Lingual thyroid with severe hypothyroidism: A case report

Introduction:Ectopic thyroid tissue presenting at the base of the tongue, called lingual thyroid, is a clinical rarity. Clinical presentation varies depending upon either the severity of regional symptoms associated with the enlargement of gland size, or the features related to thyroid dysfunction.Patient concerns:We reported a case of a 29-year-old female who presented with symptoms of easy fatigue and depression for 3 months.Diagnosis:After a series of diagnostic workup, the lingual thyroid with severe hypothyroidism was diagnosed.Intervention and outcome:She received conservative treatment with thyroid hormone replacement and the symptoms improved significantly.Lessons:Lingual thyroid is a rare entity that needs careful diagnostic workup including clinical examination, biochemical tests, imaging methods such as ultrasonography, scintigraphy, computed tomography, magnetic resonance imaging, and fine-needle aspiration cytology to plan the management. Lingual thyroid with hypothyroidism and no neck regional symptoms can be conservatively treated and requires regular follow-up for the prevention of potential risk of malignant transformation.     

开展亚临床甲状腺功能减退症的临床研究

亚临床甲状腺功能减退症 (甲减 )是一种常见的内分泌专业亚临床疾病 ,主要诊断依据是血清TSH水平增高 ,而血清FT4正常。亚临床甲减的主要不良后果是发展为临床甲减和促进缺血性心脏病的发生。影响亚临床甲减发展为临床甲减的主要因素有两个 :血清TSH水平和甲状腺自身抗体 ,两个因素有叠加作用。甲状腺激素替代治疗对于阻止亚临床甲减发展为临床甲减的效果尚不确切 ;亚临床甲减与高胆固醇血症、高血压、吸烟和糖尿病一样 ,构成动脉粥样硬化和心肌梗塞的独立危险因素 ,其对此两病的危险度分别为 1.9和 3 .1。甲状腺素纠正亚临床甲减对降低血清胆固醇有一定效果 ;妊娠妇女的亚临床甲减对后代的智力影响已经引起高度关注。我国一组根据对流行病学调查的结果 ,提出了血清TSH、甲状腺自身抗体 (TPOAb、TgAb)的正常值范围 ,以及与疾病相关的甲状腺自身抗体的切割点值 ,可供参考。     

慢性淋巴细胞性甲状腺炎

慢件淋巴细胞件甲状腺炎于1912年由日本学者首先报道,属于最常见的自身免疫性甲状腺疾病,也是甲状腺功能减退(甲减)最主要的病因,好发于中老年女性.患者起病隐匿,常无特征性的临床表现,容易漏诊.本病诊断尚缺乏国际统一标准,主要依靠一些非特异性的症状与体征,尤其是甲状腺肿大、甲状腺功能减退,并结合相应的辅助检查.如甲状腺自身抗体阳性,且滴度较高,对诊断意义更大.甲状腺穿刺细胞学检查不作为常规项目,但对诊断困难者具有确诊价值.伴有甲减者,需要常规采用替代治疗,尤其是甲状腺肿大明显者、孕妇以及儿童可以给予左旋甲状腺素替代治疗,但仅有亚临床甲减者,或甲状腺功能正常而甲状腺自身抗体阳性的患者是否需要治疗尚存在争议.     

Ectopic lingual thyroid tissue and acquired hypothyroidism: case report

Ectopic thyroid tissue with thyroid gland in its normal location is an extremely rare phenomenon. We present a case of a 38-year-old woman who was referred to our hospital with symptoms of hypothyroidism. Thyroid hormone measurement revealed clinical hypothyroidism with elevated anti-thyroid antibodies, neck ultrasonography showed a small tissue with the characteristic of Hashimoto thyroiditis, while the scintigraphy demonstrated only a lingual thyroid. Treatment consisted in L-thyroxine replacement to the euthyroid state. We reviewed the literature with respect to the embryological background and the clinical management of such cases.     

合并2型糖尿病的甲状腺疾病的管理

甲状腺疾病和2型糖尿病是内分泌代谢性疾病中最常见的两种疾病.糖尿病对甲状腺疾病会产生影响,糖尿病急症或严重感染可能会诱发甲状腺危象;甲状腺疾病及抗甲状腺药物或糖皮质激素等另一方面又影响到糖代谢,导致血糖波动甚至心血管风险增加,故合并2型糖尿病的甲状腺疾病患者病情较复杂.文章就合并2型糖尿病的甲状腺疾病包括甲状腺功能亢进...     

Pericardial effusion associated with subclinical hypothyroidism

Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Subclinical hypothyroidism is defined by elevated serum levels of TSH with normal levels of free thyroid hormones. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. It has been reported that sub-clinical hypothyroidism is associated with both, a significant risk of coronary heart disease at baseline and at follow-up and that mortality from cardiovascular causes is significantly higher at follow-up. However subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications. Pericardial effusion can be present in systemic disorders including hypothyroidism. We present a case of subclinical hypothyroidism in a 41-year-old Italian woman with an ubiquitary pericardial effusion. Also this case focuses attention on subclinical hypothyroidism.     

