碘营养充足孕妇及新生儿甲状腺功能调查

目的了解食盐加碘4年后石家庄市碘营养充足孕妇及所生新生儿的甲状腺功能.方法尿碘的测定采用酸消化砷-铈接触法,血清T3、T4、FT3和FT4的测定采用放射免疫法,TSH的测定采用免疫放射法;新生儿脐血TSH的测定采用ELISA法.结果待产母亲尿碘中位数为203.3 μg/L,<100 μg/L的比率为11.1%,母亲血清T3(2.34±0.37)nmol/L均在正常范围,T4(158.22±28.19)nmol/L在正常范围的比率为70.8%,超过正常上限占29.2%,TSH(2.43±1.06)mU/L,<5 mU/L的比率为97.9%,FT3(2.61±0.47)pmol/L在正常低限占17.80%,FT4(5.50±1.57)pmol/L在正常低限仅占4.4%,其余均低于正常低限.新生儿脐血TSH中位数为1.99 mU/L,<5 mU/L的比率为90.6%.结论碘营养充足母亲所生新生儿TSH>5 mU/L的比率<10%,用非妊娠正常人的FT3、FT4正常值范围评价孕妇甲状腺功能容易造成误诊,各实验室应建立不同人群(正常人、孕妇)的甲状腺激素正常值范围.     

高龄老年人甲状腺功能检测正常参考值

目的确立80岁以上老年人甲状腺功能正常参考值：方法健康老人81名,分为A组80～89岁高龄老人52名,B组印～69岁老人29名。测定各组血清中三碘甲状腺原氨酸(TT3)、血清总甲状腺素(TT4)、血清游离甲状腺素(FT4)、血清游离三碘甲状腺原氨酸(FT3)及促甲状腺激素(TSH)的含量。结果和结论 80岁以上老年人血TT3为1.22～2．52nmol／L,TT4为59．31～152．49nmol／L,FT4为11．11～22．51pmol／L,FT3为3．28～5．75pmol／L;80岁以上老年男性TSH为0.8～4．2mU/L．女性TSH为0．7-6．1mU/L。     

原发性甲状腺功能减退性心包积液与甲状腺功能、心肌酶、胆固醇的关系

目的探讨原发性甲状腺功能减退性心包积液与甲状腺功能、心肌酶、总胆固醇的关系。方法回顾性分析90例原发性甲状腺功能减退症合并心包积液患者,进行甲状腺功能、心肌酶、总胆固醇的调查,并按有无心包积液分为2组进行比较。结果 (1)两组患者在年龄、性别构成、病程、病因上差异无统计学意义。(2)甲状腺功能减退伴心包积液组患者TT3、TT4、FT3、FT4均较无心包积液组低[(0.66±0.48)nmol/L比(1.20±0.57)nmol/L,(14.64±24.46)nmol/L比(62.22±50.67)nmol/L,(2.11±0.74)pmol/L比(3.66±2.02)pmol/L,(3.12±4.49)pmol/L比(6.37±4.78)pmol/L],而TSH较无心包积液组高[(68.85±32.05)mU/L比(46.47±39.44)mU/L,均为P<0.05]。(3)心包积液组心肌酶谱、胆固醇均较无心包积液组高(P<0.05)。(4)偏相关分析提示心包积液与TT3、TT4、FT3、FT4、TSH相关(r=-0.400,-0.467,-0.368,-0.340,0.284;均为P<0.05)。结论原发性甲状腺功能减退性心包积液与甲状腺功能严重程度有关,与年龄、病程、病因无关,同时多伴有胆固醇及心肌酶谱升高。     

