飞行人员甲状腺功能异常的诊治及医学鉴定

目的 总结甲状腺功能异常飞行人员的临床资料,为规范相关疾病的诊治与鉴定提供依据. 方法 回顾性分析2000年12月至2014年9月间在空军总医院住院的42例甲状腺功能异常的飞行人员病例资料,包括甲状腺功能亢进症和甲状腺功能减退症,总结其疾病特点、诊治过程、治疗效果、医学鉴定结论及随访情况. 结果 ①甲状腺功能亢进症30例（71.43％）,其中26例（86.67％）应用抗甲状腺药物治疗后,医学鉴定结论为飞行合格7例、暂时飞行不合格4例、飞行不合格15例,停飞率57.69％（15/26）.4例（13.33％）应用放射性131I治疗后3例出现甲状腺功能减退;医学鉴定结论为飞行合格2例、暂时飞行不合格2例.②甲状腺功能减退症12例（28.57％）,应用药物替代治疗后,医学鉴定结论为飞行合格9例、飞行不合格3例;3例停飞者中2例为合并心房颤动.结论 飞行人员甲状腺功能亢进症单病种飞行合格率低于甲状腺功能减退症.需要进一步优化飞行人员甲状腺功能亢进症的治疗路径,完善甲状腺功能异常飞行人员的医学鉴定,既最大限度地保存飞行力量又保证飞行安全.     

超声与核素显像诊断甲状腺结节的对比研究

目的：探讨超声和核素显像法诊断甲状腺结节的价值。材料和方法：对比研究超声和核素显像诊断经手术病理证实的１００例甲状腺结节。结果：核素显像中,冷（凉）、温、热结节分别占７５％、１９％、６％;冷（凉）、温结节中甲状腺癌分别为８％和１１％,热结节中未见恶性存在。超声检查诊断甲状腺结节良恶性的敏感性６２５％、特异性９６７％、准确性９４％、阳性预测值６２５％、阴性预测值９６７％、假阴性３／８和假阳性３例。结论：甲状腺扫描能反映结节摄取９９ｍＴｃＯ４－功能,据此可判断肿瘤性质,但存在一定困难;超声对甲状腺结节具有定性诊断价值,但对恶性结节诊断时存在假阴性和假阳性。     

过量碘摄入对甲状腺功能影响的探讨

过量碘摄入可以引起甲状腺细胞形态的改变,继而引起甲状腺功能紊乱,从而导致各种甲状腺疾病。将与碘属同族元素的核素引入体内进行甲状腺显像对于诊断甲状腺疾病有重要意义,而阐述过量碘对甲状腺功能的影响,对于指导甲状腺核素显像前的准备有重要的临床价值。     

甲状腺结节核素显像与病理结果对比分析

甲状腺结节核素显像与病理结果对比分析王建国，吴惠珍，许妙群，陆红梅材料和方法本组共１３７例，其中女性１１７例（占８５Ａ％），男性２０例（占１４．６％），女：男比５．９：１。年龄为１６～７３岁，平均年令３９岁。１３７例患者临床均扪及大小不等的甲状腺结节...     

99Tcm-MIBI甲状腺显像鉴别甲状腺结节良恶性再认识

目的评价^99Tc^m-甲氧基异丁基异腈（MIBI）甲状腺亲肿瘤显像鉴别甲状腺结节良恶性的临床价值。方法106例甲状腺结节手术患者中101例先进行了甲状腺结节常^99Tc^mO4^-显像；106例患者均静脉注射^99Tc^m-MIBI 370 MBq后进行15min早期和2h延迟显像，结果与病理检查结果对比。结果13例甲状腺恶性肿瘤中的5例、93例良性结节中的23例^99Tc^m-MIBI显像阳性。^99Tc^m-MIBI显像诊断甲状腺恶性肿瘤的灵敏度为38．5％，特异性为75．3％，准确性为70．8％。甲状腺良恶性肿瘤显像的阳性率差异无显著性（x^2=0．49，P〉0．05）。结论^99Tc^m-MIBI显像不能鉴别甲状腺结节的良恶性，其临床意义有限。     

