昏迷与甲状腺毒症

本文报告一例昏迷伴有明显的皮质脊髓束病变的甲亢患者,采用标准药理学方法及血浆除去法处置,使总甲状腺素由28.8μg/dl降至10μg/dl;三碘甲状腺氨酸由332ng/dl降至150ng/dl。这些实验室检查结果与临床改善、精神状态改善以及皮质脊髓束症状的消失有关。这些资料支持过去关于甲状腺毒症的皮质脊髓束病变是可逆的论点。 以前文献曾提到甲亢与皮质脊髓束机能障碍的病因关系。这些论文描述了3例甲亢患者甲状腺机能     

介入栓塞甲状腺动脉与口服抑亢丸联合治疗Graves病

目的：观察抑亢丸与介入栓塞甲状腺动脉联合治疗甲状腺机能亢进症(Graves病)的临床疗效。方法：16例Graves病患均行介入栓塞甲状腺上、下动脉后，8例术后口服他巴唑或丙基硫氧嘧啶，8例患术后口服抑亢丸，观察比较抑亢丸的疗效。结果：介入术后口服抑亢丸与口服他巴唑或丙基硫氧嘧啶效果相同。结论：介入栓塞甲状腺动脉后口服中药抑亢丸与口服他巴唑或丙基硫氧嘧啶治疗Graves病疗效相同。     

甲状腺功能亢进症患者血清尿酸水平变化的临床分析

目的 探讨甲状腺功能亢进（以下简称甲亢）患者血清尿酸浓度变化及临床意义.方法 测定150例甲亢患者血清尿酸浓度并对其中50例经治疗后临床痊愈停药者复查血清尿酸水平.结果 新发甲亢组患者血清尿酸浓度为（404.54±53.96）μmol/L,较正常对照组（301.19±45.48）μmol/L 显著升高（P＜0.01）.治疗好转组患者复查血清尿酸浓度为（293.15±42.45）μmol/L,较治疗前明显下降（P＜0.01）.结论 新发甲亢患者血清尿酸浓度明显升高,经治疗甲状腺功能恢复正常后血清尿酸浓度可显著下降.表明甲亢作为一种消耗性疾病,其高代谢状态可导致尿酸代谢异常,使血尿酸浓度升高.     

自体骨髓干细胞移植治疗肝硬化失代偿期19例临床分析

目的 观察经肝动脉行自体骨髓干细胞移植对肝硬化失代偿期患者的治疗效果.方法 选择肝硬化失代偿期患者19例,在常规治疗的前提下抽取骨髓200 ml,在体外分离纯化骨髓干细胞并制成10 ml细胞悬液,经肝动脉将上述10 ml细胞悬液通过介入方法移植入肝脏,分别在移植后第2、4、8周复查肝脏功能,观察实验室指标、临床症状及不良反应情况.结果 移植后第4周,血浆白蛋白由（32.9±4.3）g/L升至（35.6±3.2）g/L（P〈0.05）,谷草转氨酶（AST）由（74.3±20.3）U/L降至（48.3±13.8）U/L（P〈0.05）,谷丙转氨酶（ALT）和总胆红素水平在移植前后无显著性变化,凝血酶原时间由术前的（23.7±4.8）s降至（19.3±3.1）s（P〈0.05）,甲胎蛋白由术前的（12.5±5.6）μg/L升至（24.7±9.7）μg/L（P〈0.05）;患者食欲改善,体力好转18例（94.7%）,腹胀减轻7例,腹水减少7例,胸水减少3例,下肢浮肿减轻5例.在全部19例患者中术中未发生严重并发症,患者近期无不良反应出现.结论 自体骨髓干细胞移植治疗可使失代偿期肝硬化患者肝功能明显改善,治疗安全有效且副作用小,可作为中晚期肝硬化患者的临床治疗手段之一.     