水源性高碘摄入对学龄儿童甲状腺功能和甲状腺疾病的影响

目的探讨高碘摄入对儿童甲状腺功能和甲状腺抗体及甲状腺疾病的影响。方法在3个高水碘浓度的村庄对学龄儿童进行流行病学调查和样本采集。触诊甲状腺,检测饮用水碘含量和尿碘水平,测定垂体-甲状腺激素(TSH、FT3、FT4)水平和甲状腺自身抗体(TPOAb、TGAb)水平。结果 3个调查点的水碘中位数分别156.95μg/L、241.26μg/L和433.63μg/L;MUI为319.30μg/L、473.17μg/L和764.17μg/L;TSH为3.22 mU/L、4.27 mU/L和3.27 mU/L;FT3为6.00 pmol/L、5.83 pmol/L和5.96 pmol/L;FT4为17.29 pmol/L、17.62 pmol/L和16.36 pmol/L。TSH水平在水碘241.26μg/L、UI为200～299μg/L即超过适宜量情况下较高。3个调查点TSH高于正常值上限的异常率分别为18.2%、36.1%和14.7%;FT3分别为21.2%、5.6%和14.7%;TSH和FT3均无检测出低于正常值下限的。103名被检者的TGR为18.4%,发现亚甲减患者24例,亚甲减检出率为23.3%。100～199μg/L尿碘组无亚甲减患者,200～299μg/L尿碘组亚甲减检出率43.7%,≥300μg/L组的检出率20.7%。TPOAb、TGAb阳性率各为2.1%。结论水源性高碘摄入可导致高碘性甲状腺肿流行,引起部分机体甲状腺功能异常,造成亚甲减发病率升高。建议对此开展深入研究。     

老年人甲状腺激素水平的增龄性变化

目的 探讨老年患者甲状腺激素水平变化规律. 方法 对我院2011年1-8月期间做甲状腺功能检查的2433例患者进行登记、分析.按年龄分为成年组,1030例,平均(46.0±10.8)岁;老年组,848例,平均(69.5±6.3)岁;高龄组,555例,平均(83.9±3.8)岁.采用直接化学发光法测定患者血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺素(TSH).结果 成年组、老年组、高龄组血清FT3分别为(5.08±2.99)pmol/L、(4.33±1.22) pmol/L、(3.96±0.89) pmol/L,FT4分别为(19.87±10.97)pmol/L、(18.32±5.81)pmol/L、(18.58±6.71)pmol/L,TSH分别为(4.53±14.37)mU/L、(5.51±17.39)mU/L、(3.33±5.65)mU/L;成年组与老年组、高龄组比较,血清FT3(t=7.075、8.799,均P=0.000)、FT4(t=3.732、2.709,均P=0.000)、TSH(P=0.002、0.134);老年组与高龄组血清FT3(t=6.178,P=0.114)、FT4(t=0.617,P=0.665)、TSH(P=0.180).老年组、高龄组降低异常检出率FT3 (13.3％、25.8％)、FT4(2.9％、1.8％)、TSH (6.8％、12.3％),升高异常检出率FT3(3.1％、0.1％)、FT4 (8.6％、9.9％)、TSH(18.0％、15.7％),高龄组FT3、TSH降低发生率明显高于老年组(x2=39.96、15.83,均P=0.000);而老年组在FT4降低、FT3升高发生率上明显高于高龄组(x2=27.84、16.32,均P=0.000). 结论 老年人甲状腺激素异常检出率高,对待老年患者要注意做甲状腺功能的测定,及时诊断和治疗老年人甲状腺疾病.     

不同碘营养状态对克汀大鼠脑内甲状腺激素受体的影响

目的利用放射配体结合分析法研究不同碘营养状态下克汀大鼠脑内甲状腺激素受体与激素结合的动力学参数的变化.方法利用低碘饮食复制了Wistar克汀大鼠模型,取第2代缺碘动物(即为克汀鼠),自分娩之日起,分别给每窝母鼠与其仔鼠供应低碘饲料和不同含碘量的饮水以补给不同量的碘,并依此将克汀鼠分为3组,包括低碘组(饮水内不含碘)、适碘组(饮水内含400 μg/L KIO3)、高碘组(饮水内含3 000μg/L KIO3);另设正常对照组(正常大鼠低碘饲料且饮水内含400μg/L KIO3饲养).选用出生后20日龄的克汀鼠和正常鼠进行实验,对4组动物模型甲状腺功能状态及脑内T3受体性质和数量进行了测定.结果甲状腺功能比较血清TT3水平各组间差异无显著意义(P＞0.05);血清FT3浓度低碘组(1.95±0.63)pmol/L正常对照组(1.12±0.18)pmol/L,显著高于正常对照组74.0%(P＜0.05),作为反映甲状腺功能重要指标TT4和FT4在低碘组(3.50±0.66)nmol/L和(0.59±0.12)pmol/L,在正常对照组(104.68±20.10)nmol/L和(16.86±2.70)pmol/L(P＜0.05),均为正常对照组的3.5%;适碘组(119.88±23.29)nmol/L和(21.53±3.09)pmol/L与正常组比,TT4和FT4前者均显著高于后者(P＜0.05);高碘组除了FT3(2.07±0.38)pmol/L显著高于正常对照组外,其TT4和FT4(64.79±9.54)nmol/L和(10.45±1.81)pmol/L均显著低于正常对照组(P＜0.05),分别为正常对照组的61.86%和62.0%.脑T3受体参数比较各组Ka近似而变化不大,各曲线斜率近于平行;低碘组最大结合容量显著高于正常对照组19.7%,也显著高于适碘组35.3%(P＜0.05),其它组间无显著差异.结论低碘组血中TT4和FT4低于正常组,脑中T3核受体结合容量高于正常对照组,提示甲状腺功能低下大鼠脑中受体有代偿性升高.高碘状态下脑细胞核T3受体结合容量虽略有升高,但血中TT4和FT4却低于正常,提示过量碘营养的后果不同于甲状腺功能亢进.     