180例甲状腺结节显像与病理分析

目的：评价甲状腺显像鉴别诊断甲状腺结节良，恶性的临床价值。方法：１８０例甲状腺结节患行甲状腺＾９９ｍＴｃＯ＾－４显像，并将其与病理结果进行对比研究。结果：甲状腺结节显像呈冷结节１５８例（８７．８％），温结节７例（３．９％），热结节３例（１．７％），甲状腺不显影或显极淡１２例（其病理诊断为“亚急性甲状腺炎”）（６．７％）。     

诊断甲状腺炎的新技术

目的 探讨甲状腺功能显像获得的摄锝率与甲状腺轴激素水平变化测定在甲状腺炎诊断中联合应用的价值。方法 对10例临床怀疑为甲状腺炎的患者进行^99mTc甲状腺功能显像和甲状腺轴激素水平变化的测定。结果 诊断甲状腺炎的灵敏度为88．1％，特异性为85．2％。结论 ^99mTc甲状腺功能显像的摄锝率与甲状腺轴激素变化水平测定值出现矛盾现象时，应高度怀疑甲状腺炎的可能。     

核素心室显像相位分析检测甲亢患者心功能

相位分析以心室各部位心肌收缩的同步性、协调性反映心脏的收缩功能。本研究总结了64例甲亢患者在合并甲状腺功能亢进症（简称甲亢）性心脏病前的核素心室显像相位分析结果，探讨甲亢患者心脏功能的变化，现报道如下。     

彩色多普勒超声与99mTC核素SPECT显像鉴别良恶性甲状腺结节的价值分析

目的 分析高频彩超与核素显像检查甲状腺良恶性结节的影像特征,比较两者的优缺点,探讨两者联合应用的诊断价值.方法 对68个甲状腺结节的彩超与核素检查结果对照病理进行回顾性分析.结果 两种影像学检查方法都可以显示甲状腺的形态、位置、大小.68个结节,超声全部查出,核素扫描只能显示54个.超声对甲状腺结节的大小、结构及血流清晰的显示独具优势,尤其是小于1cm的结节、钙化及颈部淋巴结超声显示清晰,而核素则无法显示.核素显像可以反应甲状腺摄锝功能,通过“冷热温凉”的特性来判断结节的性质,特别是利用血流灌注显像或亲肿瘤显像可进一步区分结节的良恶性,本组病例超声诊断符合率86.7％;14例做了动态血流灌注显像,其诊断符合率为75％;38例“冷凉”结节均做了亲肿瘤显像,其诊断符合率为90.9％;二者结合诊断符合率提高为92.3％.超声难以显示甲状腺功能状态.超声表现的囊、实性结节和核素显示的“冷热温凉”特性之间无统计学意义.结论 彩超与核素两种影像学检查方法各有特点、优势和不足,结合使用可进一步提高甲状腺良恶性结节鉴别的准确率.     

甲状腺锥体叶^99mTc显像的临床价值

目的：探讨甲状腺锥体叶显像的临床价值。材料和方法：常规肘静脉注射９９ｍＴｃＯ－４后３０分钟甲状腺显像,对２６０例甲状腺机能亢进症患者和２４３例非甲亢对照组患者行甲状腺显像,观察甲状腺锥体叶的出现情况。结果：２６０例甲亢患者中７８例锥体叶阳性,２４３例对照组中８例锥体叶阳性,两者差异有显著性（Ｐ＜００１）,锥体叶阳性对甲亢诊断的敏感性为３００％,特异性为９６６％。锥体叶可位于峡部或一叶上方,多呈舌状,放射性分布略低于左右叶,大小不等。甲亢术后原有锥体叶可长大。结论：甲状腺锥体叶显像有助于甲亢的临床诊断。     