老年人不同甲状腺功能状态下脂代谢特征与氧化应激的关系

目的 探讨老年人不同甲状腺功能状态下脂代谢特征与氧化应激的关系.方法 初诊老年甲状腺疾病患者86例[甲状腺功能亢进(甲亢)47例,甲状腺功能减退(甲减)39例]、非老年甲状腺疾病患者83例(甲亢43例,甲减40例)和老年健康对照组20例.检测空腹血浆丙二醛(MDA)和超氧化物歧化酶(SOD),氧化型低密度脂蛋白(OX-LDL)水平,同时测定血脂指标及甲状腺功能,计算SOD/MDA比值.结果 老年甲亢组血脂各组分均高于非老年甲亢组、低于老年对照组(P＜0.05或P＜0.01);老年甲亢组与非老年甲亢组、老年对照组比较,丙二醛[分别为(10.23±6.29)、(7.37±4.58)μmol/L和(3.66±2.53)μmol/L]、游离脂肪酸(FFA)[分别为(0.86±0.58)、(0.61±0.46)mmol/L和(0.45士0.12)mmol/L]和SOD显著升高(P＜0.01或P＜0.05).老年甲减组与非老年甲减组和老年对照组比较,MDA[(9.03±5.98)、(6.59±3.18)μmol/L和(3.66±2.53)μmol/L]、OX-LDL[(387.36±71.04)、(355.22±45.01)μg/L和(324.53±56.19)μg/L]及部分血脂组分均显著增高(P＜0.05或P＜O.01).老年甲亢组、甲减组SOD/MDA比值均低于老年对照组和非老年组(均为P＜0.01).多元回归分析,甲亢组游离甲状腺素(FT4)和FFA是影响MDA的因素,甲减组非HDL-C和LDL-C与MDA独立相关.结论 初诊老年甲亢和甲减患者氧化应激增强,氧化损伤程度与脂代谢紊乱有关.     

子宫动脉栓塞治疗剖宫产术后晚期产后出血22例临床分析

目的探讨子宫动脉栓塞术治疗剖宫产术后晚期产后大出血的疗效和并发症。方法 2010年1月至2013年6月,对22例剖宫产术后晚期产后大出血患者,采用seldinger技术行双侧子宫动脉插管和造影,明确出血部位及出血动脉分支,用明胶海绵颗粒栓塞双侧子宫动脉。结果 22例患者均30~70分钟内完成栓塞治疗,12例术后立即止血,10例出血明显减少,术后均生命体征平稳,经一周对症治疗后,出血均完全停止,复发1例经再次介入栓塞后治愈。栓塞后19例出现下腹部及会阴部疼痛;16例出现发热,经对症治疗后均得到有效缓解。结论使用子宫动脉栓塞介入治疗剖宫产术后晚期产后大出血,具有止血快、创伤小、可保留生育功能等优点,疗效好、不良反应少,有较高的临床应用价值。     

内分泌和遗传性疾病

中国医学文摘·内科学2000年第21卷第4期491 20002890高催乳素血症20例病因和治疗分析/吴乐霞…刀安徽医学一2000,21(l)一24 20例均女性,24一47岁,均有溢乳。血清催乳素(PRL)均呈不同程度升高(40一170拌g/L)。病因和治疗:垂体PRL瘤10例,其中9例垂体微腺瘤经口服澳隐停溢乳停止,PRL降至正常;1例垂体大腺瘤经手术治愈。甲状腺功能减退症5例,经甲状腺片替代治疗8~10周痊愈。药物性5例(吗丁琳3例、胃复安1例、奋乃静1例),停药后短时间溢乳症状消失。(杨直)20002891甲状腺功能亢进症患者w型胶原改变的临床观察/朱丽萍…刀浙江医学一2000,22(3…     

原发甲状腺功能亢进症患者术前应用地塞米松效果观察

32例甲亢患者术前用卢戈液10 d,于第8天静滴5%葡萄注射液500 ml加地塞米松20 mg,1次/d,连用3 d后手术,观察应用地塞米松前及第1、3次用药后24 h血清TT3、TT4、FT3、FT4变化.结果1次静滴地塞米松后TT3、FT3降至正常,3次后,TT4、FT4亦降为正常;术后均无甲状腺危象发生.证实甲亢术前应用地塞米松可预防甲状腺危象发生,其机制为促进甲状腺激素的分解代谢.     

