Clinical efficacy of thyroid-stimulating immunoglobulin detection for diagnosing Graves’ disease and predictors of responsiveness to methimazole

BackgroundAs thyroid-stimulating immunoglobulins (TSI) are a sign of Graves' disease (GD), measuring TSI titers is becoming increasingly important for GD diagnosis. This study evaluated the diagnostic accuracy of a new fully automated TSI immunoassay (Immulite™ TSI assay) in GD patients and compared it to the third generation thyroid-stimulating hormone receptor antibody (TRAb) electrochemiluminescence assay (Elecsys Anti-TSHR assay). Additionally, clinical characteristics associated with responsiveness to methimazole in patients with newly diagnosed GD were preliminarily explored.MethodsThis study involved 324 subjects, comprising patients with untreated GD (GD-UT), Graves’ ophthalmopathy (GO) patients, GD patients who had been treated for > 12 months (GD-T), autoimmune thyroiditis (AIT) patients, and healthy subjects (HS). The Immulite™ TSI and Elecsys Anti-TSHR assay were performed on all samples. According to their responsiveness to methimazole, the GD-UT patients were divided into rapid and slow responder groups, and their clinical characteristics were compared.ResultsA receiver operating characteristic (ROC) curve analysis of GD-UT patients showed that the optimal TSI cut-off value was 0.57 IU/L. Logistic regression revealed that age and initial FT4 and TSI levels in the middle-dose methimazole group were related to a rapid response, while the initial FT4 level, but not TSI, in the high-dose group was also associated with a rapid response.ConclusionsThe clinical diagnostic performance of the Immulite™ TSI assay for diagnosing GD was comparable to that of the Elecsys Anti-TSHR assay. The initial FT4 and TSI levels can be used as predictors of the responsiveness to methimazole in patients with newly diagnosed GD.     

甲巯咪唑对甲状腺功能亢进症患者甲状腺激素及甲状腺体积的影响

目的 观察甲巯咪唑治疗甲状腺功能亢进症对患者甲状腺激素以及甲状腺体积的影响.方法 选取2019年1月至2021年1月丹东市中心医院收治的符合入院及排除标准的64例甲状腺功能亢进症患者为研究对象并采用回顾分析法对其资料进行归纳总结,将采用甲巯咪唑治疗的32例患者设为研究组,另将采用丙硫氧嘧啶治疗的32例设为对照组.观察比...     

Significance of thyroid blood flow as a predictor of methimazole sensitivity in untreated hyperthyroid patients with Graves' disease.

OBJECTIVE: The peak systolic velocity (PSV) of the inferior thyroid artery (ITA) is increased in untreated hyperthyroid patients with Graves' disease (GD). We investigated the clinical significance of the ITA-PSV and its determinants in hyperthyroid GD patients. PATIENTS AND METHODS: ITA-PSV, together with thyroid volume, was measured by ultrasonography in untreated hyperthyroid GD patients (n=49) and healthy subjects (n=22). Established markers of GD activity such as TSH receptor antibody (TRAb), thyroid stimulating antibody (TSAb), vascular endothelial growth factor (VEGF) and immunoglobulin E (IgE) were simultaneously determined. RESULTS: ITA-PSV, thyroid volume, VEGF and IgE were significantly higher in hyperthyroid GD patients than in normal subjects. ITA-PSV in hyperthyroid GD patients was correlated positively with serum levels of FT(3), FT(4) and IgE, smoking index and thyroid volume, and negatively with total, HDL- and LDL-cholesterols, but did not correlate significantly with age, triglyceride, TRAb, TSAb or VEGF. In stepwise regression analysis, ITA-PSV showed significant positive and negative associations with IgE and LDL-cholesterol, respectively, in hyperthyroid GD patients. In the pre-treatment hyperthyroid state, FT(4) and ITA-PSV, but not IgE, were found to be significantly and positively associated with the maintenance dose of methimazole (MMI) required to keep serum TSH within normal range for at least 12 months. CONCLUSION: These results suggest that ITA-PSV in untreated hyperthyroid GD patients may reflect GD activity and thus MMI sensitivity.     

