红细胞能量成像技术定量评估甲状腺功能的应用价值

目的探讨红细胞能量成像（CFA）技术定量评估甲状腺弥漫性病变患者甲状腺功能的应用价值。 方法选取2016年10月至2017年6月哈尔滨医科大学附属第一医院就诊的甲状腺弥漫性病变患者100例。其中甲状腺功能正常者36例（甲弥甲功正常组）,甲状腺功能异常者64例,包括甲状腺功能亢进者30例（甲弥甲亢组）,甲状腺功能减低者34例（甲弥甲减组）。另选择同期该院体检的健康志愿者30名（健康对照组）。所有受试者均采用CFA技术测定甲状腺实质感兴趣区内的血流参数：血管指数（VI）与Vascularity。采用单因素方差分析比较4组受检者VI、Vascularity差异,进一步组间两两比较采用SNK-q检验。以临床诊断作为金标准,绘制VI鉴别诊断甲状腺弥漫性病变患者甲状腺功能亢进与减低、异常与正常的受试者工作特征（ROC）曲线。采用Pearson分析法分析甲弥甲亢组、甲弥甲减组VI与甲状腺功能的相关性。 结果VI、Vascularity均为甲弥甲亢组>甲弥甲减组>甲弥甲功正常组>健康对照组,且任意两组间比较差异均有统计学意义（VI：健康对照组与甲弥甲亢组、甲弥甲减组、甲弥甲功正常组比较,q=13.67、7.00、3.93,P均<0.01;甲弥甲功正常组与甲弥甲亢组、甲弥甲减组比较,q=10.35、P<0.01,q=3.27、P<0.05;甲弥甲减组与甲弥甲亢组比较,q=7.09,P<0.01;Vascularity：健康对照组与甲弥甲亢组、甲弥甲减组、甲弥正常组比较,q=15.23、10.16、6.58,P均<0.01;甲弥甲功正常组与甲弥甲亢组、甲弥甲减组比较,q=9.33、3.83,P均<0.01;甲弥甲亢组与甲弥甲减组比较,q=5.55,P<0.01）。ROC曲线显示,VI鉴别诊断甲状腺弥漫性病变患者甲状腺功能亢进与减低的阈值为9.526%,敏感度为70.0%,特异度为76.5%,曲线下面积为0.733。VI鉴别诊断甲状腺弥漫性病变患者甲状腺功能异常与正常的阈值为7.404%,敏感度为62.5%,特异度为88.9%,曲线下面积为0.768。Pearson相关分析结果显示,甲弥甲亢组患者VI与血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）浓度呈正相关（r=0.584、0.499,P均<0.05）,与血清促甲状腺激素浓度呈负相关（r=-0.447,P<0.05）;甲弥甲减组患者VI与FT4浓度呈负相关（r=-0.342,P<0.05）,与FT3、TSH浓度无相关性（r=0.121、-0.007,P均>0.05）。 结论CFA技术能量化甲状腺实质内的血流信号,对甲状腺弥漫性病变患者甲状腺功能评估有一定的应用价值。     

血清降钙素原的测定及在临床中的应用

目的探讨血清降钙素原(PCT)检测在细菌感染性疾病中的诊断价值及临床意义。方法对58例感染性疾病患者采用半定量固相免疫测定法测定患者血清PCT水平(PCT水平分别为小于0.5、0.5～2.0、2.0～10和大于10 ng/mL4个等级),并与C-反应蛋白(CRP)(CRP的水平分别为小于10、大于或等于10 mg/L 2个等级)及中性粒细胞碱性磷酸酶(NAP)(NAP的水平分别为小于80、大于或等于80分/100N.C 2个等级)进行比较,分析各指标在细菌及非细菌感染中的差异。结果 48例细菌感染性疾病患者PCT阳性40例,阳性率83.33%;CRP测定阳性31例,阳性率64.58%,NAP测定阳性29例,阳性率60.42%;同期23例非细菌感染性疾病患者PCT测定阳性3例,阳性率13%,而CRP测定阳性11例,阳性率47.83%,NAP测定阳性10例,阳性率43.48%。细菌感染组PCT、CRP和NAP的阳性率均高于非细菌感染组,其中细菌感染组PCT的阳性率与非细菌感染组PCT的阳性率比较,差异有统计学意义(P0.01),细菌感染组CRP和NAP的阳性率与非细菌感染组CRP和NAP的阳性率比较,差异有统计学意义(P0.05),而细菌感染组PCT的阳性率与CRP和NAP的阳性率比较,差异有统计学意义(P0.05)。结论 PCT检测应用于细菌感染性疾病,可作为早期快速鉴别细菌感染的实验室新指标,且血清PCT水平高低可作为是否使用抗菌药物的参考依据。     