碘缺乏对BALB/c小鼠促甲状腺激素β剪接变体基因表达的影响

目的 制备碘缺乏小鼠模型,检测促甲状腺激素(TSH)β剪接变体(TSHβ-Ⅴ)是否受循环中甲状腺激素的调节,探讨免疫系统来源的TSHβ-Ⅴ在维持甲状腺自稳态中的作用.方法 选用离乳BALB/c小鼠20只,雌雄各半.小鼠按体质量和性别随机分为2组,每组10只.对照组:饮去离子水,普通饲料喂养;低碘组:饮去离子水,低碘饲料(含碘量20 - 40μg /kg)喂养,每日碘摄入量约为0.25μg/d.3个月后处死小鼠,化学发光免疫分析法(CIA)检测小鼠血清中甲状腺激素和TSH水平,实时定量(RT)-PCR法测定小鼠骨髓、外周血、甲状腺、垂体TSHβ-Ⅴ的表达.结果 低碘组小鼠血清总甲状腺素(TT4)、游离甲状腺素(FT4)、总三碘甲腺原氨酸(TT3)、游离三碘甲腺原氨酸(FT3)[ (0.47±0.70)nmol/L、(2.41±0.28)pmol/L、(0.76±0.08 )nmol/L、(4.01±0.40) pmol/L]显著低于对照组[(55.2±3.68)nmol/L、(32.72±1.02) pmol/L、(1.10±0.06)nmol/L、(5.40±0.38 )pmol/L,t=43.81、86.04、9.81、7.51,P均＜0.01];低碘组小鼠TSH[(35.67±17.39)mU/L]明显高于对照组[(0.24±0.10)mU/L,t =-6.11、,P＜0.001];低碘组小鼠骨髓、外周血TSHβ-Ⅴ mRNA表达水平[(9.62±0.60)、(9.25±0.83)]均低于正常对照组(7.69±0.36、7.11±0.41,t=6.77、5.64,P均＜0.001);低碘组小鼠甲状腺TSHβ-Ⅴ mRNA表达(9.32±0.91)与对照组(9.12±0.62)相比较,差异无统计学意义(t=0.45,P＞0.05);在骨髓、外周血、甲状腺未检出天然型TSHβ;垂体中TSHβ-Ⅴ mRNA和天然型TSHβ表达水平(1.99±0.61、- 7.17±1.78)均高于对照组(5.75±0.98、-1.43±0.51,t=-8.02、- 7.60,P均＜0.01].结论 低碘饮食引发小鼠甲状腺功能低下,抑制骨髓和外周血TSHβ-Ⅴ mRNA的表达,提示免疫系统来源的TSHβ-Ⅴ可能具有比天然型TSHβ更重要的免疫-甲状腺调节作用.     

