3种血清标志物检测在桥本甲状腺炎中的诊断探讨

目的探讨甲状腺过氧化物酶抗体(anti-TPO)、甲状腺球蛋白抗体(anti-Tg)、促甲状腺激素受体抗体(TRAb)水平对桥本甲状腺的临床诊断意义。方法收集2014年1月至2015年12月在本院已确诊桥本甲状腺炎(HT)患者89例,根据其甲状腺功能分为甲状腺功能低下组(HT1)21例,甲状腺功能亢进组(HT2)9例,甲状腺功能正常组(HT3)59例;临床确认为Graves病(GD)35例;单纯性结节性甲状腺肿(SG)40例;80例来本院健康体检者作为对照组,其中男18例,女62例。用电化学发光免疫分析(CLIA)方法测定5组anti-TPO、anti-Tg、TRAb水平并统计分析。结果不同疾病患者血清中的anti-TPO、anti-Tg和TRAb水平及阳性率间差异均有统计学意义(P0.05);在HT患者中,HT1组anti-TPO水平高于HT2及HT3组,anti-Tg水平在HT1、HT2、HT3组之间差异无统计学意义(P0.05),anti-TPO和anti-Tg水平在HT组高于GD组,GD组高于SG组及健康对照组,且差异有统计学意义(P0.05),但SG组与健康对照组差异无统计学意义(P0.05)。TRAb阳性率在GD组最高,与其他4组阳性率比较,差异均有统计学意义(P0.05)。结论联合检测anti-TPO,anti-Tg是诊断HT的重要指标,TRAb对鉴别诊断HT与GD有重要意义。     

应用彩色多普勒超声诊断桥本甲状腺炎

目的 探讨二维及彩色多普勒超声对桥本甲状腺炎的诊断价值。方法本组28例桥本甲状腺炎病人，根据二维超声及彩色多普勒血流特点分为弥漫肿大型、结节肿大型及局限性桥本病三型。结果 桥本甲状腺炎的甲状腺体积增大(局限性桥本病除外)，内部回声减低，呈网络样改变，病变部位血流信号丰富。结论 二维及彩色多普勒超声可以对桥本甲状腺炎正确分型，对各型桥本病进行鉴别诊断。     

Thyroiditis: differential diagnosis and management

Thyroiditis is a group of inflammatory thyroid disorders. Patients with chronic lymphocytic thyroiditis (also referred to as Hashimoto's thyroiditis) present with hypothyroidism, goiter, or both. Measurement of serum thyroid autoantibodies and thyroglobulin confirms the diagnosis. Subacute granulomatous thyroiditis (sometimes referred to as de Quervain's disease) is a self-limited but painful disorder of the thyroid. Physical examination, elevated erythrocyte sedimentation rate, elevated thyroglobulin level and depressed radioactive iodine uptake (RAIU) confirm the diagnosis. Subacute lymphocytic thyroiditis (silent thyroiditis) is considered autoimmune in origin and commonly occurs in the postpartum period. Symptoms of hyperthyroidism and depressed RAIU predominate. Acute (suppurative) thyroiditis is a rare, infectious thyroid disorder caused by bacteria and other microbes. The rare, invasive fibrous thyroiditis (Riedel's thyroiditis) presents with a slowly enlarging anterior neck mass that is sometimes confused with a malignancy.     

高频超声对桥本甲状腺炎的诊断价值

目的探讨桥本甲状腺炎(HT)的二维及彩色多普勒超声表现。方法对60例HT患者进行常规二维高频超声及彩色多普勒超声检查,并经手术或穿刺活检证实。将超声检查结果与手术或多点穿刺活检结果对照。结果局灶性回声减低型7例(11.7%);弥漫性回声减低型40例(66.7%);多发结节型13例(21.6%)。10例(16.7%)甲状腺内可见强回声光斑。HT组甲状腺上动脉PSV及RI值较正常组高,两者比较差异有显著性意义(P<0.05)。HT组有51例甲状腺内血流增加。结论高频超声对HT的正确诊断有重要价值。     