血清TT3、FT3、TT4、FT4以及TSH检测意义

目的探讨TT3、FT3、TT4、FT4以及TSH在甲状腺疾病患者中检测的价值;总结分析各指标变化情况。方法收集分析本院200例甲状腺疾病患者,并选取健康者50例作为对照组。用化学发光分析法检测各组甲状腺功能,并对各组各指标的检测值进行比较。结果甲亢组T3、T4、FT3、FT4均高于健康对照组,甲减组T3、T4、FT3、FT4均低于健康对照组。TSH含量甲亢组低于健康对照组,甲减组明显高于健康对照组。与健康对照组比较其差异均有统计学意义。甲亢组FT3诊断符合率为96%,TSH为96%,T3为92%,FT4为90%,T4为88%。甲减组TSH诊断符合率为100%,FT4为93%,T4为90%,FT3为77%,T3为70%。结论 FT3、T3、TSH在甲亢诊断中有临床意义;FT4、T4、TSH在甲减诊断中有临床意义。     

Suppression of Pituitary TSH Secretion in the Patient with a Hyperfunctioning Thyroid Nodule

10 patients with a single hyperfunctioning thyroid nodule each were studied for pituitary thyrotropin (TSH) suppression. They were judged to be euthyroid on clinical grounds. The total thyroxine (T(4)D), free thyroxine (FT(4)), total triiodothyronine (T(3)D), and free triiodothyronine (FT(3)) were normal in most of the patients. Incorporation of (131)I into the hyperfunctioning thyroid nodules was not suppressed by the administration of physiological doses of T(3). Basal serum TSH concentrations were undetectable (<0.5 - 1.0 muU/ml) in all patients. The metabolic clearance of TSH in one patient before and after excision of the thyroid nodule was unchanged (40 vs. 42 ml/min) whereas the calculated production rate was undetectable before the operation (<29 mU/day) and normal after (103 mU/day). These data, in one patient, suggest that the undetectable concentration of TSH in these patients is a result of suppressed TSH secretion rather than accelerated TSH clearance.In eight patients, basal serum TSH concentrations failed to increase after the intravenous administration of 200 mug of thyrotropin-releasing hormone (TRH); minimal increases in serum TSH concentrations were observed in two patients. The suppression of TSH was evident despite "normal" concentrations of circulating thyroid hormones. The observation that normal serum concentrations of T(4)D, FT(4), T(3)D, and FT(3) may be associated with undetectable basal serum TSH concentrations and suppressed TSH response to TRH was also found in four hypothyroid patients given increasing doses of L-thyroxine and sequential TRH stimulation tests.     

Extended clinical utility of a sensitive and reliable radioimmunoassay of thyroid-stimulating hormone

We have developed a radioimmunoassay for thyroid-stimulating hormone (TSH) that is sufficiently sensitive to permit reliable measurement of subnormal serum TSH levels. We report our evaluation of the utility of this radioimmunoassay in the diagnosis and management of thyroid disease. In 59 normal subjects, the mean serum TSH level was 1.49 +/- 0.10 microU/ml (mean +/- SEM) with the range 0.5 to 4.5 microU/ml. In patients without pituitary-hypothalamic lesions, the serum TSH level accurately reflected thyroid status, being subnormal in 29 hyperthyroid patients, supranormal in 26 hypothyroid patients, and normal in 31 euthyroid patients being treated for nonthyroid conditions. In patients being treated for either hyperthyroidism or hypothyroidism, the serum TSH level appeared to be a sensitive indicator of thyroid status, and its return to normal appeared to be a useful therapeutic criterion. We conclude that improving the sensitivtity and reliability of the serum TSH radioimmunoassay greatly extends its clinical applications.     