成功治疗垂体前叶功能减退症合并嗜酸性粒细胞增多一例

患者男性,62岁,因乏力、食欲减退、消瘦4个月,加重半个月,于2010年6月11日入院.患者入院前4个月无任何诱因出现乏力、食欲减退,体质量减轻约14 kg.外院就诊,查甲状腺功能后诊断为甲状腺机能减退症,随即给予口服左旋甲状腺素片50 μg,每日1次,上述症状有所改善.入院前2周因劳累过度,出现极度疲乏、无力行走、食欲减退、困倦,于2010年6月10日来我院门诊查甲状腺功能:促甲状腺激素 (TSH) 79.13 mU/L、游离三碘甲状腺原氨酸 (FT3) 2.10 pmol/ L、游离甲状腺素(FT4)2.34 pmol/L,以乏力待查、甲状腺机能减退症收住病房.     

左旋甲状腺素在甲状腺功能减退症合并高脂血症治疗中的应用

目的观察左旋甲状腺素在甲状腺功能减退症合并高脂血症治疗中的应用效果。方法对68例甲状腺功能减退症合并高脂血症患者采用左旋甲状腺素治疗,观察治疗前后血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、超敏促甲状腺激素(TSH)和血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)水平变化。结果本组患者治疗前血清FT3为(2.19±0.72)pmol/L,FT4为(6.87±1.26)pmol/L,TSH为(86.42±9.53)mU/L,TG为(2.23±0.52)mmol/L,TC为(6.16±1.54)mmol/L,LDL为(3.56±0.41)mmol/L,HDL为(1.02±0.34)mmol/L;治疗后分别为(5.17±1.82)pmol/L、(19.15±6.93)pmol/L、(2.25±1.13)mU/L及(1.14±0.29)、(4.82±1.07)、(2.72±0.28)、(1.32±0.57)mmol/L;治疗后各指标与治疗前比较,P均<0.05。结论左旋甲状腺素治疗甲状腺功能减退症合并高脂血症,既可改善甲状腺功能指标,又能降低血脂水平。     

缬沙坦对原发性高血压患者血清胰岛素样生长因子1和一氧化氮浓度的影响

目的探讨原发性高血压(EH)患者缬沙坦治疗前后血清胰岛素样生长因子1(IGF-1)和一氧化氮(NO)水平的变化.方法用特异性放射免疫法测定50例EH患者(EH组)缬沙坦治疗前和治疗6个月后及25例正常人(正常对照组)的血清IGF-1水平.用硝酸酶还原法检测EH组缬沙坦治疗前和治疗6个月后及正常对照组的血清NO水平.结果 EH患者血清IGF-1水平明显高于正常对照组(13.36±3.36 nmol/L 比9.67±2.57 nmol/L,P<0.01),而EH患者血清NO水平低于对照组(63.35±17.18 μmol/L 比77.15 ±13.50 μmol/L,P<0.01).EH并发LVH患者平均血清IGF-1水平明显高于无LVH者(14.15±4.23 nmol/L 比11.57±3.10 nmol/L,P<0.01)而其血清NO水平低于无LVH者(56.20±17.15 μmol/L比67.68±18.97 μmol/L P<0.05).缬沙坦治疗6个月后,血清IGF-1水平由13.36±3.36 nmol/L降至10.85±2.97 nmol/L(P<0.01);血清NO水平由63.35±17.18 μmol/L升至72.07±15.45 μmol/L(P<0.01);左室质量指数(LVMI)由126.39±18.45 g/m2降至111.13±15.27 g/m2(P<0.01).结论 EH患者血清IGF-1水平升高,而NO水平降低,尤其是伴发LVH者.提示IGF-1和NO两者失衡可能参与EH及其并发LVH的形成.缬沙坦可使EH患者血清IGF-1水平降低,NO水平升高,并能逆转左室肥厚的发生.     

An increase in plasma cholesterol independent of thyroid function during long-term amiodarone therapy. A dose-dependent relationship

