左旋甲状腺素治疗妊娠期亚临床甲减妇女对后代神经智力发育影响的前瞻性研究

目的 通过前瞻性观察妊娠期亚临床甲状腺功能减退(甲减)妇女左旋甲状腺素(L-T4)治疗后甲状腺功能指标的动态变化和后代神经智力的发育情况,探讨L-T4对妊娠期亚临床甲减妇女后代神经智力发育的影响.方法17例亚临床甲减孕妇未接受治疗(SCH组),23例亚临床甲减孕妇接受L-T4治疗(SCH+LT4组),24例正常孕妇(C组)作为对照组.3组孕妇分别在妊娠12周(G12)、16周(G16)、20周(G20)、24周(G24)、28周(G28)、32周(G32)和(或)36周(G36)接受随访检查,检测血清TSH、TT4、FT4、TT3、FT3、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb).应用Bayley量表对所有孕妇的后代在14～30月龄检测智力和运动评分.结果SCH组、SCH+LT4组和C组孕妇后代的智力发育指数(MDI)分别为115.12分、118.56分和117.63分;运动发育指数(PDI)分别为115.47分、120.65分和117.50分.与其他两组比较,SCH+LT4组MDI和PDI评分均较高,SCH组MDI和PDI评分均较低,但3组间比较没有统计学差异.SCH组孕妇的血清TSH在妊娠过程中始终保持在2.0 mIU/L以上,各时点都明显高于C组(均P＜0.05);血清TT4和FT4水平除G28和G32外其他时点均略低于同时点C组水平.SCH+LT4组孕妇基础血清TSH水平明显高于其他两组(均P＜0.01),血清TT4和FT4水平则低于其他两组;在接受L-T4治疗后血清TSH水平明显下降,自G12至孕末期始终与C组水平相当,且低于同时点SCH组孕妇的水平;血清TT4和FT4水平则明显升高至与对照组相当的水平.结论L-T4的及时治疗能够维持妊娠早期亚临床甲减患者妊娠全程血清TSH在正常水平,这很可能会避免后代智力和运动能力发育水平的下降.     

Serum free thyroid hormones in different degrees of hypothyroidism and in euthyroid autoimmune thyroiditis

Serum total and free T4 and T3, thyroxine-binding globulin (TBG) and TSH, basal and 20, 30 and 60 min after TRH (200 micrograms, iv), were evaluated in 125 hypothyroid patients (38 with severe, 23 with mild, and 64 with subclinical hypothyroidism), in 35 euthyroid subjects with autoimmune thyroiditis, and in 51 healthy controls. T4/TBG and T3/TBG ratios were also calculated. A significant decrease in all indices of thyroid function except for T3 occurred simultaneously with a significant increase in basal and TRH-stimulated TSH levels from healthy subjects to subclinical hypothyroids, from subclinical to mild and from mild to severe hypothyroids; euthyroid patients with autoimmune thyroiditis did not differ from healthy subjects. All severe hypothyroid patients had low T4 as well as free T4 (FT4), free T3 (FT3), T4/TBG and T3/TBG ratios, but among mild and subclinical hypothyroids direct determination of FT4 and FT3 proved to be a better index of thyroid function than determination of T4 and T3 even after correction for TBG levels. FT4 was the most commonly abnormal index (19 of 23 subjects with mild and 14 of 64 with subclinical disease). Regression analysis showed that FT4, T4/TBG ratio, T4, and FT3 had a significant inverse correlation with TSH in hypothyroid patients. Discriminant analysis showed that among the thyroid parameters, FT4 is the variable which discriminates best between control subjects and the 3 groups of hypothyroid patients. These data extend previous reports and in a large series of patients confirm the biological meaning and the clinical value of direct measurement of serum free thyroid hormones in hypothyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thyroid Function Abnormalities and Cognitive Impairment in Elderly People: Results of the Invecchiare in Chianti Study