Clinical significance of metabolic superscan in patients with hyperthyroidism

BACKGROUND: Hyperthyroid patients commonly complain of generalized bony aches, which are frequently overlooked due to the more prominent symptoms of cardiovascular and nervous disturbances. Hyperthyroid patients are expected to have abnormal bone metabolism as part of the generalized hypermetabolic status. The aim of this study is to verify the presence of metabolic bone superscan in association with the hypermetabolic stats in various groups of hyperthyroidism. Secondly, to correlate these superscan features with the various laboratory results in hyperthyroid patients. MATERIAL AND METHODS: Forty-five hyperthyroid patients confirmed by clinical and laboratory results were enrolled in this work. In all patients, a (99m)Tc-pertechnetate thyroid uptake scan was acquired. On a different day, total body bone scan was acquired three hours post IV injection of 555-925 MBq of (99m)Tc-MDP. Serum FT3, FT4, TSH, Ca++, alkaline phosphatase (AP) and parathyroid hormone (PTH) were monitored in all patients as markers of thyroid and bone metabolism. Ten cases with no thyroid diseases were included as a control group. Patients with thyroiditis or long history of antithyroid drugs for more than one year were excluded from the study. RESULTS: The patients were subdivided into three groups: Graves disease (GD) (n = 30), toxic nodular goiter (TNG) (n = 10) and autonomous toxic adenoma (AT) (n = 5). The TSH for the whole group was significantly suppressed compared to the control group with higher suppression in the Graves disease group than in the TNG or AT groups. (99m)Tc-pertechnetate uptake values in the Graves disease group were significantly higher than the TNG and AT groups (p < 0.05). Metabolic superscan (MSS) was noted in 90% of the Graves cases, 20% in TNG and in none of the AT group. There were no significant differences regarding Ca+, AP and PTH between the Graves and non-Graves groups (p > 0.05). CONCLUSIONS: Disturbances in bone metabolism are more prevalent in Graves disease than in other types of hyperthyroidism. The addition of the bone scan to the diagnostic work up of patients with Graves disease is a sensitive indicator for metabolic bone changes and could help in the future management and follow up for this group of patients.     

MR imaging of the thyroid: comparison with scintigraphy in the normal and diseased gland

Spin-echo magnetic resonance (MR) imaging of the thyroid gland was performed in patients using a superconducting magnet operating at 0.35 T. There were 17 women and two men with an age range of 21-77 years. All of the patients with disease were also evaluated with scintigraphy and three of the four subjects with normal thyroid glands also had scintigraphy. Final diagnoses in the patients were normal gland in four, Graves disease in two, thyroid cyst in one, benign follicular adenoma in two, papillary cell carcinoma in one, Hürthle cell carcinoma in one, Hashimoto thyroiditis in one, and multinodular goiter in seven. The normal thyroid and surrounding anatomy were clearly demonstrated by intrinsic signal intensity differences of the tissues. The thyroid gland in Graves disease was enlarged and had homogeneously increased signal intensity at all pulse sequences compared with skeletal muscle and normal thyroid. The thyroid cyst and benign adenoma were well defined; however, the cyst displayed the greater signal intensity on more T2-weighted pulse sequences. The MR signal intensity features of multinodular goiter and Hashimoto thyroiditis appear similar to those of the normal gland. In cases of focal masses, MR could not reliably distinguish benign from malignant tumor. However, using intensity ratio data there was a statistically significant difference between solid and hemorrhagic cystic disease.     