OBJECTIVE: To determine whether long-term amiodarone treatment is associated with a rise in plasma cholesterol, and, if so, to analyze its relation with thyroid function. DESIGN: Consecutive entry trial, including cardiac patients who initiated amiodarone medication but excluding those with abnormal thyroid function (defined as peak thyroid-stimulating hormone [TSH] response to thyrotropin-releasing hormone [TRH] less than 2.8 or greater than 22.0 mU/L) either before or during amiodarone treatment. PATIENTS: Twenty-three patients who remained euthyroid were studied. INTERVENTION: Oral administration of amiodarone (mean duration of treatment, 17 months; range, 6 to 30 months). MEASUREMENTS: Fasting plasma lipids, thyroid hormones, and peak TSH to TRH values were recorded before and every 6 months during amiodarone treatment. RESULTS: Plasma cholesterol gradually increased from 5.1 +/- 0.2 mmol/L before treatment to 6.9 +/- 0.8 mmol/L after 30 months of amiodarone medication (P less than 0.001); the peak TSH response to TRH did not change. When age- and sex-specific reference values were applied, 30% of the patients had cholesterol values above the 75th percentile before treatment; this number rose to 69% after 2 years of treatment. The rise in plasma cholesterol was associated with an equal increase in apoprotein B. Plasma cholesterol was not related to the daily dose of amiodarone or to plasma concentrations of amiodarone, desethylamiodarone, thyroxine (T4), triiodothyronine (T3), or reverse triiodothyronine (rT3). Linear regression analysis indicated a positive relation between plasma cholesterol and the cumulative dose of amiodarone (r = 0.25, P less than 0.05). CONCLUSION: Long-term amiodarone treatment is associated with a dose-dependent increase in plasma cholesterol that is independent of thyroid function.     

Impact of long-term administration of amiodarone on the thyroid function of patients with Chagas' disease.

The effect of long-term treatment with amiodarone on patients with Chagas' disease has seldom been reported. This nonrandomized observational study attempted to analyze the follow-up of patients with Chagas' disease regarding their clinical evolution, thyroid dysfunction, and goiter. We compared 72 patients with long-term use (11 +/- 5 years) of amiodarone, including 22 patients who developed goiter, to 33 patients who did not use amiodarone, followed-up for 2 to 20 years (7 +/- 11 years). Follow-up of 72 patients for 9 +/- 5.4 years with periodic cardiac and thyroid function evaluations showed that only 26 maintained normal serum thyrotropin (TSH) levels; 24 presented with elevated levels; 4 had low levels, and 18 patients presented with fluctuations of TSH level. Among the 22 patients with goiter, only 3 (14%) patients maintained normal TSH, 8 (36%) had elevated TSH, 2 (9%) had low TSH, and 9 (41%) patients presented with fluctuating serum TSH levels. Most individuals remained clinically euthyroid with no evidence of cardiac impairment that could be attributed to thyroid dysfunction and the arrhythmias were adequately controlled by amiodarone. We suggest that amiodarone treatment may be continued for patients with Chagas' disease with arrhythmias, even in those who develop thyroid function abnormalities or goiter.     

Thyroid hormone metabolism in patients with congestive heart failure: the low triiodothyronine state.

Thyroid hormone has multiple effects on the cardiovascular system, ranging from molecular and cellular effects to the consequent hemodynamic alterations. Consequently, thyroid function has been evaluated in small cohorts of patients with advanced heart failure that indicate a significant prevalence of morphologic or functional thyroid disorders. We sought to determine the prevalence of altered thyroid hormone metabolism in a broad spectrum of ambulatory heart failure patients. Thyroid function tests were evaluated in 132 ambulatory patients (98 males, 32 females, mean age, 67 years) with left ventricular systolic dysfunction (EF < 35%) and New York Heart Association (NYHA) class I-IV symptoms. Hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) > 4.25 U/mL and low triiodothyronine (T3) state was defined as T3 levels < 80 ng/dL, with normal thyroxine (T4) and TSH level. Seven percent of patients were found to have primary hypothyroidism and 34% have a low T3 state. Of patients receiving amiodarone, 21% had elevated TSH levels and 76% had low T3 levels. The prevalence of abnormal thyroid function correlated with NYHA class. There is an unexpectedly high risk of hypothyroidism and low T3 syndrome in patients regardless of treatment with amiodarone, which appears to correlate with disease severity that requires further investigation.     