合肥市全民食用碘盐前后儿童甲状腺功能研究

目的 为获得全民食盐加碘前合肥市儿童垂体－甲状腺功能状态本底资料和食盐加碘后的影响情况。为城市碘盐的合理实施提供实验依据。方法 以２６４４（前）、２３９５（后）名７～１４岁儿童为基础,以８～１０岁儿童３为中心完成垂体－甲状腺功能多指标、多学科的综合对比研究。结果 发现食盐加碘前ＴＲＨ－ＳＴ ６０ｍｉｎ高于０ｍｉｎ３～４倍,ＥＴ４均值５．９ｍｐｏｌ／Ｌ、Ｔｇ均值１３．４μｇ／Ｌ均高于正常值上限。甲状     

糖尿病住院患者434例甲状腺疾病患病率分析

目的 探讨江苏地区糖尿病患者中甲状腺疾病的现患情况.方法 横向断面调查2006年10月至2007年6月于南京医科大学第一附属医院就诊的长期居住于江苏地区的434例糖尿病患者的甲状腺功能,其中109例患者作了甲状腺超声检查.结果 (1)糖尿病患者合并甲状腺疾病的患病率为23.27%,女性多见(P＜0.05),其中甲状腺功能减退者占16.36%(临床甲减4.15%,亚临床甲减12.21%),明显高于甲状腺功能亢进者6.91%(临床甲亢4.61%,亚临床甲亢2.30%),两者差异有统计学意义.(2)糖尿病患者中,甲状腺功能减退的患病率随患者年龄和糖尿病病程的增加而增加(P＜0.01);甲状腺功能亢进的患病率随糖尿病痛程的增加而降低(P＜0.05),随年龄的增加患病率改变无统计学意义.(3)糖尿病患者中甲状腺结节患病率为40.37%,性别差异无统计学意义,患病率随年龄的增加而增加(P＜0.05),不随糖尿病痛程的增加而增加.结论 糖尿病患者合并甲状腺疾病较常见,可能影响糖尿病患者的病情和预后,筛查和随访糖尿病患者的甲状腺功能及形态学状态具有重要的临床意义.     

甲状腺功能减退症的诊治

甲状腺功能减退症（甲减）是由多种原因引起的甲状腺激素合成、分泌或生物效应不足所致的一种全身代谢减低综合征。原发性甲减是其中最常见的类型,主要由自身免疫甲状腺炎如桥本病所致,其他原因包括由于中枢促甲状腺激素释放激素（TRH）或促甲状腺激素（TSH）不足、甲状腺手术或放射性碘治疗导致的甲减。甲状腺激素的测定,包括TSH和游离甲状腺素（FT4）等,是甲减诊断的主要手段。甲减的诊断可分为临床（TSH高,FT4低）或亚临床甲减（TSH高,FT4正常）。甲减治疗的目的是纠正甲状腺功能不足,减轻症状,避免进展至粘液性水肿。甲减通常采用合成的左甲状腺素治疗。尽管典型甲减的诊断、治疗在临床上较为简单,但有相当部分患者治疗并未达到最优化,即使甲状腺功能指标正常仍感觉生活质量较差。本文简述了甲减的病因、分类、诊断和治疗。对部分患者治疗效果不佳的可能原因及优化措施亦进行了讨论。     

Progressive systemic sclerosis and Graves' disease. Report of three cases

Progressive systemic sclerosis (PSS) is associated with a broad spectrum of autoimmune thyroid diseases. While an association between PSS and hypothyroidism is well established, a relationship between PSS and hyperthyroidism is less well defined. We treated three patients with PSS whose course was complicated by Graves' disease. Because hyperthyroidism can simulate many of the symptoms of PSS progression and treatment of hyperthyroidism can lead to resolution of clinical deterioration in such patients, it is important to recognize the simultaneous occurrence of these diseases.     

Modification of nonspecific bronchial reactivity in hypothyroid children under different regimens of substitutive opotherapy

Although it has been experimentally proved that thyroid hormones stimulate beta 2 receptor activity and tissue responsiveness to catecholamines, previous studies have established that asthma and nonspecific bronchial reactivity (NSBR) can worsen if complicated by hyperthyroidism. Our study is an effort toward the analysis of this contradiction. In 20 congenitally hypothyroid children, substitutive opotherapy was completely withdrawn for 1 month, resumed in the original dosage for 2 months, and then increased by 20% from day 91 to day 110. Mean NSBR, expressed in carbachol-related PD20-FEV1 and PD25-V25, was significantly increased by day 30, remained significantly elevated by day 90, and returned to initial values by day 110. These results suggest that thyroid hormones per se in nonasthmatic subjects decrease bronchial reactivity. This observation should be taken into consideration when attempting to explain the worsening condition of asthmatics who became affected with hypothyroidism. Bronchial reactivity appears to be under the control of many factors (including thyroid hormone levels). Once it is altered, a period of time seems necessary to restore the original bronchomotor tone (2 months in our study).     