人血清TRAb酶联免疫吸附试验检测在甲状腺疾病患者中的临床应用

目的 探讨促甲状腺激素受体抗体（TRAb）水平对健康人和不同甲状腺疾病患者的临床意义.方法 分别以重组人促甲状腺激素受体（TSHR）膜外区氨基（N）端蛋白和羧基（C）端蛋白作为抗原建立N法和C法,分别检测89名健康者（正常对照组）和254例各种甲状腺疾病患者的血清TRAb水平,组间血清TRAb水平比较采用方差分析,组间阳性率比较采用x2检验.结果 应用N法检测发现：89名健康者405 nm处的光吸收值（（x）±s）为0.511±0.135,阳性切限值（（x）±2s）为0.789,阳性率为4.5％（4/89）;初发Graves病（毒性弥漫性甲状腺肿）患者及Hashimoto甲状腺炎伴甲状腺功能减退症（简称甲减）患者405 nm处的光吸收值（（x）±s）分别为：0.95±0.30、0.61±0.22,高于健康者（F=2.4851和2.0763,P均＜0.05）;N法对初发Graves病患者、治疗中的Graves 病患者、Graves病治疗恢复期患者、Hashimoto甲状腺炎伴甲减患者检测的阳性率分别为73.2％、55.9％、32.1％、45.0％,与正常对照组阳性率之间的差异均有统计学意义（x2=68.55、56.45、20.71和25.51,P均＜0.05）;初发Graves病患者阳性检出率高于Hashimoto甲状腺炎伴甲减患者（x2=4.63,P＜0.05）,初发Graves病患者与Graves病治疗恢复期患者阳性率之间的差异有统计学意义（x2=15.94,P＜0.05）.应用C法检测发现：89名健康者405 nm处的光吸收值（（x）±s）为0.507±0.142,阳性切限值（（x）＋2s）为0.791,阳性率为3.4％（3/89）;Hashimoto甲状腺炎伴甲减患者及初发Graves病患者405 nm处的光吸收值（（x）±s）为1.18±0.25、0.78±0.25,明显高于健康者（F=3.8164和2.4539,P＜0.05）;C法对Hashimoto甲状腺炎伴甲减患者、初发Graves病患者、治疗中的Graves病患者、Graves病治疗恢复期患者检测的阳性率分别为：75.0％、46.3％、23.6％、16.1％,与正常对照组阳性率之间的差异均有统计学意义（x2=66.34、36.87、15.79和7.30,P均＜0.05）;Hashimoto甲状腺炎伴甲减患者阳性检出率明显高于其他患者（x2=4.48、19.70和23.68,P均＜0.05）.结论 应用N法和C法检测Graves病和Hashimoto患者血清TRAb水平均有重要意义,可用于临床Graves病和Hashimoto甲状腺炎伴甲减患者的诊断、治疗及疗效的评估.     

甲状腺“火海征”的超声分析及鉴别诊断

目的：分析彩色多普勒血流成像（CDFI）检查甲状腺时出现“火海征”的相关疾病的声像图特征,并对其进行鉴别诊断。方法回顾分析我院85例CDFI呈“火海征”甲状腺的大小形态、内部回声,观测甲状腺上动脉血流频谱特征、峰值流速及阻力指数（RI）。结果毒性弥漫性甲状腺肿（甲亢）、慢性淋巴细胞性甲状腺炎（桥本甲状腺炎）、亚临床甲状腺功能低下（亚甲低）CDFI均可出现“火海征”,但各自声像图特征及甲状腺上动脉血流频谱、峰值流速及RI存在差异。结论甲状腺CDFI出现“火海征”多见于甲亢,但并不是甲亢所特有,在桥本甲状腺炎及亚甲低等甲状腺疾病中都可出现“火海征”声像图,应结合各自声像图表现及甲状腺上动脉频谱、流速及RI改变加以鉴别。     

Computed tomography in the evaluation of thyroid disease

Traditionally, thyroid imaging has been performed primarily using radionuclide scanning. High-resolution computed tomography (CT) was performed in 18 patients to evaluate the CT appearance of various thyroid abnormalities including diffuse toxic goiter, multinodular goiter, Hashimoto thyroiditis, thyroid adenoma, and malignant thyroid tumors. CT images of the thyroid were correlated with radionuclide scanning, surgical findings, and clinical and laboratory results. CT provided a complementary method for evaluation of the thyroid by defining the morphology of the thyroid gland and more precisely defining the anatomic extent of thyroid abnormalities in relation to the normal structures of the neck and mediastinum.     