放射性131I联合甲巯咪唑治疗甲状腺功能亢进合并心房颤动临床研究

目的探讨献射性131碘联合甲巯咪唑片治疗甲状腺功能亢进合并心房颤动患者的临床疗效.方法将60例甲状腺功能亢进合并心房颤动患者按随机数字表法分为实验组与对照组,每组30例,对照组给予口服甲巯咪唑片治疗,实验组在对照组基础上口服放射性131碘治疗,观察1 a.比较两组临床疗效、心房颤动转律率、心电图复查好转率、不良反应发生率;治疗前后检测血清游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素、24 h平均心率及血清降钙素、β-胶原蛋白、骨钙素水平变化.结果(1)实验组治疗总有数率(96.7%)显著高于对照组(66.7%)(P<0.01);(2)治疗后实验组心电图复查好转率、心房颤动转律率显著高于对照组(P<0.05),24 h平均心率显著低于对照组(P<0.01);(3)治疗后实验组血清游离三碘甲状腺原氨酸、游离甲状腺素水平显著低于对照组(P<0.01),促甲状腺激素水平显著高于对照组(P<0.05);(4)治疗后实验组血清降钙素、β-胶原蛋白、骨钙素水平显著低于对照组(P<0.01);(5)实验组不良反应发生率(13.3%)与对照组(20.0%)比较差异无统计学意义(P>0.05).结论放射性131碘联合甲巯咪唑片治疗甲状腺功能亢进合并心房颤动患者疗效确切,可控制心率,提高心房颤动转律率,改善甲状腺功能,纠正骨代谢异常,且安全性较高.     

Autoantibodies to thyroxin and triiodothyronine

Two clinically euthyroid patients with multinodular goiter were found to have high "free" thyroxin (Amerlex-M, Amersham and Coat-a-Count, DPC) and triiodothyronine (Amerlex-M) concentrations (FT4 and FT3, respectively). The presence of antibodies to T4 and T3 was confirmed by the finding that polyethylene glycol precipitated a far greater proportion of radioactivity when radiolabeled FT4 or FT3 analog (Amerlex-M) was incubated with serum from these patients than was true for normal subjects. With this method we could not demonstrate antibodies to thyroid hormones in 116 healthy volunteers. Of 101 hyperthyroid patients tested, one had antibodies to T4 but none had antibodies to T3. One patient had antibodies to T4, and one to T3, of 36 hypothyroid patients tested. All patients with thyroid hormone antibodies also demonstrated antithyroglobulin antibodies (measured immunoradiometrically). Evidently, the presence of thyroid hormone antibodies should be suspected when results of thyroid-function tests are discordant with the clinical state, and we suggest that measurement of thyrotropin by an assay with improved detection limits will aid in correctly determining thyroid status.     

甲巯咪唑治疗Graves病的临床疗效及预后研究

目的探讨甲巯咪唑治疗Graves病的临床疗效,分析影响Graves病的复发因素。方法选择186例Graves病患者为研究对象,均予甲巯咪唑进行治疗,根据用药后的治疗效果将患者分为缓解组、复发组和未停药组。采用化学发光法检测血清游离甲状腺素3（FT3）、游离甲状腺素4（FT4）、敏感促甲状腺激素（sTSH）、抗甲状腺球蛋白抗体（TgAb）、抗甲状腺过氧化物酶抗体（TPOAb）,采用酶联免疫吸附测定（ELISA）法检测抗促甲状腺素受体抗体（TRAb）,采用ELISA双抗体夹心法检测CXC趋化因子配体10（CXCL10）。采用Logistic回归分析Graves病的复发因素。结果缓解组患者血清FT3、FT4、TgAb、TPOAb、TRAb及CXCL10明显低于复发组和未停药组（P〈0.05）,sTSH明显高于复发组和未停药组（P〈0.05）。甲状腺大小、TRAb水平及FT3/FT4值为治疗后复发的危险因素（P〈0.05）。结论甲硫咪唑可在一定程度上缓解Graves病的症状,但发病初甲状腺明显肿大、TRAb水平高、FT3/FT4比值高的患者,停药后复发风险较大。     