超声诊断桥本甲状腺炎的临床价值

目的探讨二维超声及彩色多普勒显像（CDFI）对诊断桥本氏甲状腺炎（HT）的临床价值。方法回顾性分析经实验室检查、临床或手术病理证实的45例HT患者的超声声像图特点。结果超声下显示HT患者甲状腺体积不同程度增大,峡部明显增厚;甲状腺内部回声分为4型：弥漫性回声减低型28例,结节型12例,局限性回声减低型3例,无明显变化型2例;39例HT患者甲状腺内彩色血流信号明显增加,可探及双侧颈部淋巴结者35例。结论 HT超声声像图具有一定的特异性,在HT的诊断、鉴别诊断上有重要价值,能为临床提供更可靠的诊断依据。     

桥本甲状腺炎合并甲状腺癌的临床病理研究

目的:探讨桥本甲状腺炎(HT)与甲状腺乳头状癌(PTC)的关系。方法:单纯HT73例,HT合并PTC23例,分析两者的临床表现、病理组织学表现,并作酪氨酸激酶受体(RET)免疫组化染色。结果:HT临床表现多样化,部分表现为结节状,合并的甲状腺癌均为乳头状癌,且微小癌占多数。50%HT病变对于RET染色存在局灶性阳性反应。结论:HT病变组织中不同程度地存在与PTC相同的肿瘤基因,HT合并的PTC可能与HT有关。     

Thyroiditis: a clinical update

Thyroiditis may be categorized as acute (suppurative), subacute (granulomatous or lymphocytic), or chronic (invasive fibrous or lymphocytic). Acute suppurative thyroiditis is typically caused by a bacterial infection and resolves with appropriate antibiotic treatment. The subacute thyroiditides are characterized by spontaneously resolving hyperthyroidism associated with low radioiodine uptake, often followed by transient hypothyroidism. Neck pain is the initial symptom in subacute granulomatous thyroiditis, and the disorder recurs only in a minority of patients. Subacute lymphocytic thyroiditis is typically painless, often occurs in the postpartum period, and is being increasingly recognized in the Great Lakes area of the United States. Invasive fibrous thyroiditis (Riedel's struma) is exceedingly rare, often mimics carcinoma, and is associated with extracervical foci of fibrosclerosis. Chronic lymphocytic (Hashimoto's) thyroiditis, an organ-specific autoimmune disease, occurs in at least 2% of women. Although the disorder often produces hypothyroidism, the type of thyroid dysfunction present in patients with Hashimoto's disease reflects the character of the dominant thyroid autoantibody--that is, destructive, blocking, or stimulatory.     

Vitamin D receptor gene polymorphisms are associated with risk of Hashimoto's thyroiditis in Chinese patients in Taiwan

The etiology of the autoimmune thyroid, Hashimoto's thyroiditis (HT) is not very clear. However, genetic susceptibility is thought to play a critical role. The vitamin D receptor (VDR)-related endocrine system has been demonstrated to be able to carry out modulation of the immune response. Here, we investigated whether single nucleotide polymorphisms (SNPs) of VDR are associated with HT patients. VDR SNP was detected by polymerase chain reaction (PCR)-based restriction analysis in 109 patients with HT and 90 normal controls. Significant differences were found in the genotype distribution of VDR SNP between Hashimoto's thyroiditis patients and controls (P=0.0458). Allelic frequency of the VDR gene distinguished HT patients from controls (P=0.0089). The results revealed a significant difference between HT patients and normal controls in VDR SNP and a statistic correlation between VDR-FokI polymorphisms and HT formation. It could be concluded that patients who carry the C/C homozygote of the VDR-FokI gene polymorphism in exon 2 may have a higher risk of developing HT in Chinese patients in Taiwan.     

Hashimoto encephalopathy with pegylated interferon alfa-2b and ribavirin

OBJECTIVE: To report an instance of Hashimoto encephalopathy probably resulting from pegylated interferon alfa-2b and ribavirin. CASE SUMMARY: A 36-year-old woman with a 10-year history of autoimmune thyroiditis presented with symptoms and signs consistent with Hashimoto encephalopathy during therapy with pegylated interferon alfa-2b and ribavirin for chronic hepatitis C. DISCUSSION: Hashimoto encephalopathy is a rare autoimmune condition that occurs in patients with Hashimoto thyroiditis and high titers of antithyroid antibodies. It is characterized by a variety of nonspecific neuropsychiatric symptoms, increased cerebrospinal fluid protein level, and abnormal brain imaging and electroencephalogram. Prompt response to corticosteroids is observed in most cases. As of August 29, 2005, this is the first report of such an association. An objective causality assessment revealed that the Hashimoto encephalopathy was probably caused by the patient's medications. CONCLUSIONS: Hashimoto encephalopathy may rarely be triggered by interferon alfa therapy in susceptible patients.     