Cardiac systolic time intervals and thyroid hormone levels during treatment of hypothyroidism.

This study was undertaken to compare results of modern serum thyroid hormone assays with cardiac systolic time intervals (STI) during thyroxine treatment in hypothyroid patients. The patients were assessed clinically (Billewicz index) and the STI and serum thyrotropin (TSH), total and free thyroxine (T4) and total and free triiodothyronine (T3) were determined in 16 hypothyroid women (Group I) treated with 50 micrograms increments of thyroxine, and in 13 women who had a history of thyroid carcinoma and high-dose thyroxine replacement therapy and had elevated thyroid hormone concentrations (Group II). The STI of 24 matched healthy female controls were used for reference of STI. The pre-ejection period (PEP) index and the PEP/LVET ratio (left ventricular ejection period) were greater in untreated overtly and mildly hypothyroid patients (p less than 0.05) than in the controls. During stable thyroxine therapy [mean daily dosage for Group I 137.5 (7.3) micrograms and for Group II 220 (61) micrograms] the PEP correlated with serum free T4 (FT4), as measured by a two-step method (SpectriaR) (r = -0.55, p less than 0.01, n = 29) and total T4 (r = -0.51, p less than 0.05, n = 29), but not with TSH, T3, FT3 or FT4 measured by an analogue method Amerlex-M(R). The TRH test was not valuable in follow-up because of the strong correlation between basal TSH and stimulated TSH values (r = 0.95). In conclusion, STI are useful for assessment of the thyroid state in untreated hypothyroid patients. Serum TSH becomes normal in the same time as STI and is the best for follow-up. If serum TSH is low and the patient is on stable thyroxine therapy, we recommend serum FT4 for monitoring thyroxine replacement. Two-step FT4 assays had the best correlation with STI, which has significance in patients with non-thyroidal illness.     

难治性甲亢患者超声影像学特征及其与相关血清学指标的相关性

探讨难治性甲亢患者超声影像学特征及其与相关血清学指标的相关性。方法 选取我院2016年1月~2018年1月收治的156例难治性甲亢患者为观察组,再选取同期于我院体检健康者121例为对照组,所有研究对象均经实验室检查和彩色多普勒超声检查。对比分析超声影像学特征、血清学指标总三碘甲腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）水平,通过Pearson分析影像学特征与血清学指标的相关性。结果 观察组患者甲状腺体积、最高流速、管径显著高于对照组（P＜0.05）,血流阻力指数略大于对照组,但比较无明显差异（P＞0.05）;观察组患者血清FT3、FT4、 TT3、TT4水平均显著高于对照组（P＜0.05）,TSH水平显著低于对照组（P＜0.05）;经Pearson相关性分析,TSH与甲状腺体积、最高血流速度、管径大小呈负相关（r＜0,P＜0.05）;FT3、FT4、TT3、TT4与甲状腺体积、最高血流速度、管径大小均呈正相关（r＞0,P＜0.05）。结论 采用超声检查难治性甲亢患者甲状腺体积、最高血流速度、管径大小可较好反映难治性甲亢病情,为诊治和监测难治性甲亢提供可靠参考。     

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...     

Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients

In either an ambulatory or a hospitalized patient setting, a normal serum sensitive thyrotropin (TSH) value is strongly suggestive of euthyroidism if the patient has intact hypothalamic-pituitary function and is not receiving drugs known to suppress pituitary TSH secretion. In stable ambulatory patients, an abnormal sensitive TSH value is strongly suggestive of clinical or subclinical thyroid hormone excess or deficiency, which can be confirmed by a free thyroxine (T4) index (FT4I) and evaluation for antimicrosomal antibody (AMA) as a marker of autoimmune thyroid disease. In a hospitalized patient, an abnormality in sensitive TSH or FT4I does not necessarily indicate a thyroid problem but may merely reflect a nonthyroidal illness or glucocorticoid or dopamine treatment. A thyrotropin releasing hormone (TRH) test may be needed to diagnose hyperthyroidism in a hospitalized patient with a basal sensitive TSH level of less than 0.1 microU/ml because a detectable TRH response contraindicates hyperthyroidism whereas hyperthyroid patients with nonthyroidal illness have the expected absent response. In a hospitalized patient, hypothyroidism must be diagnosed on the basis of both a high TSH level and a low FT4I because an isolated high TSH value may merely reflect the recovery phase of a nonthyroidal illness. No clinical urgency exists for establishing a diagnosis of subclinical hypothyroidism in a hospitalized patient; definitive determination of thyroid status can be deferred until recovery and discharge.     

Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy

Many patients taking customary doses of levothyroxine have slightly elevated serum thyroxine (T4), apparently normal serum triiodothyronine, suppressed serum thyrotropin (thyroid-stimulating hormone; TSH) concentrations, and no clinical symptoms of hyperthyroidism. Recent reports suggest that these patients may have adverse effects from subclinical hyperthyroidism, including abnormally short systolic time intervals, elevations in liver enzymes, and reductions in bone density. Controversy exists about which thyroid function tests should be used to monitor patients taking levothyroxine. A review of currently available data suggests that replacement doses of levothyroxine given to hypothyroid patients should be adjusted so that serum TSH measured by the new sensitive assays is within the normal range. Patients requiring suppressive doses of levothyroxine to shrink goitrous thyroid tissue or to prevent growth of abnormal tissue should be given the minimal dose needed to accomplish the desired clinical or biochemical response.     

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.     

青壮年甲状腺功能亢进患者的骨代谢特征

目的：通过对初发的青壮年甲状腺功能亢进症（甲亢）患者的骨密度（BMD）的测定,研究甲亢患者骨代谢的特征。方法采用双能X线吸收法对我院369例初发未经治疗的青壮年甲亢患者组和148名健康对照组进行腰椎L2-4,股骨近端的BMD检测,同时测定甲状腺功能、AKP、PTH、CT、24 h尿钙、血钙等。结果比较甲亢组与健康对照组的FT3、FT4和TSH差异有统计学意义（P0.05）;甲亢骨量正常组24 h尿钙与对照组比较差异无统计学意义（P〉0.05）,而甲亢骨量异常组24 h尿钙与对照组比较有显著性差异（P〈0.05）;甲亢患者BMD与血清FT3、FT4呈负相关,与TSH呈正相关。结论通过甲状腺功能、骨密度及骨代谢指标的研究分析,发现甲亢将导致青壮年骨量减少和骨质疏松,因此在治疗甲亢时,不应忽略对骨质疏松的预防。     