甲巯咪唑对甲状腺功能亢进症患者甲状腺激素水平及肝功能的影响研究

目的探讨分析甲巯咪唑对甲状腺功能亢进症患者甲状腺激素水平及肝功能的影响。方法前瞻性选择2016年1月至2019年1月在四川省林业中心医院就诊的86例甲状腺功能亢进症患者为研究对象,按随机数字表法分为研究组(n=43)与对照组(n=43)。其中对照组予以丙硫氧嘧啶治疗,研究组予以甲巯咪唑治疗。观察比较2组患者的临床疗效、治疗前和治疗后12个月的甲状腺激素[总三碘甲腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)]水平变化及肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBIL)]指标变化情况、肝功能损伤发生率与发生时间。结果研究组总有效率为95.35%,明显高于对照组的83.72%,差异有统计学意义(P<0.05)。2组患者治疗前的甲状腺激素和肝功能指标水平比较,差异无统计学意义(P>0.05)。研究组治疗后12个月的TT3、TT4、FT3、FT4水平分别为(1.92±0.51)nmol/L、(120.58±10.26)nmol/L、(5.26±1.33)pmol/L、(17.35±3.84)pmol/L,均明显低于对照组[(2.73±0.62)nmol/L、(149.35±13.62)nmol/L、(9.25±1.89)pmol/L、(21.87±4.36)pmol/L],而TSH(2.84±0.75)nmol/L明显高于对照组(2.32±0.53)nmol/L,差异有统计学意义(P<0.05)。研究组治疗后12个月的ALT、AST、ALP、TBIL水平分别为(45.26±7.33)U/L、(50.22±6.96)U/L、(150.34±26.34)U/L、(16.03±3.98)μmol/L,均明显低于对照组[(54.66±8.24)U/L、(59.64±7.15)U/L、(181.42±28.45)U/L、(21.39±4.13)μmol/L],差异有统计学意义(P<0.05)。研究组肝功能损伤发生率为9.30%,明显低于对照组的18.60%(P<0.05);肝功能损伤发生时间为(20.64±4.26)d,明显早于对照组的(38.25±6.39)d(P<0.05)。结论与丙硫氧嘧啶相比,甲巯咪唑治疗甲状腺功能亢进症疗效确切,可有效改善甲状腺激素水平,且对肝功能的影响小,肝功能损伤发生率低,但肝功能损伤发生时间较早。     

The non-thyroidal illness syndrome after coronary artery bypass grafting: a 6-month follow-up study.

The non-thyroidal illness syndrome (NTIS) is considered a transient and completely reversible phenomenon, but it has been shown that it may last for several days postoperatively after coronary artery bypass grafting (CABG) surgery. This study was undertaken to assess thyroid function 6 months after uncomplicated CABG. The thyroid profile was evaluated in 40 consecutive patients undergoing CABG preoperatively, at 0, 12, 48, and 120 h postoperatively, and at 6-month follow-up. Triiodothyronine (T3), free T3 (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were assayed using a microparticle enzyme immunoassay. T4 and total serum thyroid hormone-binding capacity (T-uptake) were measured on the same samples using a fluorescence polarization immunoassay. Patients with severe systemic illness and patients treated with amiodarone were excluded. All patients were euthyroid at admission. Mean age was 67.4+/-9.0 years. There were 31 (77.5%) men. Typical NTIS was observed in all patients, and the FT3 concentration was still reduced by postoperative day 5 (p<0.0001). At 6-month follow-up, all patients were free from cardiac symptoms, and no new cardiac events were recorded. The thyroid profile was normal in 35 patients (87.5%). One patient (4.5%) had developed overt hypothyroidism. Two patients had isolated low T3 and FT3 levels with normal TSH. Two patients had moderately increased FT3 levels with suppressed TSH. In most uncomplicated patients, thyroid function returns to normal 6 months after CABG. However, we observed significant alterations of the thyroid profile in 5 out of 40 patients. Further studies are needed to define the long-term consequences of postoperative NTIS.     