The role of thyroid scanning in hyperthyroidism

Radionuclide thyroid imaging was performed in 872 consecutive patients with hyperthyroidism. Of these, 84% were found to have diffuse toxic hyperplasia (Graves' disease), while 12% had autonomously functioning nodules (Plummer's disease), 3% had Graves' disease developing in a multinodular gland, and in the remaining 1%, either a clear diagnosis could not be established or the hyperthyroidism was due to thyroiditis or the Job-Basedow phenomenon. It was found that a thyroid scan seldom provides additional diagnostic information in patients with Graves' disease when a diffuse goitre is present. However, if patients are to be treated with radioiodine (¹³¹I), thyroid imaging with tracer quantitation can replace a 24-h ¹³¹I uptake measurement, this having the advantages that the patients are required to attend only once, and that the gland size can be measured. In addition, visual confirmation of tracer uptake by the thyroid is obtained and patients with thyroiditis will not receive inappropriate therapy. When single or multiple thyroid nodules are palpated, a thyroid scan is crucial in establishing an accurate diagnosis, as it is not otherwise possible to differentiate between Plummer's disease and Graves' disease developing in a multinodular gland. Indeed, in 20 of our 63 patients (32%) with single autonomously functioning nodules, the initial clinical assessment had been incorrect.     

The role of thyroid scanning in hyperthyroidism

Radionuclide thyroid imaging was performed in 872 consecutive patients with hyperthyroidism. Of these, 84% were found to have diffuse toxic hyperplasia (Graves' disease), while 12% had autonomously functioning nodules (Plummer's disease), 3% had Graves' disease developing in a multinodular gland, and in the remaining 1%, either a clear diagnosis could not be established or the hyperthyroidism was due to thyroiditis or the Jod-Basedow phenomenon. It was found that a thyroid scan seldom provides additional diagnostic information in patients with Graves' disease when a diffuse goitre is present. However, if patients are to be treated with radioiodine (131I), thyroid imaging with tracer quantitation can replace a 24-h 131I uptake measurement, this having the advantages that the patients are required to attend only once, and that the gland size can be measured. In addition, visual confirmation of tracer uptake by the thyroid is obtained and patients with thyroiditis will not receive inappropriate therapy. When single or multiple thyroid nodules are palpated, a thyroid scan is crucial in establishing an accurate diagnosis, as it is not otherwise possible to differentiate between Plummer's disease and Graves' disease developing in a multinodular gland. Indeed, in 20 of our 63 patients (32%) with single autonomously functioning nodules, the initial clinical assessment had been incorrect.     

MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究

目的 研究MRI弥散加权成像（DWI）的表观弥散系数（ADC）、甲状腺摄131I率（RAIU）和血清指标等在Graves甲状腺功能亢进症（简称甲亢）和无痛性甲状腺炎（PT）鉴别中的价值.方法 选取102例Graves甲亢患者和37例PT患者入组.测定所有患者的血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、TSH、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）水平.采用3.0T超导型MRI仪完成MRI检查,并获得ADC.测定甲状腺24 h RAIU,并进行甲状腺静态显像.Graves甲亢患者的病理组织从接受手术的患者中获取（6例）,PT患者的病理组织从接受活检的患者中获取（2例）.采用Pearson检验明确各指标间的相关性,用受试者工作特征曲线（ROC）分析各项指标的诊断价值,确定各项指标的切分点值,并判断各项指标的诊断灵敏度、特异度、准确率、阳性预测值和阴性预测值.结果 与PT患者比较,Graves甲亢患者的ADC、TRAb和RAIU显著升高（t=15.126、7.226和31.574,P均＜0.01）.ADC、TRAb和RAIU之间存在显著的正相关性.ROC显示,RAIU、ADC和TRAb的曲线下面积大于0.900.其中,RAIU具有最好的诊断价值,当最佳切分点值确定为24.500％时,灵敏度、特异度、准确率、阳性预测值和阴性预测值均为100％.ADC比TRAb的诊断价值更高,当最佳切分点值分别确定为1.837×10^-3 mm^2/s和1.350 IU/ml时,ADC的上述统计指标分别为96.078％、91.892％、95.000％、97.059％和89.474％,TRAb的上述统计指标分别为88.235％、75.676％、84.892％、90.909％和70.000％.病理组织学结果显示：Graves甲亢以滤泡增生、滤泡上皮细胞增生以及血管扩张和充血为主要表现;PT以淋巴细胞浸润、淋巴滤泡形成以及滤泡破坏为主要表现.结论 对于Graves甲亢和PT的鉴别,RAIU、ADC和TRAb均有价值,RAIU最佳、ADC次之.ADC的显像原理是基于不同疾病细     