OBJECTIVES: To investigate thyroid function testing abnormalities in older persons and to explore the relationship between thyroid dysfunction and cognition.
DESIGN: Cross-sectional.
SETTING: Community-based.
PARTICIPANTS: One thousand one hundred seventy-one men and women aged 23 to 102.
MEASUREMENTS: Thyroid function was evaluated by measuring plasma concentrations of thyrotropin (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Prevalence of overt and subclinical thyroid dysfunction was evaluated in different age groups (<65 vs ≥65). Age trends in TSH, FT4, and FT3 were examined in euthyroid participants. The cross-sectional association between thyroid dysfunction and MMSE score was evaluated adjusting for confounders.
RESULTS: Subclinical hypothyroidism and subclinical hyperthyroidism were more prevalent in older than in younger participants (subclinical hypothyroidism, 3.5% vs 0.4%, P <.03; subclinical hyperthyroidism, 7.8% vs 1.9%, P <.002). In euthyroid participants, TSH and FT3 declined with age, whereas FT4 increased. Older participants with subclinical hyperthyroidism had lower MMSE scores than euthyroid subjects (22.61±6.88 vs 24.72±4.52, P <.03). In adjusted analyses, participants with subclinical hyperthyroidism were significantly more likely to have cognitive dysfunction (hazard rate=2.26, P =.003).
CONCLUSION: Subtle age-related changes in FT3, FT4, and TSH occur in individuals who remain euthyroid. Subclinical hyperthyroidism is the most prevalent thyroid dysfunction in Italian older persons and is associated with cognitive impairment.     

The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area.

OBJECTIVE: The aim of the present study was to analyze the current status of morphologic and functional thyroid abnormalities in a previously iodine-deficient area. METHODS: The population based Study of Health in Pomerania (SHIP) comprised 4310 participants, aged 20-79 years. Thyroid function (thyrotropin [TSH] free triiodothyronine [FT(3)], and free thyroxine [FT(4)]) and serum autoantibodies to thyroperoxidase (TPOAb) were evaluated from blood samples. Thyroid structure and size were measured by ultrasound. Data from 3941 participants with no known thyroid disorders were analyzed. RESULTS: The median iodine urine excretion was 12.4 microg/dL. The rate of decreased serum TSH levels (<0.3 mIU/L) was 11.3%; 2.2% of participants had suppressed serum TSH levels (<0.1 mIU/L). The prevalence of subclinical hyperthyroidism was 1.8%, the prevalence of overt hyperthyroidism 0.4%. Elevated TSH levels were found in 1.2% of individuals. Subclinical hypothyroidism was observed in 0.5%, overt hypothyroidism in 0.7% of the sample. Elevated TPOAb were detected in 7% of subjects, 4.1% of participants had TPOAb greater than 200 IU/mL. The prevalence of goiter was 35.9%. An inhomogeneous echo pattern was detected in 35.2% and nodules in 20.2% of participants. Diffuse autoimmune thyroiditis was diagnosed in 47 subjects (1.2%). CONCLUSION: There are a number of thyroid disorders in this previously iodine-deficient region. Further studies are required to investigate the change of thyroid disorders during iodine supplementation programs.     

开展亚临床甲状腺功能减退症的临床研究

亚临床甲状腺功能减退症 (甲减 )是一种常见的内分泌专业亚临床疾病 ,主要诊断依据是血清TSH水平增高 ,而血清FT4正常。亚临床甲减的主要不良后果是发展为临床甲减和促进缺血性心脏病的发生。影响亚临床甲减发展为临床甲减的主要因素有两个 :血清TSH水平和甲状腺自身抗体 ,两个因素有叠加作用。甲状腺激素替代治疗对于阻止亚临床甲减发展为临床甲减的效果尚不确切 ;亚临床甲减与高胆固醇血症、高血压、吸烟和糖尿病一样 ,构成动脉粥样硬化和心肌梗塞的独立危险因素 ,其对此两病的危险度分别为 1.9和 3 .1。甲状腺素纠正亚临床甲减对降低血清胆固醇有一定效果 ;妊娠妇女的亚临床甲减对后代的智力影响已经引起高度关注。我国一组根据对流行病学调查的结果 ,提出了血清TSH、甲状腺自身抗体 (TPOAb、TgAb)的正常值范围 ,以及与疾病相关的甲状腺自身抗体的切割点值 ,可供参考。     