Free thyroxin index and direct measurements of free thyroxin compared for evaluating postpartum autoimmune thyroid dysfunction

Measurement of free thyroxin (FT4) by a recently introduced commercial assay (Amerlex Free T4 RIA) was compared with the calculated free thyroxin index (FT4I) for serum from 104 postpartum women. Of these, 63 had transient thyroid dysfunction due to autoimmune thyroiditis, six had transient Graves' thyrotoxicosis, and 35 were euthyroid with no signs of autoimmune thyroid disease. The correlation between results for FT4 and the calculated FTI for 95 serum samples from women with no signs of autoimmune thyroiditis (r = 0.941; p = 0.0001) was almost identical to that for 270 serum samples from women with thyroid microsomal autoantibodies characteristic of autoimmune thyroiditis (r = 0.937; p = 0.0001). Furthermore, we observed no difference when the autoimmune group was subdivided according to low or high titers of thyroid microsomal antibodies. In no case did autoantibodies to thyroxin interfere with the FT4 assay. However, one woman had a spuriously low value for FT4I owing to interference by autoantibodies to triiodothyronine with the triiodothyronine resin uptake test. We conclude that the FT4 RIA assay provided diagnostic information in this group of postpartum women equivalent to that of the more elaborate procedure of determining FT4I.     

血清25-(OH)D3与自身免疫性甲状腺疾病体液免疫的相关性

目的:探讨自身免疫性甲状腺疾病(AITD)患者血清中25-(OH)D3与健康人群有无差异,及25-(OH)D3与AITD患者体液免疫紊乱之间的关系.方法:选取Graves病(GD)50例、桥本甲状腺炎(HT)30例,健康人20例,检测样本血清25-(OH)D3、甲状腺自身抗体(TSAb、TGAb、TPOAb)及甲状腺功能,并对25-(OH)D3水平与其他检测指标进行相关分析.结果:GD组及HT组25-(OH)D3均显著低于对照组,GD组25-(OH)D3与TSAb、FT3、FT4呈负相关,与TSH呈正相关;HT组25-(OH)D3与TGAb、TPOAb、TSH呈负相关,与FT3、FT4呈正相关.结论:AITD患者存在低25-(OH)D3血症,与患者的体液免疫紊乱密切相关.     

131I治疗中重度甲状腺肿伴甲状腺功能亢进的效果观察

目的 （1）观察131I治疗中重度甲状腺肿伴甲状腺功能亢进（甲亢）的效果;（2）治疗前抗甲状腺药物（ATD）他巴唑（MMI）、丙基硫氧嘧啶（PTU）对131I疗效的影响.方法 选择在我院接受131I治疗的甲状腺质量≥40 g Graves甲亢患者338例,治疗前测定甲状腺功能、甲状腺吸131I率和甲状腺显像.治疗后1～3个月复查甲状腺功能,随访时间6个月至4年.结果 甲亢131I治疗后3个月血清游离三碘甲状腺原氨酸（FT3）从（31.9±16.2）pmol/L下降至（7.8±8.5）pmol/L（t=23.9,P=0.000）;游离甲状腺素（FT4）从（58.8±22.2）pmol/L下降至（19.4±16.9） pmol/L（t =25.4,P=0.000）,治疗前、后比较差异均有统计学意义.131I治疗后甲低、临床治愈、部分缓解、无效、复发率分别为32.2％、26.9％、26.9％、5.9％、8.0％,总有效率为94.1％.治疗有效组甲状腺质量、血清FT3、FT4、甲状腺球蛋白抗体（TGA）、甲状腺微粒体抗体（MCA）分别为（49.8±9.9）g、（32.5±16.3） pmol/L、（59.5±22.2） pmol/L、（43.6±35.3）％、（30.1±22.6）％,而治疗无效组分别为（56.9±15.7）g、（22.8±12.8）pmol/L、（47.9±20.3）pmol/L、（22.8±30.0）％、（15.3±20.5）％,两组比较差异均有统计学意义（t值分别为2.932、2.602、2.287、2.501、2.766,P值分别为0.000、0.010、0.023、0.013、0.006）.Logistic回归分析表明,甲状腺质量、血清H3浓度是影响疗效的主要因素.结论 131I治疗中重度甲状腺肿伴甲亢安全、疗效好;治疗前使用ATD对治疗效果无明显影响.FT3、甲状腺质量是影响治疗效果的关键因素.     