The prevalence of overmedication with levothyroxine in ambulatory elderly patients

Objective To estimate the prevalence of overmedication with levothyroxine in ambulatory elderly patients and to determine if this older patient population is inherently more likely to have suppressed serum TSH concentration. Research design and methods The medical records of 180 elderly men above the age of 60 years who were on levothyroxine therapy were reviewed. The prevalence of suppressed TSH as measured by a supersensitive assay in 935 ambulatory patients in a Department of Veterans Affairs Medical Center and 214 unselected elderly subjects presenting to a health fair was also evaluated. Concomitant free T₄ measurements done with a competitive binding assay kit were available in 381 patients. Results The overall prevalence of low serum TSH levels among patients on levothyroxine therapy followed up in an academic center is 13,3%. Patients seen in general medicine (8.7%) and geriatric clinic (7.7%) had the lowest rates of overreplacement with thyroid hormone compared to other medical subspecialty clinics (16.7%). There was a significant correlation between levothyroxine dose used and serum free T₄, TSH or log TSH values. The prevalence of low TSH in elderly subjects without known history of thyroid disease was 1.7% in the community and 3.1% in patients seen in clinics. The sensitivity of the pituitary thyrotrophs to thyroid hormone was not increased in elderly patients. Conclusions The prevalence of overmedication with levothyroxine in elderly patients is high, especially in those seen in community clinics. The suppressed serum TSH levels in elderly patients on levothyroxine is the result of overdosage rather than secondary to increased pituitary gland sensitivity to thyroid hormone.     

Masked thyroid dysfunction among elderly patients with atrial fibrillation

Seventy-five elderly patients with atrial fibrillation (41 males and 34 females with a mean age of 75.6 years) were studied to evaluate the incidence of masked thyroid dysfunction. A thyrotropin (TSH)-releasing-hormone (TRH) test (intravenous injection of 250 micrograms of synthetic TRH) was performed in the patients and 30 age matched controls without atrial fibrillation. In the controls, no abnormal TRH stimulated TSH response was observed. In the patients with atrial fibrillation, no response of TSH to TRH (hyperthyroidism) was found in 5 cases (6.6%), while hyperresponse of TSH to TRH (hypothyroidism) was found in 6 cases (8.0%). Thyroid dysfunction (hyper or hypothyroidism) was more frequently observed in the patients than in the controls (p less than 0.05). Two of 5 hyperthyroid patients had normal thyroid hormone levels. All patients with hyperthyroidism were treated with antithyroid drugs or 131I. Unfortunately, atrial fibrillation persisted in all but 1 case. It is concluded that the TRH test is a useful screening test for detecting those patients with abnormal thyroid function among elderly patients with atrial fibrillation, and that hypothyroidism should be considered as a cause of atrial fibrillation in the elderly.     

Amiodarone and thyroid function

Amiodarone blocks the action of thyroid hormone by the inhibition of 5′-deiodinase which reduces production of T₃ in peripheral tissues and possibly by blocking nuclear binding of T₃. Since the drug inhibits peripheral conversion of T₄ to T₃, many patients taking amiodarone have abnormal thyroid function studies (increased T₄ and rT₃; decreased T₃) despite being euthyroid. Treatment of patients with amiodarone generates an iodine excess, which contributes greatly to the significant incidence of altered thyroid status in this population. The diagnosis of hyperthyroidism and hypothyroidism can be difficult. However, using the overall clinical picture and the tolerance limits of hormone levels determined for patients remaining euthyroid on amiodarone therapy, the accurate diagnosis of clinically significant thyroid dysfunction can almost always be made. To screen for thyroid disease, thyroid function should be assessed before initiating therapy, semiannually during therapy or whenever clinical features of thyroid dysfunction occur. Subclinical hypothyroidism as denoted by modest increases in TSH levels do not require treatment or the discontinuation of amiodarone therapy. An appreciation of the mechanism of the interaction between amiodarone and thyroid hormone metabolism allows the clinician to recognize thyroid dysfunction at an early stage and initiate appropriate therapy, thereby minimizing the morbidity associated with forms of amiodarone toxicity.     

Amiodarone and the thyroid

Amiodarone is an iodine-rich drug widely used for the management of cardiac arrhythmias. During long-term amiodarone therapy drug toxicity may occur and a substantial proportion of amiodarone-treated patients develop either hypothyroidism or thyrotoxicosis. Several mechanisms are involved in amiodarone-induced thyroid dysfunction: defective thyroid auto-regulatory mechanism in presence of excessive iodine offer, immunological factors and cytotoxicity. Approximately 50% of patients taking amiodarone present abnormal thyroid function. Therefore, for adequate clinical follow up of these patients, it is critical a careful monitoring of thyroid hormones and TSH, before and during treatment.     

