancer was 3.6% and 6.2% in patients with nontoxic nodular goiter and toxic multinodular goiter, respectively (P = not significant). CONCLUSIONS: The prevalence of incidental thyroid carcinoma in patients with Graves' disease is comparable with patients with nontoxic or toxic goiter. Incidental thyroid carcinomas in patients with Graves' disease were papillary microcarcinomas of no clinical consequence.     

开放与后腹腔镜肾部分切除术治疗早期肾癌的安全性与疗效比较

目的对比分析开放与后腹腔镜肾部分切除术治疗早期肾癌的安全性与疗效。方法总结2004年12月至2010年2月我中心60例肾癌肾部分切除术,其中开放手术19例,男∶女=17∶2;后腹腔镜手术41例,男∶女=33∶8。对比两组患者基本资料及围手术期相关数据,所有患者肾癌临床分期均为T1N0M0,术后病理证实透明细胞癌54例,乳头状肾细胞癌6例。结果所有手术均获成功,开放组与后腹腔镜组患者年龄分别为(57.7±17.7)岁vs(55.2±16.6)岁(P=0.607);肿瘤直径为(3.3±0.9)cmvs(2.9±1.0)cm(P=0.063);术前肌酐为(107.9±54.7)μmol/Lvs(96.8±18.2)μmol/L(P=0.396);术后肌酐为(117.8±55.9)μmol/Lvs(107.5±19.6)μmol/L(P=0.443);手术前后肌酐变化分别为(9.8±22.2)μmol/L和(9.8±14.3)μmol/L(P=0.988);两组手术时间为(167.9±46.9)minvs(148.5±41.2)min(P=0.108);肾动脉阻断时间为(21.6±10.2)minvs(26.9±9.0)min(P=0.058);术中失血量为(327.9±174.2)mlvs(181.8±120.1)ml(P=0.247);术后住院时间为(11.0±3.4)dvs(8.9±4.0)d(P=0.015)。开放组与后腹腔镜组术后输血患者分别为3例和4例(P=0.668),出现术后并发症的患者分别为2例和3例(P=0.648)。两组患者分别随访38.8及45.4个月,肿瘤控制良好,两组患者末次随访肾功能差异无统计学意义。结论后腹腔镜肾部分切除术在治疗早期肾肿瘤方面,安全性及疗效与开放手术相似,而手术创伤小、恢复速度快。     

结节性甲状腺肿合并甲状腺癌25例

目的：探讨结节性甲状腺肿中甲状腺癌的临床特征和预后。方法：回顾性分析手术治疗结节性甲状腺肿合并甲状腺癌２５例临床资料。结果：２５例结节性甲状腺肿合并甲状腺癌,男６例,女１９例,年龄１２～６５（３６．８±１３．１）岁,占同期手术治疗３９５５例结节性甲状腺肿的０．６３％。术前、术中诊断甲状腺癌的占３２％,６８％为术后病理检查发现。甲状腺微小癌占４８％。结论：结节性甲状腺肿合并甲状腺癌预后较好。不能简单地认为结节性甲状腺肿是良性病变而忽略对其的处理,也不应过分强调甲状腺癌在治疗结节性甲状腺肿中的地位随意放宽手术指征,或扩大手术。     

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??Coexisting nodular goiter and thyroid carcinoma: a retrospective analysis of 262 cases HE Liang, ZHANG Hao??DONG Wen-wu, et al. Department of General Surgery, the First Hospital, China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Hao,E-mail: haozhang@mail.cmu.edu.cn
Abstract Objective To summarize the clinical characteristics and the highlight of diagnosis and treatment of nodular goiter in patients with coexistent thyroid carcinoma??Methods A total of 262 nodular goiter coexisting with thyroid carcinoma patients underwent operations from January 1998 to December 2007 at the First Hospital, China Medical University were retrospectively reviewed??Results Two hundreds and sixty-two patients accounted for 33.9% in thyroid carcinoma patients at the same time. The age mainly ranged from 40 to 59 years. The sex ratio was 1:5.2 (male:female). The clinical characteristics were manifested as nodular goiter. In addition to 25 patients who received secondary operation had a clear diagnosis before surgery. 70.0% of tumors were suspected as malignant lesions by preoperative ultrasound examination, in which 39.2% exhibited as microcalcification. The accuracy rate of intra-operative fast frozen section pathological examination was 93.2%. Tumor nodules less than 2.0 cm in diameter accounted for 62.9%, and microcarcinomas accounted for 40.1%. Clinical phase I cases accounted for 74%. The main pathological type was papillary carcinoma??93.1%??. The various styles of thyroidectomy were performed according to the different pathological results?? Neck dissection was performed in 122 patients, and 46 of them had cervical lymph node metastasis. Conclusion Most patients with coexisting thyroid carcinomas and nodular goiter have small tumor size and lower incidence of lymph node metastasis. The coexistent thyroid carcinoma was often well differentiated papillary cancer??The preoperative ultrasonography and the intra-operative fast frozen section examination are helpful for the diagnosis of thyroid carcinoma in nodular goiter?? Regular follow-up in patients with nodular goiter could improve the early diagnostic rate of coexisting thyroid carcinoma.     