In vitro regulation of antithyroglobulin synthesis by lymphocytes of patients with Hashimoto's disease by an antigen-specific "suppressor factor" derived from cultured normal human T-lymphocytes

Suppressor factors (SF) elaborated by peripheral blood T-lymphocytes in culture from normal subjects activated by thyroglobulin as well as those from patients with Hashimoto's thyroiditis (HT), were tested for their ability to modulate antithyroglobulin synthesis by cultured HT-lymphocytes. A micro ELISA system and a micro reverse haemolytic plaque assay system were employed to detect antithyroglobulin and antithyroglobulin secreting B-lymphocytes respectively. In the latter system, the SF from normal T-lymphocytes caused suppression of thyroglobulin-specific plaque formation by HT lymphocytes while the "SF" from HT T-lymphocytes did not cause any suppression in most of the cases studied. A "SF" obtained by using liver antigen as a non-specific antigen, did not cause suppression of plaques. These results were highly significant (p less than 0.001). Although differences were seen with and without SF in the ELISA system, they were not statistically significant, likely due to a lack of sensitivity of the ELISA system as compared with the plaque assay. These observations imply that the HT-lymphocytes were deficient in thyroid antigen specific T-suppressor cell function and/or numbers to begin with and that the added normal SF afforded the signal necessary to the helper T-cells to suppress antibody synthesis by the B-lymphocytes. It is thus inferred that there is a defect in antigen-specific suppressor T-lymphocyte function in Hashimoto's thyroiditis.     

Patterns of cellular immune responses to thyrocyte membrane antigens and specific immunoregulatory defects in autoimmune thyroid disease

Although Graves' disease (GD), Hashimoto's thyroiditis (HT) and idiopathic myxoedema (Myx) are clinically distinct autoimmune thyroid diseases, previous studies using crude thyroid preparations as a source of antigens have failed to identify differences in cellular immune responses. In this study, we have assessed cellular immunity in patients with these disorders to two antigen preparations (derived from thyroid gland and cervical fat) enriched in cell membranes and known to share a functional TSH receptor. Using an indirect T-lymphocyte migration inhibitory factor (T-LIF) assay, T-cell immunity to thyroid membranes was demonstrated in 11/11 patients with GD, 4/5 with HT and 4/5 with Myx, but in none of 18 patients with chronic active hepatitis (another organ-specific autoimmune disease) or sixteen healthy controls. In contrast, T lymphocytes responsive to adipocyte membranes were detected only in patients with GD. TSH binding inhibiting antibodies were found exclusively in six patients with GD, and thyroid stimulating antibodies in five of these patients. In co-culture experiments designed to study the activity of antigen-specific suppressor T cells, low numbers of T cells from 6/6 normal controls, 4/4 patients with HT and 5/5 patients with myxoedema suppressed the response to adipocyte membranes of T lymphocytes from patients with Graves' disease. The results of this study demonstrate different patterns of T-cell reactivity to thyroid antigens in patients with Graves' disease, Hashimoto's thyroiditis and myxoedema and suggest that cellular immunity to the TSH receptor is restricted to patients with Graves' disease and associated with a defect in the specific immunoregulatory control of this response.     