Preoperative plasmapheresis experience in Graves’ disease patients with anti-thyroid drug-induced hepatotoxicity

Hepatotoxicity is a rare but serious side effect of antithyroid drug (ATI) therapy in Graves’ disease patients. Cessation of ATI drug is needed in most of the patients if liver enzymes highly elevated or in case of agranulocytosis. Permanent therapy, surgery or radioactive iodine ablation are the treatment choices to ensure euthyroidism in active Graves’ disease patients.Therapeutic plasma exchange (TPE) can be an option to ensure euthyroidism, especially in patients scheduled for urgent surgery. In the present study, we present consecutive five cases of methimazole related severe hepatotoxicity that underwent TPE before thyroid surgery. The median number of apheresis sessions was 3 (range: 2–5). Free triiodothyronine (FT3) 65–83 %, free thyroxine (FT4) 22–66 %, thyrotropin receptor antibodies (TRAB) 55–96 % decreases were observed. All patients underwent total thyroidectomy. TPE is an effective method to reduce serum FT3, FT4, TRAB levels in the short term to provide better thyroid hormone status before urgent surgery in ATI induced toxic hepatitis patients.     

Reference intervals for thyroid hormones on the architect analyser.

The objective of this study was to establish reference intervals for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyronine (TT4) and total triiodothyronine (TT3) on the Architect i2000 analyser (Abbott). Serum samples were obtained from apparently healthy adults (n=217, age 18-90 years) excluding individuals taking oral contraceptives or under hormone replacement therapy. The second group were ambulatory euthyroid patients (n=323) excluding those with a history of thyroid disorders. We also investigated thyroid hormones in sera from euthyroid hospitalised patients (n=490) excluding those with severe non-thyroidal illness. The reference intervals for the healthy adults were for TSH 0.17-4.23 mIU/l, for FT4 11.24-26.86 pmol/l, for FT3 2.56-6.36 pmol/l, for TT4 55.8-155.1 nmol/l and for TT3 0.90-2.54 nmol/l. TSH and TT3 concentrations were similar in males and females. However, FT4, FT3 and TT4 levels exhibited significant differences between females and males. No significant differences were observed between the concentrations of TSH, FT3, TT3, FT4 and TT4 in healthy subjects and in euthyroid ambulatory patients aged 18-90 years. TSH levels in healthy subjects were the same in younger and older individuals. In contrast, in outpatients and in hospitalised patients TSH concentrations were significantly lower (20%) in subjects older than 50 years compared to those younger than 50 years. For FT3 and TT3 we consistently observed in all three study groups 6-7% and 8-12% higher concentrations in the younger (< 50 years) compared to the older (> 50 years) subjects. For FT4 and TT4 no consistent pattern of correlation with age was detectable when the three study groups were analysed independently. The reference intervals for thyroid hormones determined in this study differ considerably from values found in other European and non-European countries. This underlines the need for population-specific reference ranges.     

Performance of direct equilibrium dialysis and analogue-type free thyroid hormone assays, and an immunoradiometric TSH method in patients with thyroid dysfunction

Direct equilibrium dialysis and analogue-type radio-immunoassays for free triiodothyronine (FT3) and free thyroxine (FT4) in serum were compared in 168 subjects with various states of thyroid function. A good diagnostic efficacy for FT3 and FT4 by either type of assay was observed in hyperthyroidism. In hypothyroidism the free thyroid hormone assays, particularly the FT3 assays, performed diagnostically less well, partly because patients with mild disease were included in the study. No significant differences in the percentages of misclassifications of thyroid dysfunction patients by corresponding dialysis and analogue assays were found. We observed a good linear correlation between dialysis and analogue methods for FT3 (r = 0.98) and FT4 (r = 0.97) in this study comprising out-patients not suffering from severe non-thyroidal disease, known from earlier studies in this and other laboratories to interfere in these assays. It is concluded that analogue assays may be used on out-patients in whom severe systemic diseases are less frequent than in hospitalized patients. There are, however, other limitations to the use of analogue assays than systemic diseases. We observed two euthyroid patients with thyroxine auto-antibodies causing very high FT4 concentrations as determined by analogue assay; their dialysable FT4 concentrations were normal. We also tested a recently developed immunoradiometric serum TSH assay, which was found to perform well in primary hypo- and hyperthyroidism. Serum TSH was elevated in one patient hyperthyroid because of a TSH-producing pituitary adenoma, and within the reference limits in a patient with secondary hypothyroidism.     