An investigation of epidemiologic factors associated with large nodular goiter

BACKGROUND: Sporadic nodular goiter is a common problem in the United States and significant compressive symptoms may occur with progression to a critical size. METHODS: Potential epidemiological variables associated with the development of large unilateral (> or = 50 g) and bilateral (> or = 100 g) nodular goiter were investigated including: age, gender, race, body mass index (BMI), family history of thyroid disease, pregnancy at time of diagnosis, insurance status, and tobacco or alcohol use. Data were obtained from an IRB-approved thyroid database and retrospective chart review of consecutive patients operated on for nodular goiter from 1990 through 2005. A univariate and multivariate analysis of epidemiological variables in patients with "large" versus "small" nodular goiter was completed. RESULTS: Of the 488 patients operated on for nodular goiter, 113 (23%) were classified as "large," 43 with unilateral (mean 106 +/- 72 g) and 70 with bilateral enlargement (mean 173 +/- 92 g) and 375 (77%) were classified as "small," 179 with unilateral (18 +/- 10 g) and 196 with bilateral (37 +/- 24 g) enlargement. Based on univariate analysis, African-American race, age > or = 40 years, BMI > or = 30 kg/m2, and lack of insurance were associated with an increased risk of large nodular goiter (P < or = 0.001), whereas alcohol use was protective (P = 0.002). A multivariate analysis revealed that African-American race [adjusted odds ratio (adj. OR) 3.3, 95% CI = 2.0-5.4], age > or = 40 years (adj. OR 2.1, 95% CI = 1.2-3.8), and BMI > or = 30 kg/m2 (adj. OR 2.5, 95% CI = 1.5-4.0) were independently associated with large nodular goiter. No significant differences were observed in gender, family history of thyroid disease, pregnancy, or tobacco use (P > 0.1). CONCLUSIONS: African-American race, obesity, and increasing age are independent risk factors for the development of large nodular goiter. These results may be helpful in determining how best to monitor patients with nodular goiter, with earlier intervention to help prevent progressive enlargement and its sequelae.     

TSH水平与甲状腺乳头状微小癌之间的关系探讨

目的探讨促甲状腺激素(TSH)与甲状腺乳头状微小癌之间的关系。方法回顾性分析2006年1月至2016年2月手术治疗的341例甲状腺结节患者,根据病理结果分为两组:甲状腺乳头状微小癌组104例,良性甲状腺结节组237例,收集并比较各组临床实验资料。数据分析采用SPSS 19.0统计软件,计量资料采用(x珋±s)表示,患者在年龄、结节直径、TSH浓度、淋巴结转移与TSH关系比较使用t检验;甲状腺乳头状微小癌发生率与TSH的关系采用χ2趋势检验,以P0.05表示差异具有统计学意义。结果甲状腺乳头状微小癌组患者结节直径平均为(1.92±1.13)cm,低于良性甲状腺结节组患者的(2.82±1.44)cm(t=-5.654,P0.05);甲状腺乳头状微小癌组患者TSH平均为(3.01±1.51)μIU/ml,高于良性甲状腺结节组患者的(1.90±1.32)μIU/ml(t=6.836,P0.05),差异均有统计学意义;按照TSH水平分为0.34μIU/ml、0.34~1.00μIU/ml、1.01~2.00μIU/ml、2.01~5.60μIU/ml和5.60μIU/ml,甲状腺乳头状微小癌组发生比例分别为11.76%、14.29%、23.94%、39.06%和53.33%,检验结果显示TSH水平越高其甲状腺乳头状微小癌的发生率越高(χ2=28.783,P0.05);甲状腺乳头状微小癌伴淋巴结转移患者TSH为(5.07±1.31)μIU/ml、明显高于无淋巴结转移患者的(2.83±1.55)μIU/ml,差异比较有统计学意义(t=5.844,P0.05)。结论 TSH可作为预测甲状腺乳头状微小癌风险的指标之一,可为临床诊断提供参考依据。