桥本氏甲状腺炎的彩色超声声像图分析

目的探讨桥本甲状腺炎(HT)的声像图特征。方法回顾性分析经病理、针吸细胞学及实验室检查确诊的60例HT患者的声像图特征。结果①HT的声像图特征可分为4种类型,即局限型(9例)、结节型(6例)、弥漫型(21例)和弥漫型并结节(24例);②不同声像类型甲功减低的发生率不同;③弥漫型并结节中的HT结节可由弥漫型发展而来,药物干预后结节可逐渐消失而再次转回为弥漫型HT;④弥漫型及弥漫型并结节的HT共45例,其腺体血供均出现不同程度增多,但仅14例呈"火海征"。结论彩色多普勒超声可以对声像图复杂的HT做出比较准确的诊断。     

二维及彩色多普勒超声对桥本氏病的诊断价值

本文对45例病理组织学明确诊断的桥本氏病患者进行了二维超声（2D）及彩色多普勒显像（CDI）检查，发现本病多呈弥漫性回声减低型，同时伴有甲状腺增大、其内纤维组织增生呈网格样改变等特点，仅少数患者为限局性回声减低型及多发结节型。各型病变部位均呈多血流表现，甲状腺上动脉收缩期最高流速除限局性回声减低型接近正常外，其余均较正常组明显增高。结果表明，桥本氏病的2D及CDI特点有助于临床诊断及与Graves’病相鉴别。     

Riedel's thyroiditis: clinical, pathological and imaging features

Riedel's thyroiditis (RT) is an extremely rare form of chronic thyroiditis, characterised by a fibroinflammatory process which partially destroys the thyroid, often involving surrounding tissues. We describe an unusual case of RT in a 38-year-old woman, and discuss its typical clinical, pathological, ultrasound, radionuclide scanning and magnetic resonance findings. We conclude that the diagnosis of RT is highly suggestive in the presence of a hard gland (or nodule), fixed to adjacent structures; 'cold' on Tc99 scan; hypoechoic with absence of vascular flow, invading the adjacent neck structures on ultrasound; hypointense in T1- and T2-weighted MR images; and showing fibrous tissue fragments with inflammatory cells at cytological examination. Thyroidectomy has to be performed to confirm the diagnosis and to relieve pressure symptoms.     

Total thyroidectomy for the treatment of Hashimoto’s thyroiditis coexisting with papillary thyroid carcinoma

The coexistence of Hashimoto’s thyroiditis (HT) and papillary thyroid carcinoma (PTC) is controversial. This study was conducted to evaluate the correlation between HT and PTC and to identify predictive factors for the coexistence of PTC and HT. A total of 922 patients underwent surgery for thyroid disorders between January 2001 and August 2005. In all, 199 patients had been diagnosed with PTC, 37 of whom had coexistent HT; in 689 patients, benign thyroid disease had been diagnosed. Patients’ age and sex, as well as histopathology, tumor size, nodal involvement status, multicentricity, presence of metastasis, and serum thyroglobulin levels, were retrospectively reviewed. A significant correlation was observed between HT and PTC, although no statistical significance was noted between PTC and HT type (nodular or diffuse). Most patients with PTC+HT were female and younger (<40 y old) than those with PTC only. The rate of occult tumor in patients with PTC+HT was higher than that in patients with PTC alone. Data indicate the coexistence of PTC and HT and suggest that PTC may develop even in cases of diffuse HT. Total thyroidectomy is the surgical procedure of choice, especially in young, female patients with HT.     

超声诊断桥本甲状腺炎合并结节样病变56例分析

【目的】探讨桥本甲状腺炎（HT）合并结节样病变的超声声像特征、鉴别诊断及误诊原因。【方法】分析56例经手术病理证实的桥本甲状腺炎合并结节样病变的超声声像特征。【结果】56例HT合并结节样病变中,病理证实：32例单纯HT结节（单发或多发）,15例HT合并乳头状癌,7例HT合并滤泡性腺瘤,2例HT合并结节性甲状腺肿。超声检查诊断单纯HT结节（单发或多发）26例,甲状腺癌7例,腺瘤5例,结节性甲状腺肿2例,与病理相符,诊断准确率71．4％（40／56）。误诊16例,其中5例单纯HT结节、7例甲状腺癌及2例腺瘤误诊为结节性甲状腺肿,2例单纯HT结节误诊为腺瘤,误诊率为28．6％。甲状腺癌与单纯性HT结节,在结节形态不规则、边界不清晰、内部伴钙化声像表现上有显著差异。【结论】对HT甲状腺结节的超声诊断应以结节外腺体回声情况及腺体血供情况并结合血清学甲状腺抗体的检测进行全面分析和判断;对于结节形态不规则、边界不清晰、伴有钙化灶者要警惕．合并有恶变的可能。     