原发性甲状腺功能亢进症患者血尿酸相关性研究

【目的】探讨原发性甲状腺功能亢进症（甲亢）患者血尿酸（UA）与甲状腺功能水平的相关性。【方法】收集原发性甲亢患者61例,按照血 UA 水平（男性＞420μmol／L ,女性＞360μmol／L ）分为高尿酸血症（ HUA）组、正常尿酸血症（ NUA）组,另外收集同期年龄和性别匹配的健康体检人群作为健康对照组,检测并比较三组甲状腺功能指标[游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH ）水平]、空腹血糖（FBS）、肾功能指标[尿素氮（BUN）、肌酐（Cr）、UA ];肝功能[丙氨酸基转移酶（ALT ）和天冬氨酸氨基转移酶（AST ）]、血脂[三酰甘油（TG）、胆固醇（TC）、高密度脂蛋白（HDL‐C）、低密度脂蛋白（LDL‐C）],分析 UA 与甲状腺功能水平的相关性。【结果】NUA 组 FT3、FT4均明显高于对照组（P ＜0．01）,而 TC 、HDL‐C 、LDL‐C 、TSH 均明显低于对照组（P ＜0．01）,但两组 FBS 、AST 、TG 、BUN 、Cr 、UA 比较差异无统计学意义（P ＞0．05）。与 NUA 组比较,HUA 组 BUN 、UA 、Cr 、FT3、FT4明显升高（P ＜0．05）,TSH 水平明显下降,其差异均有统计学意义（P ＜0．05）;而两组 FBS 、ALT 、AST 、TG 、TC 、HDL‐C 、LDL‐C 比较差异无统计学意义（P ＞0．05）。 UA 与 FT3、FT4呈正相关（P ＜0．05）,与 TSH 呈负相关（P ＜0．05）,血清 Cr 与 FT3、FT4呈负相关（P ＜0．05）。【结论】原发性甲亢患者易合并血 UA 升高,血 UA 水平与患者的高甲状腺激素水平密切相关。     

血清半胱氨酸蛋白酶抑制剂C水平与甲状腺功能的相关性研究

目的研究血循环中半胱氨酸蛋白酶抑制剂C（Cys C）与甲状腺功能指标的相关性,探讨甲状腺功能对Cys C产生和分泌的影响。方法采用乳胶粒子增强散射免疫比浊法测定36例甲状腺功能亢进症（简称甲亢）、34例甲状腺功能减退症（简称甲减）患者及34名健康对照者的血清Cys C浓度,并追踪随访观察甲亢及甲减患者经药物治疗病情缓解、甲状腺功能指标恢复正常后血清Cys C浓度的变化。结果与健康对照者比较,甲亢患者血清Cys C浓度明显升高（P〈0．001）,甲减患者明显降低（P〈0．01）。经药物治疗后,甲亢患者血清Cys C浓度较治疗前明显降低（P〈0．001）;甲减患者血清Cys C浓度较治疗前明显升高（P〈0．01）,与健康对照组比较,差异无统计学意义（P〉0．05）。直线相关回归分析结果表明,血清Cys C浓度与血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）浓度呈显著正相关（r=0．791,P〈0．001;r=0．796,P〈0．001）,与血清促甲状腺激素（TSH）浓度呈显著负相关（r=-0．511,P〈0．001）。结论血清Cys C水平与甲状腺功能状态具有相关性,甲亢时升高,甲减时降低。FT3、FT4和／或TSH可能对细胞产生、分泌Cys C有调控作用。     

Biochemical markers of bone turnover in patients with thyroid dysfunctions and in euthyroid controls: a cross-sectional study.

Hyperthyroidism is associated with reduced bone mineral density. Conflicting data exist regarding the effects of thyroxine therapy on bone metabolism. The aim of the present study was to assess changes in markers of bone turnover in thyroid dysfunction. A total of 28 patients with overt hyperthyroidism, eight patients with suppressed TSH levels (thyroid hormones within the euthyroid range, no T4 therapy), 25 euthyroid and four hypothyroid patients were included in the present study. Hyperthyroidism resulted in increased bone metabolism, as reflected by increased bone resorption and bone formation parameters. No significant differences in mean levels between patients with TSH supression and those with euthyroidism could be observed; however, a higher frequency of elevated urinary PYD- and DPD excretion rates were noted in patients with TSH suppression. Regression analysis revealed highly significant correlations between bone resorption markers and thyroid parameters, suggesting, that even a mild thyroid hormone excess may lead to an increase in bone resorption. In subjects with suppressed TSH levels and peripheral thyroid hormone levels within the euthyroid range, elevated bone resorption markers point to subclinical hyperthyroidism, if other reasons for an increase in bone turnover rates can be excluded.     