甲状腺彩色超声检查在飞行员健康体检中的临床价值

目的 调查飞行员甲状腺彩色超声检查结果及鉴定情况,为航空卫生保障提供依据.方法 回顾分析在解放军第四五六医院因健康体检行甲状腺彩色超声检查的629名飞行员的超声检查结果、病理诊断以及医学鉴定情况,并进行统计学分析. 结果 ①629名飞行员中,检出甲状腺疾病139例,阳性率22.10％.②随年龄增长,飞行员甲状腺疾病发病率逐步增高（x2=35.564,P＜0.01）.③甲状腺疾病与飞行员所飞机种无关.④139例患甲状腺疾病的飞行员中飞行合格124例,其中桥本甲状腺炎6例,急性/亚急性甲状腺炎4例;暂时飞行不合格13例,其中原发性甲状腺功能亢进2例,桥本甲状腺炎合并甲状腺功能亢进3例,甲状腺腺瘤术后5例;飞行不合格（停飞）2例,均为甲状腺癌. 结论 结节性甲状腺肿在飞行人员中较常见,对飞行安全无明显影响.甲状腺癌及继发性甲状腺功能亢进患病率有增加趋势,且对飞行安全有着直接或间接影响,应加强预防和早期治疗.甲状腺彩色超声检查对甲状腺疾病的早发现、早诊断、早治疗具有重要意义.     

The significance of FDG uptake in bilateral thyroid glands

AIM: To evaluate the significance of bilateral fluorodeoxyglucose (FDG) uptake in the thyroid glands. METHODS: Bilateral thyroid FDG uptake, defined as visualization of thyroid glands, was found in 66 (3.4%) of 1925 subjects who underwent our FDG PET cancer-screening program. Additionally, 16 of the 41 patients with Graves' disease and hyperthyroidism (GD(H)) and six of the 20 subjects with Graves' disease and euthyroidism (GD(E)), who had FDG uptake in thyroid glands, were enrolled in this study. RESULTS: Among the 66 subjects, 22 were normal variant, 39 subjects had chronic thyroiditis (35 subjects presented with diffuse goitre and four with multinodular goitre), and five subjects had multinodular goitre (MNG) without chronic thyroiditis. Fourteen of 22 (63.6%) of the subjects with the normal variant had a visual uptake intensity less than that of the liver, while 30 of 39 (76.9%) of the subjects with chronic thyroiditis and 14 of 22 (63.6%) of the subjects with Graves' disease had visual uptake intensity greater than or equal to liver uptake. Two of the five subjects with MNG with focally intense uptake were proven to have thyroid carcinoma. Bilateral loser uptake in thyroids associated with thymus and symmetrical skeletal muscle uptake were found in GD(H). The standard uptake value (SUV) (mean+/-SD) in subjects with chronic thyroiditis (2.76+/-1.24) were higher, while those with GD(H) (1.59+/-0.36) were lower than that of the normal variant (1.99+/-0.63). Subjects with hypothyroidism (3.04+/-1.39) had higher SUV levels than those subjects with euthyroidism (2.44+/-1.11). In addition, patients with GD(H) had lower levels than those with GD(E) (2.0+/-0.38). CONCLUSION: (1) Bilateral thyroidal uptake of FDG can be found in normal variants and subjects with various thyroid disorders, showing varieties of uptake patterns. (2) Diffuse intense uptake and higher SUV levels are a clue to a diagnosis of chronic thyroiditis, especially for those with hypothyroidism. (3) Focally intense uptake suggests the possibility of a thyroid carcinoma. (4) Sparse uptake associated with the thymus and symmetrical skeletal muscle uptake and lower SUV level raise the possibility of Graves' disease with hyperthyroidism.