甲亢合并糖尿病的临床分析-附40例报告

选择2012年1月~2016年12月DM合并甲亢患者40例,加强饮食控制,以维生素较高、微量元素含量较高和富含蛋白质的食物为主,血糖水平较高,甲亢选择是甲巯咪唑或丙硫氧嘧啶,20例开始采用胰岛素治疗,20例考试采用口服降糖药物服用。结果。全部患者经过2~3月治疗,临床症状均有效的控制与改善。治疗后空腹血糖(FPG)(6.23±0.78)mmol/L、餐后2h血糖(2h PG)(7.58±1.06)mmol/L、FH3(4.22±0.89)μg/L、FH4(9.13±1.65)μg/L低于治疗前的(9.78±2.14)mmol/L、(12.98±3.29)mmol/L、(13.95±2.22)μg/L、(35.27±8.33)μg/L;TSH(4.12±2.22)IU/ml高于治疗前的(0.43±0.14)IU/ml(P0.05)。结论 DM和甲亢是相互加重病情应该足够重视。     

介入治疗无海绵体瘘的高流量性阴茎异常勃起

目的探讨以明胶海绵微粒栓塞阴茎背动脉治疗无动脉海绵体瘘的高流量性阴茎异常勃起的可行性及疗效。方法对10例无动脉海绵体瘘的高流量性阴茎异常勃起患者进行超选择性阴茎背动脉造影并明胶海绵微粒栓塞。结果 10例患者排除低流量型异常勃起后,造影见阴茎背动脉较粗,未见动脉海绵体瘘、动静脉畸形、假性动脉瘤等异常病变,介入栓塞后阴茎恢复疲软状态,临床治愈。对栓塞术后4、6和18个月患者勃起功能和性生活质量进行随访,效果满意,未复发。结论超选择性阴茎背动脉造影及明胶海绵微粒栓塞治疗无动脉海绵体瘘的高流量性阴茎异常勃起安全、有效。     

甲状腺功能亢进性肝损害与甲巯咪唑继发性肝损害的临床比较研究

目的分析甲状腺功能亢进症(简称甲亢)性肝损害患者的肝功能与甲状腺功能的相关性,探讨抗甲亢药物甲巯咪唑所致肝损害患者的临床特征及其引起肝损害的相关因素。方法纳入甲亢性肝病患者54例(甲亢性肝损害组)和初诊未治的无肝损害甲亢患者33例(甲亢无肝损害组),收集两组患者用药前的一般资料和临床资料(甲状腺功能和肝功能),分析甲亢性肝损害的相关因素;将同期抗甲亢药物甲巯咪唑致肝损害患者(27例)根据肝功能指标分为肝细胞型组(7例)、胆汁淤积型组(12例)和混合型组(8例),收集其一般资料和临床资料(甲状腺功能和肝功能)并比较。结果甲亢性肝损害组患者治疗前的ALT、AST、碱性磷酸酶(ALP)、谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)、游离三碘甲腺原氨酸(FT 3)、游离甲状腺激素(FT 4)和促甲状腺激素受体抗体(TRAb)水平明显高于甲亢无肝损害组(P<0.05),两组患者ALT、ALP、γ-GT水平均与FT 3、FT 4、TRAb水平呈明显正相关(P<0.05)。肝细胞型组、胆汁淤积型组和混合型组患者的年龄、用药时间、ALT、ALP比较差异均有统计学意义(P<0.05)。结论甲亢患者甲状腺功能异常的严重程度可能与其肝损害相关;抗甲亢药物甲巯咪唑引起的肝损害类型可能与患者年龄、病程及用药时间有关。     