Synchronous occurrence of papillary carcinoma in the thyroid gland and thyroglossal duct in an adolescent with congenital hypothyroidism

Thyroid carcinoma (TC) combined with congenital hypothyroidism is rare. The synchronous occurrence of these two conditions is even rarer. We describe a patient with congenital hypothyroidism in whom hyperthyroglobulinemia and nodules developed despite adequate replacement therapy. Papillary TC was detected at age 19 years. Postoperative diagnostic scintigraphy showed increased uptake in the thyroglossal duct region. Repetitive imaging of the thyroid gland can be useful in the early detection of TC in patients with congenital hypothyroidism. Moreover, this rare situation can be complicated by a synchronous thyroglossal duct carcinoma. Thyroglossal duct carcinoma can be detected if diagnostic scintigraphy is performed after total thyroidectomy.     

Thyroid disease in pregnancy

Thyroid diseases are common in women of childbearing age and it is well known that untreated thyroid disturbances result in an increased rate of adverse events, particularly miscarriage, preterm birth and gestational hypertension. Furthermore, thyroid autoimmunity per se seems to be associated with complications such as miscarriage and preterm delivery. While strong evidence clearly demonstrates that overt dysfunctions (hyper- or hypothyroidism) have deleterious effects on pregnancy, subclinical disease, namely subclinical hypothyroidism, has still to be conclusively defined as a risk factor for adverse outcomes. Additionally, other conditions, such as isolated hypothyroxinemia and thyroid autoimmunity in euthyroidism, are still clouded with uncertainty regarding the need for substitutive treatment.     

钠碘转运体与甲状腺疾病

钠碘转运体(NIS)为甲状腺滤泡上皮细胞基底膜上的一类膜蛋白，主要作用是促进甲状腺逆浓度梯度转运无机碘，NIS受促甲状腺激素、碘、多种细胞因子及其他一些激素的调节。NIS与自身免疫性疾病、先天性甲状腺功能低下、甲状腺肿瘤的发生密切相关，对其进行深入研究对甲状腺疾病的治疗具有重要的临床价值。     

Diffuse amyloid deposition in thyroid gland: a cause for concern in familial Mediterranean fever

Thyroid gland is among the many organs that could be infiltrated in systemic amyloidosis. However, diffuse infiltration of the thyroid gland secondary to systemic amyloidosis associated with Familial Mediterranean fever (FMF) is rare. Here, we present a 49-year-old woman diagnosed with FMF and systemic amyloidosis, who had a large goiter and multiple nodules that developed slowly through the years and was complicated by tracheal compression symptoms and a mild thyroid dysfunction. Multiple fine needle aspiration biopsies of the nodules and the thyroid parenchyma revealed amyloid deposits. We would like to point out that amyloidosis may have a significant impact on the thyroid gland and fine needle aspiration biopsy is a valuable tool for diagnosis.     

Clinical associations of maternal thyroid function with foetal brain development: Epidemiological interpretation and overview of available evidence

Thyroid hormone is an important regulator of early brain development, particularly during early stages of gestation during which foetal thyroid hormone availability depends on the maternal transfer of thyroid hormones. There is a wide range of experimental studies showing that low maternal thyroid hormone availability is associated with suboptimal brain development parameters. While few clinical studies have shown that overt maternal hypothyroidism is associated with lower child IQ, the question whether more subclinical changes in maternal thyroid function could also lead to suboptimal foetal brain development. In this review, we put the latter studies in perspective and discuss their interpretation from an epidemiological and clinical perspective. Furthermore, we extend this discussion to also include future perspective and identify important knowledge gaps in the field.     

Five‐year incidence and progression of thyroid dysfunction in an older population