声触诊组织量化技术在桥本氏甲状腺炎诊断中的应用价值

目的 探讨声触诊组织量化(VTQ)技术在桥本氏甲状腺炎(HT)诊断中的临床应用价值。方法 选取53例HT患者和46例健康志愿者行甲状腺常规超声及VTQ检查,根据剪切波速度绘制ROC曲线。结果 53例HT的二维超声表现分为5类,各类型HT的剪切波速度差异无统计学意义(F=0.424,P=0.790)。ROC曲线分析阈值,当剪切波速度≥2.53时,诊断HT的灵敏度、特异度分别为87 ％、100％。53例HT按甲状腺功能分甲亢、甲减及甲功正常组。三组HT的剪切波速度两两比较,差异无统计学意义(P =0.884),但均较正常甲状腺组明显增高,差异均有统计学意义(均P=0.000)。结论VTQ技术作为无创、量化检测HT的方法,可评价甲状腺组织的硬度,对HT的诊断有一定帮助。     

Successful use of caplacizumab in a case of refractory acquired thrombotic thrombocytopenic purpura following subacute thyroiditis

Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare condition mainly characterized by microangiopathic hemolytic anemia, thrombocytopenia, reported in approximately three cases per one million adults per year. Some reports describing co-occurrence of aTTP and other autoimmune disorders, as Graves’ thyroiditis, are reported. To the best of our knowledge this is the first report describing co-occurrence of subacute thyroiditis and aTTP. The patient was refractory to conventional therapy with plasma exchange, steroids and rituximab but was successfully treated with the addition of caplacizumab, an anti‐VWF bivalent variable‐domain‐only immunoglobulin fragment that inhibits interaction between VWF multimers and platelets.     

Thyroid hormone resistance syndrome due to a novel heterozygous mutation and concomitant Hashimoto’s Thyroiditis: A pedigree report

Thyroid hormone resistance syndrome (THRS) is a rare disease characterized by reduced sensitivity to thyroid hormones. Mutations in the thyroid hormone receptor beta (THRB) gene are considered as contributing to the pathogenesis. This report describes a Chinese pedigree with THRS and Hashimoto’s thyroiditis (HT) due to novel point mutation in the 11th exon of the THRB gene (c. 1378 G > A). The proband complained of goitre with increased thyroid hormone and normal thyroid stimulating hormone levels. Gene sequencing was performed to confirm the diagnosis. HT was also diagnosed based on positive thyroid autoantibodies and diffuse, grid-like changes in the thyroid on ultrasound examination. Additionally, a comprehensive examination of the proband’s pedigree was conducted. The patient’s father exhibited the same gene mutation site and was diagnosed with THRS and HT. No mutation site was detected in three patients with HT only and three healthy volunteers. Thus, gene sequencing should be considered the gold standard for diagnosing THRS. Furthermore, treatment should be individualized to control the patient’s symptoms rather than normalizing thyroid hormone levels. Further studies that determine the relationship between THRS and TH are warranted.     

Steroid responsiveness in a case of Riedel's thyroiditis and retroperitoneal fibrosis

Riedel's thyroiditis is a rare chronic inflammatory disease of the thyroid characterised by an invasive fibrotic process. We present a lady with newly diagnosed hypothyroidism, rapidly enlarging hard, fixed goitre, strongly positive thyroid antibodies and raised erythrocyte sedimentation rate (ESR). A tru-cut biopsy confirmed Riedel's struma. Regression of the goitre and reduction of antibody titres occurred after starting prednisolone, which was stopped after 10 months. Six months later, she presented with renal failure due to retroperitoneal fibrosis that was successfully treated by reinstitution of steroids and ureteric stenting. Very high titres of thyroid antibodies and hypothyroidism predating development of goitre suggest coexistence of Hashimoto's thyroiditis and Riedel's thyroiditis. Tru-cut biopsy obviated the need for open thyroidectomy. A predominantly inflammatory as opposed to fibrotic thyroid histology may predict good response to steroids. Relapse following steroid withdrawal may not only be in the thyroid but also at other sites.