系统性红斑狼疮合并甲状腺疾病的临床特征分析

目的 调查系统性红斑狼疮（SLE）合并免疫性甲状腺疾病的年患病数,并探讨分析其临床特点.方法 回顾性调查2008年度武汉同济医院风湿免疫科住院的172例SLE病例,分析其中49例检测了甲状腺功能患者的临床资料,并分组比较SLE合并甲状腺疾病的临床特征.结果 SLE合并甲状腺功能减退症（甲减）组,17例;SLE合并甲状腺功能亢进症（甲亢）组,10例;病例对照组,22例.SLE合并甲状腺疾病的总体患病率约为15.7%,合并甲减和甲亢的患病率分别为9.89%和5.81%.多关节炎和抗ds-DNA抗体阳性检出率低是SLE合并甲减的主要特征,发热则在SLE合并甲亢的病人多见（P均＜0.05）.结论 SLE合并甲状腺疾病临床并不少见,它具有独特的临床特征,应注意监测其甲状腺功能.     

平阳霉素碘油乳剂栓塞甲状腺动脉的实验研究

观察平阳霉素碘油乳剂(PLE)栓塞犬甲状腺动脉的效果。结果提示PLE栓塞甲状腺效果良好,反应较轻,并发症较少,是一种可供选择的甲亢栓塞剂。     

Thyroid function and changes in ultrasound morphology during antiviral therapy with pegylated interferon and ribavirin in patients with chronic hepatitis C

Summary. Thyroid disease is a common side‐effect of interferon‐based antiviral therapy for chronic hepatitis C, which may lead to dose reduction or discontinuation of therapy. The aim of this study was to investigate changes in ultrasound morphology, thyroid function, autoimmunity as well as predictive factors for the development of thyroid dysfunction in patients with hepatitis C virus infection treated with pegylated interferon‐α (PEG‐IFN‐α) and ribavirin. A total of 59 patients with chronic hepatitis C assigned for antiviral treatment with PEG‐IFN‐α and ribavirin were enrolled into the study. All patients were subjected to an ultrasound examination of the thyroid gland before treatment, and after 1, 3 and 6 months of antiviral therapy. In addition, thyroid function and autoimmune status were determined at fixed time‐points. Prior and during the course of therapy, 11 patients (19%) developed thyroid dysfunction (one hypothyroidism, nine hyperthyroidism, one hyperthyroidism followed by hypothyroidism). Hyperthyroidism was shown to be Graves’ disease in one patient and destructive thyroiditis in nine patients. Power‐Doppler ultrasound could differentiate between destructive thyroiditis and Graves’ disease. A reduction in echogenicity suggestive for a destructive process of the thyroid gland was observed even before changes in thyroid function of antibody status could be measured. Risk factors for the development of thyroid dysfunction were age, female gender, pre‐treatment thyroid volume, pre‐existing thyroglobulin/thyroid peroxidase antibodies and viral load. Changes in thyroid function are a common side‐effect occurring during antiviral therapy with PEG‐IFN‐α and ribavirin. Ultrasound presents a simple complementary tool for screening and follow‐up during antiviral therapy, which helps to differentiate between the common types of hyperthyroidism and gives insight into morphological changes of the thyroid gland during antiviral therapy.     

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.     

Hypothyroidism after iodine-131 or surgical therapy for Graves' disease hyperthyroidism