抑郁症患者甲状腺功能变化的研究

目的研究抑郁症患者甲状腺功能的变化情况。方法比较纳入研究的5 316例抑郁症患者(病例组)与5 316例同期健康体检者(对照组)促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平的差异;不同性别抑郁症患者TSH、FT3、FT4水平的差异;老年与中青年抑郁症患者甲状腺疾病检出率的差异。结果病例组与对照组TSH、FT3、FT4水平差异有统计学意义(P0.05);抑郁症患者中男女间TSH、FT3、FT4水平差异有统计学意义(P0.05);抑郁症患者老年组与中青年组比较,甲状腺功能亢进患者分别占6.50%、6.10%,但差异无统计学意义(P0.05),亚临床甲状腺功能减退患者分别占24.30%、9.40%,差异具有统计学意义(P0.05),甲状腺功能减退患者分别占14.30%、2.90%,差异具有统计学意义(P0.05)。结论甲状腺激素水平降低易引起抑郁症,对易出现甲状腺功能减退的女性及老年人群更应预防抑郁症的发生;甲状腺激素可作为抑郁症的常规筛查指标,但不是特异性指标。     

醋酸泼尼松+环磷酰胺治疗甲亢合并突眼的临床疗效及血清TRAb、IL-1变化研究

目的 探讨醋酸泼尼松+环磷酰胺治疗甲亢合并突眼的临床疗效及血清促甲状腺激素受体抗体(TRAb)、白细胞介素-1(IL-1)变化研究.方法 前瞻性选取2016年5月至2019年12月北京医院收治的64例甲亢合并突眼患者,采用随机数字表法将其分为2组:对照组(n=30)予以常规甲亢治疗,研究组(n=34)在常规治疗基础上应...     

Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients

Thyrotropin (TSH) concentrations were measured in 1580 hospitalized patients and 109 normal persons. Using the mean +/- 3 SD limits of the log values for the controls (0.35-6.7 milli-int. units/L), the proportion of abnormal TSH results in the hospitalized patients was 17.2%. TSH was undetectable (less than 0.1 milli-int. unit/L) in 3.1% of patients, suggesting hyperthyroidism, and high (greater than 20 milli-int. units/L) in 1.6%, suggesting hypothyroidism. On follow-up of 329 patients, 62% with abnormal TSH (less than 0.35 or greater than 6.7 milli-int. units/L) and 38% with normal TSH concentrations, only 24% of those with undetectable TSH had thyroid disease: 36% of them were being treated with glucocorticoids and 40% had nonthyroidal illness (NTI). Although half the patients with TSH greater than 20 milli-int. units/L had thyroid disease, 45% of patients had high TSH values associated with NTI. TSH concentrations usually returned towards normal when patients' therapy with glucocorticoids was discontinued or they recovered from NTI. TSH test sensitivity appeared good when the mean +/- 3 SD limits of the reference population were used, i.e., no cases of hyper- or hypothyroidism, as identified by free thyroxin index (FT4I), were missed. However, TSH test specificity was inferior to that of the FT4I test (90.7% vs 92.3%), although specificity could be improved to 97.0% if the wider TSH reference limits of 0.1 to 20 milli-int. units/L were used--limits considered pathological if applied to outpatients. Evidently, different reference intervals for TSH are needed for hospitalized and nonhospitalized patients. We conclude that a "sensitive TSH assay" is not a cost-effective thyroid screening test for hospitalized patients as compared with the FT4I.     

Total and free triiodothyronine and thyroid-binding globulin concentration in elderly human persons.