儿童甲状腺功能亢进症的临床治疗

目的探讨儿童甲状腺功能亢进症的治疗措施及临床效果。方法对入选的200例儿童甲状腺功能亢进症患儿给予甲巯咪唑0.5～1.0mg/（kg·d）、盐酸普萘洛尔0.3mg/（kg·d）治疗,2～4个月待患儿甲状腺功能基本恢复正常后,将患儿随机分为对照组（n=100）及研究组（n=100）。对照组只给予甲巯咪唑治疗,研究组则继续给予甲巯咪唑并联合左甲状腺素钠治疗。比较治疗前和治疗后6个月、1年及2年患儿甲状腺体积,FT4、FT3和TSH水平,观察治疗后2年不良反应发生情况。结果与对照组比较,治疗6个月后研究组甲状腺体积明显降低（P〈0.05）,药物性甲状腺功能减退症发生率低（P〈0.05）,不良反应少。结论两种治疗措施均能有效改善儿童甲状腺功能亢进症的高代谢症候群,使FT3、FT4及TSH水平恢复正常,甲状腺体积明显降低,但甲巯咪唑联合左甲状腺素钠治疗能更安全有效地控制甲状腺肿大及药物继发性甲状腺功能减退症,并能减少症状复发。     

血清IL-10和IL-12在自身免疫性甲状腺疾病中的表达特征

目的：研究自身免疫性甲状腺疾病中血清白细胞介素－10（IL－10）和白细胞介素－12（IL－12）的表达特征及其在免疫反应发生中的作用和机制。方法：对38例Graves病（GD）患者（18例未治疗的初诊患者，为GDa组；20例抗甲亢药物治疗的患者，为GDb组）、24例慢性淋巴细胞性甲状腺炎（HD）患者及22例正常者（对照组）检测了血清中IL－10，IL－12的表达水平及甲状腺功能的变化。IL－10和IL－12采用酶联免疫法（ELISA）测定。血清游离T3（FT3），游离T4（FT4）和促甲状腺激素（TSH）测定用化学发光免疫分析法。抗甲状腺球蛋白抗体（TgAb)和抗甲状腺微粒体抗体（TmAb)用放射免疫法。结果：GDa组的IL－10、IL－12均高于对照组（P＜0．05，P＜0．01），但以IL－12的增高占优势，IL－12／IL－10比值增高（P＜0．05）。GDb组的IL－12水平和IL－12／IL－10比值较GDa组显著降低（P＜0．05，P＜0．01），与对照组比较无显著差异。IL－10水平较GDa组有上升趋势但无统计学意义，但高于对照组（P＜0．01），HD患者IL－12水平和IL－12／IL－10比值均较对照组增高（P＜0．01，P＜0．01），较GDb组也显著增高（P＜0．05，P＜0．01），IL－10水平与对照组比较无显著差异，但显著低于GDb组（P＜0．05）。结论：GD患者，在甲状腺功能亢进状态时，由Thl细胞产生的IL－12水平和低表Th2细胞活力的IL－10水平均明显增高，提示Th1和Th2的表达均增高，细胞免疫和体液免疫均参入了甲亢的自身免疫反应过程。在HD患者也有IL－12水平的显著增高，表明了Th1细胞因子所介导的细胞免疫在HD的病理反应中起主导作用。在GD和HD患者，均表现有IL－12／IL－10比值的变化，提示Th1/Th2间的平衡紊乱可能对介导甲状腺自身免疫炎症反应的产生起关键作用。     

Use of an artificial neural network to predict Graves' disease outcome within 2 years of drug withdrawal