BACKGROUND: The aim of this work was to describe late permanent hypothyroidism after iodine-131 or surgery, and to seek predictive factors of hypothyroidism for the two treatments. MATERIAL: From 1979 to 1994, 462 patients with Graves' disease hyperthyroidism underwent definitive treatment. Three hundred and fifty-five patients were treated with low calculated doses of iodine-131, and 107 patients with subtotal thyroidectomy. Life-table analysis was performed and the cumulative incidence of hypothyroidism was calculated by Kaplan-Meier's method, and survival (euthyroidism) within the groups was compared by the Mantel-Cox method. RESULTS: Of the 355 patients treated with one dose of 6.6 1.9 mCi of iodine-131, 246 became euthyroid after one dose, and 109 needed 2 or more doses. Twenty-two patients received one or more doses higher than 10 mCi. The probability of euthyroidism at 145 months after low-dose was 10. 19% and age, sex, pretreatment with antithyroid drugs, previous subtotal surgery did not influence the final outcome. Of the 107 surgically treated patients the probability of euthyroidism at 144 months was 56.1%. Age, sex, duration of hyperthyroidism, duration of antithyroid treatment, weight of thyroid resected, did not influence the final outcome. The weight of the thyroid remnant was 5.4 1.5 g and the multivariate statistical model by conditional logistic regression showed that the weight of thyroid remnant was the only variable that influenced long-term thyroid function. CONCLUSIONS: There is no ideal dose of iodine-131 that would correct hyperthyroidism in Grave? disease without risk of hypothyroidism. Surgery is an alternative definitive treatment with a risk of hypothyroidism within the 2 first years, and a cumulative risk of hypothyroidism lower than with iodine-131.     

Ultrasensitive TSH : a new diagnostic approach to hyperthyroidism

The value of new ultrasensitive and rapid immunoradiometric assay of thyroid stimulating hormone (TSH) for the diagnosis of hyperthyroidism was assessed in 130 patients with suspected hyperthyroidism and in 330 controls. The diagnosis was established by the clinical evaluation, thyroid scintigraphy and serum concentrations of thyroid hormones. Using the ROC (Receiver Operating Characteristic) curve methodology which allows the optimization of sensitivity and specificity, the physician can choose the "Cut-off" value between hyperthyroidism and euthyroidism. Two points of the curve seem to be interesting : using the "cut-off" value of 0.1 mUI/l, sensitivity is 0.98 and specificity is 0.98 ; using the "cut-off" value of 0.3 mUI/l, sensitivity is 1.00 and specificity is 0.92. Using the association TSH and FT4 (Free Thyroxin), sensitivity is 0.94 and specificity is 0.99. Sixty four per cent of euthyroid patients with TSH under 0.3 mUI/l have one or several hot nodules and only two have no thyroid disease. A TRH (Thyrotrophin Releasing Hormone) test was carried out in 63 patients with suspected thyrotoxicosis : basal and TRH stimulated TSH levels were under 0.1 mUI/l. This immunoradiometric assay for TSH may simplify the approach to thyroid function testing in patients with suspected thyrotoxicosis : a basal TSH under 0.3 mUI/l is sufficient to confirm a clinical suspicion of thyrotoxicosis without TRH test within four hours. In a department devoted to testing thyroid function, this new method provides a great benefit in cost and work.     

Effect of long-term amiodarone therapy on thyroid hormone levels and thyroid function

Both hyperthyroidism and hypothyroidism have been noted to occur in some patients treated with amiodarone for cardiac arrhythmias. To determine the frequency of the development of thyroidal abnormalities in patients receiving amiodarone, 45 euthyroid patients were prospectively evaluated. Serum samples were obtained for measurement of thyroxine, thyrotropin, triiodothyronine, and triiodothyronine resin uptake prior to initiation of amiodarone treatment and serially over a 12- to 27-month period during which amiodarone was administered. The patients were divided into four subgroups as follows: Group I (n = 22) had elevated thyroxine levels, Group IIA (n = 13) had normal thyroxine levels and normal thyrotropin levels, Group IIB (n = 7) had normal thyroxine levels and elevated thyrotropin levels, and Group III (n = 3) had subnormal thyroxine levels. Demographic factors (such as route of administration, cardiac diagnosis, sex of the patient, or indication for amiodarone therapy) and amiodarone levels had no significant effect on the thyroid hormone parameters. However, Group I patients were statistically older than the patients in the other groups. Linear regression analysis revealed a negative correlation for thyroxine levels and a positive correlation with thyrotropin levels with age for the whole group. The various groups were not statistically affected by duration of therapy, but a positive trend existed for increasing thyroxine levels. Although virtually all patients showed changes in their thyroid hormone levels, chemical hyperthyroidism (elevated thyroxine and triiodothyronine levels without symptoms) developed in only two patients (4 percent), and clinical hyperthyroidism (elevated thyroxine and triiodothyronine levels with symptoms) developed in no patients. Four patients (9 percent) became biochemically and clinically hypothyroid. Thus, amiodarone frequently influences thyroid hormonal parameters, but less commonly causes a change in actual thyroid function. However, hyperthyroidism and hypothyroidism do occur in a significant number of patients.     