Background: Very few studies have assessed both the incidence and progression of thyroid dysfunction in a single older population‐based cohort. In this study, we aimed to assess the 5‐year incidence, progression and risk factors for development of thyroid dysfunction in an older Australian population. Methods: The Blue Mountains Eye Study is a longitudinal population‐based cohort study. During 1997–1999, 1768 participants (≥55 years) had thyroid function assessed. After excluding participants reporting any form of treatment for their thyroid condition at baseline, 951 participants (91.4%) without thyroid dysfunction and 54 (5.4%) with thyroid dysfunction were re‐examined 5 years later. Thyroid dysfunction was defined using serum thyrotropin (thyroid stimulating hormone (TSH)) screen, followed by serum free T4 assessment. Results: The overall 5‐year incidence of thyroid dysfunction was 4.7% (95% confidence interval (CI) 3.4–6.1). Obesity (body mass index ≥ 30 kg/m²) and serum TSH > 2 mIU/L at baseline predicted incident overt hypothyroidism (odds ratio (OR) 4.05, CI 1.74–9.41) and (OR 5.46, CI 1.16–25.67) respectively. The 5‐year incidence of subclinical hypothyroidism was significantly higher in women than in men, 2.5% versus 0.7% (P= 0.03). Progression to overt hypothyroidism was observed in 17.9% of subjects with subclinical hypothyroidism over 5 years. Conclusions: The 5‐year incidence of thyroid dysfunction in this older population was relatively low, and was associated with obesity and serum TSH level > 2 mIU/L at baseline. Over one in six persons with subclinical hypothyroidism progressed to overt thyroid dysfunction over the 5‐year period. Our findings highlight the need for appropriate management of subclinical hypothyroidism among older people.     

老年人甲状腺功能异常与心血管疾病

甲状腺功能异常与心血管疾病密切相关。老年人促甲状腺激素分布曲线向高水平方向偏移,因此,需应用年龄特异的参考范围判断甲状腺功能状态。近来,亚临床甲状腺疾病日益得到重视。研究表明亚临床甲状腺功能亢进（亚甲亢）可引起心脏结构和功能的改变,可引起房颤的发生率增加。而亚临床甲状腺功能减退（亚甲减）可能是心力衰竭、缺血性心脏病、全因死亡的一个潜在危险。异常甲状腺功能经纠正后,与甲亢和甲减相关的心血管疾病可得到缓解。基于老老年患者中亚临床甲减可能有保护作用,因此,亚临床甲状腺功能异常对心血管疾病的影响以及何种患者经过治疗可以获益,需要更多的循证医学的证据用以指导临床实践。     

Neuropsychiatric aspects of hypothyroidism and treatment reversibility.

Thyroid hormone has important actions in the adult brain, and it is well accepted that hypothyroidism is associated with neuropsychiatric complaints and symptoms. Neuropsychiatric symptoms refer to a spectrum of emotional and cognitive problems that are directly related to changes in the brain secondary to multiple factors, including the direct effects of thyroid disease, as well as hormone deprivation in brain tissue. Hypothyroidism impacts aspects of cognitive functioning and mood. More severe hypothyroidism can mimic melancholic de-pression and dementia. Neuropsychiatric symptoms tend to improve with treatment and normalization to a euthyroid state, though the pattern is inconsistent and complete recovery is uncertain. The degree to which mild hypothyroidism, or subclinical hypothyroidism (SCH), impacts mood and cognitive functions and whether these symptoms respond to treatment, remains controversial. Most studies support a relationship between thyroid state and cognition, particularly slowed information processing speed, reduced efficiency in executive functions, and poor learning. Furthermore, hypo-thyroidism is associated with an increased susceptibility to depression and reductions in health-related quality of life. Controlled studies suggest that cognitive and mood symptoms improve with treatment, though the data are equivocal and limited by diverse methodologies. Functional neuroimaging data provide support for the mood and cognitive findings and treatment reversibility for both overt and SCH. These findings are not, however, without controversy. Recent investigations into the impact of SCH on cognition and mood, coupled epidemiological studies investigating the normal spectrum of thyroid stimulating hormone, have fueled significant debate regarding the appropriate, healthy range for TSH levels. This has led to concern over whether patients with overt hypothyroidism may be undertreated and whether SCH patients are truly out of the range of normal thyroid functioning and should be treated. The following is a review of the extant literature on the impact of hypothyroidism on cognition and mood, reversibility of symptoms, and treatment approaches. The spectrum of thyroid disease is reviewed, but mild, or subclinical, hypothyroidism is emphasized. The potential role of autoimmunity in neuropsychiatric symptoms and treatment resistance is addressed. Limitations of the current literature and future directions are discussed.     

Tissue-Specific Actions of Thyroid Hormone: Insights From Animal Models

The major developmental targets for thyroid hormone are the brain, small intestine, and bone. Clear defects in gene regulation and tissue function as a consequence of TR gene inactivation can additionally be shown in the pituitary, hypothalamus, heart, and liver. TR gene knockout models show a clear distinction between thyroid hormone requirements for development and those that are required for functions in the adult animal. T3-mediated gene repression appears especially important in a number of tissues including brain, pituitary, and the heart. Preliminary evaluation of the combined TR knockout models suggests that hypothyroidism is associated with more significant abnormalities than receptor deficiency, indicating that the repressive action of the unliganded receptor may have physiological relevance. These various animal models should be very useful to design and test thyroid hormone analogues to selectively stimulate desired thyroid hormone actions.