BACKGROUND: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism, which can relapse in many patients after antithyroid drug treatment withdrawal. Several studies have been performed to predict the clinical course of GD in patients treated with antithyroid drugs, without conclusive results. The aim of this study was to define a set of easily achievable variables able to predict, as early as possible, the clinical outcome of GD after antithyroid therapy. METHODS: We studied 71 patients with GD treated with methimazole for 18 months: 27 of them achieved stable remission for at least 2 years after methimazole therapy withdrawal, whereas 44 patients relapsed. We used for the first time a perceptron-like artificial neural network (ANN) approach to predict remission or relapse after methimazole withdrawal. Twenty-seven variables obtained at diagnosis or during treatment were considered. RESULTS: Among different combinations, we identified an optimal set of seven variables available at the time of diagnosis, whose combination was useful to efficiently predict the outcome of the disease following therapy withdrawal in approximately 80% of cases. This set consists of the following variables: heart rate, presence of thyroid bruits, psycological symptoms requiring psychotropic drugs, serum TGAb and fT4 levels at presentation, thyroid-ultrasonography findings and cigarette smoking. CONCLUSIONS: This study reveals that perceptron-like ANN is potentially a useful approach for GD-management in choosing the most appropriate therapy schedule at the time of diagnosis.     

Endocrine effects of organophosphate antidotal therapy

To determine the endocrine effects of the treatment of organophosphate poisoning, this prospective study was conducted in a university-based emergency department among patients with a history and clinical findings compatible with those of organophosphate poisoning. Thyrotrophin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), progesterone (PRG), adrenocorticotropic hormone (ACTH), cortisol, and testosterone (TST) levels were analyzed before and after treatment with atropine and pralidoxime. The Wilcoxon’s sign rank sum (nonparametric) test was used to compare dependent variables before and after treatment. A total of 44 patients (19 male; mean age: 28.5±12.6 y) were enrolled in the study. Patients were hospitalized for 5.4±1.3 days. Posttreatment ACTH, cortisol, PRL, FT3, FSH, and PRG levels were significantly lower than pretreatment levels (P<.05). The decrease in TSH, LH, and TST levels did not reach statistical significance, while FT4 levels increased following the treatment (P<.05). Six patients were diagnosed on admission with sick euthyroid syndrome, and 11 patients who were euthyroid on admission developed sick euthyroid syndrome following treatment. ACTH, cortisol, PRL, FT3, FT4, FSH, and PRG levels are affected by acute organophosphate poisoning. The change in hormone levels may result from the effects of neurotransmitters, from the direct effect of the toxic agent, or from stress associated with events leading to the poisoning incident.     

药物治疗对Graves病甲亢患者血清脂联素表达水平的影响

目的对药物治疗Graves病甲亢患者后血清脂联素水平的变化情况进行分析研究。方法选择108例Graves病甲亢患者为研究对象,将其分成GD1和GD2两个亚组,GD2组患者接受甲亢药物治疗;另取同期来我院行健康检查的50例体检健康者为健康对照组,全面探究Graves病甲亢患者治疗前后血清脂联素水平的变化情况。结果血清脂联素水平变化:和健康对照组相比,GD1组患者较高,GD2组较低,各组数据之间的差异具有统计学意义(P0.05)。TSH水平变化:GD组患者比对照组低,GD1组的TSH水平低于GD2组(P0.05)。FT3水平变化:和健康对照组相比,GD两个亚组患者均显著升高,且GD1组高于GD2组(P0.05)。FT4水平变化:和健康对照组相比,GD1组患者血清FT4水平显著升高(P0.05);GD2组的FT4水平稍低(P0.05)。各组血清脂联素水平和TSH呈负相关,和FT4,FT3为正相关,与其余基线资料不存在相关性。结论 Graves病甲亢患者脂联素水平上升,在经过药物治疗之后,其水平下降且低于健康体检组,同时与甲状腺激素水平保持相关性,这说明脂联素水平受甲状腺激素调控。     

Diagnostic performance of sensitive measurements of serum thyrotropin during severe nonthyroidal illness: their role in the diagnosis of hyperthyroidism

Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.