Evolution and predictive factors of thyroid disorder due to interferon alpha in the treatment of hepatitis C

AIM： To study predictive factors of thyroid dysfunction associated with interferon-alpha （IFNa） therapy in chronic hepatitis C （CHC） and to describe its long-term evolution in a large population without previous thyroid dysfunction. METHODS： We performed a follow-up of thyroid function and detection of thyroid antibodies in 301 patients treated for CHC with IFNα from 1999 to 2004. RESULTS： Thyroid disorder developed in 30/301 （10%） patients with a mean delay of 6 ± 3.75 mo： 13 patients had hyperthyroidism, 11 had hypothyroidism, and 6 had biphasic evolution. During a mean follow-up of 41.59 ± 15.39 mo, 9 patients with hyperthyroidism, 3 with hypothyroidism, and 4 with biphasic evolution normalized thyroid function in 7.88 ± 5.46 mo. Recovery rate of dysthyroidism was not modified by treatment discontinuation, but was better for patients with negative thyroid antibodies before antiviral treatment （P = 0.02）. Women had significantly more dysthyroidism （P = 0.05）. Positive thyroid peroxidase and thyroglobulin antibodies were more frequent before antiviral treatment in patients who developed dysthyroidism （P 〈 0.0003 and P = 0.0003, respectively）. In a multivariate model, low fibrosis was found to be a predictive factor of dysthyroidism （P = 0.039）.
CONCLUSION： In this monocentric population of CHC, dysthyroidism, especially hyperthyroidism, developed in 10% of patients, Low fibrosis was found to be a predictive factor of dysthyroidism, Thyroid disorder recovered in 16/30 patients （53%） and recovery was better in the non-autoimrnune form,     

Thyroid disorders and autoantibodies in systemic lupus erythematosus and rheumatoid arthritis patients

To determine the patterns of thyroid dysfunction and autoantibodies associated with SLE and RA patients, twenty patients with SLE and another group of twenty with RA were studied. The results were compared with those of twenty apparently healthy age- and sex- matched controls. All patients were subjected to complete history taking, thorough clinical examination and joint examination. All patients and controls were subjected to the following investigations: T3, T4, TSH, antithyroglobulin antibodies (ATGAb) and thyroid peroxidase antibodies (TPOAb). Also, complete blood picture, ESR, RF, ANA, CRP and LE cells were done. This study revealed that thyroid disorders were significantly increased in SLE patients (50%) when compared to RA (15%) (P<0.05). In SLE group, 20% had euthyroid sick syndrome, 20% had hypothyroidism (10% subclinical and 10% biochemical), and 10% had hyperthyroidism (5% subclinical and 5% biochemical). However, in RA, 10% had hypothyroidism (subclinical) and 5% had subclinical hyperthyroidism. TPOAb was found in 15% of SLE and 5% of RA patients and 10% of controls, but the titres were higher in SLE and RA patients. Also, ATGAb was found in 5% of SLE, 30% of RA patients and 10% of controls, but the titres were higher in SLE and RA patients. It is concluded that thyroid abnormalities are more implicated with euthyroid sick syndrome and hypothyroidism (subclinical and overt) than hyperthyroidism in SLE patients. SLE and RA were associated with antithyroid antibodies (TPOAb in SLE and ATGAb in RA). Performance of thyroid function tests in patients with SLE, in particular and RA as a part of the biochemical and immunological profiles, may help in early detection of associated thyroid disorders.