重组人生长激素治疗对生长激素缺乏症患者甲状腺功能的影响

为探讨生长激素治疗对甲状腺功能的影响及其机制，给１９例特发性生长激素缺乏症患者每日皮下注射重组人生长激素（ｒｈＧＨ）Ｇｅｎｏｔｒｏｐｉｎ０．１ＩＵ／ｋｇ体重，治疗１年，观察治疗前后甲状腺功能及血促甲状腺激素（ＴＳＨ）对静脉推注促甲状腺素释放激素（ＴＲＨ）的反应。经Ｇｅｎｏｔｒｏｐｉｎ治疗后，患者血清Ｔ４及ＦＴ４水平较治疗前明显下降（Ｐ＜０．０１）；治疗半年后，血清ＦＴ３水平亦较治疗前下降（Ｐ＜０．０５）；而血清Ｔ３、３，３′，５′－三碘甲状腺原氨酸及ＴＳＨ水平无明显变化（０．２＜Ｐ＜０．３）。治疗１年后，８例患者血清ＦＴ４水平降至正常范围以下，依此将患者分为治疗后甲状腺功能正常组及降低组，结果证实甲状腺功能降低组在治疗前或治疗后ＴＳＨ对ＴＲＨ兴奋的反应均较甲状腺功能正常组高（Ｐ＜０．０５）。血清ＴＳＨ对ＴＲＨ的反应增强提示患者治疗前就已有潜在的ＴＲＨ缺乏，后者可能是ｒｈＧＨ治疗过程中ＦＴ４及Ｔ４水平下降的潜在基础。因此在ｒｈＧＨ治疗过程中需监测特发性生长激素缺乏症患者的甲状腺功能，以及时给予替代治疗。     

The effect of short-term treatment with recombinant human thyroid-stimulating hormones on leydig cell function in men.

High levels of thyroid-stimulating hormone (TSH) have been implicated as a cause for precocious puberty associated with severe long-standing juvenile hypothyroidism. Recombinant human thyroid-stimulating hormone (rhTSH) is available for the management of patients with thyroid carcinoma, and after its administration the serum TSH levels are similar to those observed in hypothyroid infants with precocious puberty. Our objective was to investigate whether rhTSH increased testosterone secretion in adult males with differentiated thyroid carcinoma. Thirty-one adult Caucasian men, ages 18-59 years, with differentiated thyroid carcinoma were studied. While continuing on thyroid hormone therapy, patients received 0.9 mg of rhTSH 24 hours apart. Blood samples were obtained before the first rhTSH dose (day 1) and at 24 hours (day 3) and 72 hours (day 5) after the second rhTSH dose. TSH, total testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were determined. Serum TSH levels were increased at day 3 (129.2 +/- 5.7 micro U/mL) versus day 1 (0.6 +/- 0.2 micro U/mL) but observed differences in total testosterone, LH and FSH throughout the study were not statistically significant. In conclusion, short-term elevations in serum TSH levels in the range reported in hypothyroid boys with precocious puberty did not increase serum testosterone levels in adult men.     

Outcome of thyroid function in newborns from mothers treated with amiodarone.

Amiodarone, a drug extensively used as an antiarrhythmic agent, contains 37% iodine and causes several thyroid abnormalities. The transplacental passage of amiodarone occurs with chronic therapy; we describe in this report the outcome of 9 pregnant women who used amiodarone (200 mg/day) for treatment of resistant tachycardia and the follow-up of their newborns. All women were clinically euthyroid at the 3rd trimester and showed expected values of thyroid hormones (mean +/- SD: total T4, 228 +/- 45 nmol/L; total T3, 4.0 +/- 0.65 nmol/L; TSH, 4.0 +/- 1.8 mU/L; negative thyroid antibodies). At birth all newborns were normal on routine examination with no goiter or corneal changes. T4 and TSH, measured on dried umbilical blood spots were normal or borderline-normal in 8 of 9 babies. Only 1 neonate presented clearly abnormal values of T4 and TSH (96 mU/L); on clinical grounds the baby was normal, without signs of hypothyroidism. At 1 month of life, T4 and TSH were normal. Follow-ups at 3, 6, and 12 months were normal. We conclude that is not necessary to discontinue treatment with amiodarone in pregnant women with resistant tachycardia, but it is imperative to evaluate the thyroid function of the newborn, since transient hypothyroidism may occur.