Total thyroxine (TT4) and triiodothyronine (TT3) were found to be low in healthy elderly subjects with a preferential decrease of triiodothyronine. In order to determine the importance of these findings 22 healthy elderly subjects were examined. Free triiodothyronine (FT3), thyroid binding globulin (TBG) concentration and basal thyroid stimulating hormone (TSH) were measured by radioimmunoassay. Liver enzymes, cholesterol and total protein concentration were also assayed. TBG was significantly increased compared to a middle-aged group and did not correlate with TT4, TT3 and TSH. Basal TSH values were in the normal range and could be detected in all the elderly subjects in contrast to undetectable values in 40% of the younger subjects. FT3 determined directly did not correlate with the values calculated according to the law of mass action. According to the FT3 values the elderly subjects could be subdivided into three groups independent of their TT4, TT3, TBG and TSH values. FT3 was undetectable in one group, in the low normal to normal range in another and elevated in the third group. Our results suggest that 1) there is no correlation between TT4, TT3, elevated TBG and FT3 determined directly or by calculation, 2) basal TSH values seem to indicate possible hypothyroidism in elderly persons which is correlated with elevated cholesterol levels and 3) FT3 measured directly subdivides this metabolic state into three groups possibly depending on the intracellular concentration of T4.     

临床甲亢和亚临床甲亢患者血清 Nrg4，TSK水平与血脂、甲状腺激素和基础代谢率的相关性分析

目的　探讨临床甲状腺功能亢进症（ hyperthyroidism,HT）、亚临床甲状腺功能亢进症（简称亚甲亢）患者血清神经调节蛋白 4（Nrg4）、Tsukushi（TSK）水平与血脂、甲状腺激素、基础代谢率（ basal metabolic rate,BMR）的相关性。方法　纳入黑龙江省红十字（森工总）医院 2018年 12月～ 2020年 12月收治的 HT患者 150例、亚甲亢患者 130例分别作为 HT组、亚甲亢组,选取同期该院体检的健康志愿者 80例作为表观健康组。比较三组血清 Nrg4, TSK水平以及血脂指标 [总胆固醇（ TC）、三酰甘油（ TG）、低密度脂蛋白胆固醇（ LDL-C）、高密度脂蛋白胆固醇（HDL-C）]、甲状腺激素指标 [TSH、甲状旁腺素（ PTH）、游离甲状腺素（ FT4）、游离三碘甲状腺原氨酸（ FT3）、总三碘甲状腺原氨酸（ TT3）,总甲状腺素（ TT4）]和 BMR,分析患者血清 Nrg4,TSK水平与血脂、甲状腺激素、 BMR的相关性,观察血清 Nrg4与 TSK的相关性。结果　HT组血清 Nrg4,TSK,PTH,FT4,FT3,TT3,TT4和 BMR高于亚甲亢组（ t=9.591～ 29.295,均 P＜ 0.05）和表观健康组（ t=11.543～ 26.872,均 P＜ 0.05）,而血清 TSH,TC, TG,LDL-C和 HDL-C水平低于亚甲亢组（ t=3.776～ 27.429,均 P＜ 0.05）和表观健康组（ t=3.531～ 17.533,均 P＜ 0.05）,差异均有统计学意义。亚甲亢组血清 Nrg4,TSK水平高于表观健康组（ t=5.277,7.008,均 P＜ 0.05）,但 HDL-C, TSH水平低于表观健康组（ t=10.358,28.220,均 P＜ 0.05）,差异均有统计学意义。 Pearson线性相关分析提示 HT患者血清 Nrg4,TSK水平与血清 TC,LDL-C,HDL-C和 TSH水平呈负相关（ r=-0.652～ -0.371,均 P＜ 0.05）,与血清 PTH,FT4,FT3,TT3,TT4及 BMR呈正相关（ r=0.349～ 0.593,均 P＜ 0.05）;亚甲亢患者血清 Nrg4,TSK水平与 HDL-C,TSH水平呈负相关（ r=-0.615～ -0.489,均 P＜ 0.05）;HT,亚甲亢患者血清 Nrg4与 TSK水平均呈正相关（r=0.581,0.563,均 P＜ 0.05）。结论　针对性别、年龄、吸烟史、饮酒史混杂因素进行校准,并将上述因素剔除后发现 HT,亚甲亢患者血清 Nrg4,TSK水平均增高,且 HT患者的 Nrg4,TSK与血脂、甲状腺激素和 BMR有明显相关性,而亚甲亢患者的 Nrg4,TSK仅与 HDL-C,TSH有关。