Growth hormone/insulin-like growth factor axis in patients with subclinical thyroid dysfunction

ObjectiveOur aim was to evaluate serum concentrations of GH, IGF-I, and insulin-like growth factor-binding protein-3 (IGFBP-3) in patients with subclinical thyroid dysfunction before and after normalization of thyroid function.Design and methodsThe study included 51 patients (mean age 42.2 ± 1.8 years) with subclinical hypothyroidism and 30 patients (mean age 44.3 ± 2.4 years) with subclinical hyperthyroidism. A group of 37 euthyroid healthy subjects were studied as controls. Serum concentrations of TSH, FT4, FT3, GH, insulin, IGF-I, and IGFBP-3 were measured in all patients before starting therapy and after normalization of thyroid function. The dosage of levothyroxine (LT4) and antithyroid drugs was adjusted in attempt to keep the serum-free thyroxine (FT4) and thyrotropin (TSH) concentrations within the normal range.Main outcomeBaseline growth hormone levels were similar with hypothyroid group and hyperthyroid group in relation to euthyroid control subjects. Fasting serum IGF-I levels were significantly lower in the subclinical hypothyroid group compared with the control group. On the other hand, IGF-I levels of subclinical hyperthyroid patients and control group were similar. After normalization of thyroid function tests, IGF-I concentrations were increased in subclinical hypothyroid subjects, but unchanged in subclinical hyperthyroid subjects. Patients with subclinical hyperthyroidism showed slightly lower mean serum IGFBP-3 concentrations than those found in control group, but the difference was not statistically significant. Serum GH and IGFBP-3 levels were unaltered by treatment.ConclusionsIn this study, it was shown that GH–IGF axis was not affected in patients with subclinical hyperthyroidism, while it was affected in patients with subclinical hypothyroidism. That is, investigation of the axis in subclinical hyperthyroidism would not bring any extra advantages, but LT4 replacement therapy could prevent abnormalities related to GH–IGF axis in patients with subclinical hypothyroidism.     

老年高血压患者亚临床甲状腺功能减退与血压变异性的关系

目的探讨亚临床甲状腺功能减退(亚甲减)的老年高血压患者每日血压变异性(BPV)指标特点及与亚甲减的关系。方法共纳入260例老年高血压患者,其中129例合并亚甲减,131例甲状腺功能正常者作对照,采集患者身高、体重、诊室坐位血压、血甲状腺功能指标、空腹血糖(FBG)、糖化血红蛋白、血脂、高敏C反应蛋白、血尿酸、同形半胱氨酸等指标,同时作24 h动态血压监测。结果亚甲减组与甲功正常组比较,夜间收缩压、清晨收缩压、反杓形节律构成比更高(P<0.05),杓形节律构成比、舒张压夜间下降率更低(P<0.05)。多元逐步回归分析显示:即便排除其他因素影响,清晨收缩压仍与游离三碘甲状腺原氨酸(FT3)负相关,与促甲状腺激素(TSH)正相关;清晨舒张压与年龄负相关,与体重、TSH正相关;夜间收缩压下降率与FBG负相关,与FT3正相关;夜间舒张压下降率与FT3正相关。结论老年高血压患者BPV增大与亚甲减密切相关。     

Thyroid hormone indices during illness in six hypothyroid subjects rendered euthyroid with levothyroxine therapy.

PURPOSE: We wanted to evaluate changes in the natural course of serum thyroxine (T4), tri-iodothyronine (T3), reverse tri-iodothyronine (rT3), and thyroid stimulating hormone (TSH) concentrations during hospitalization for an acute illness, in subjects rendered euthyroid with Levothyroxine (LT4) replacement therapy. METHODS: Six male subjects ranging in age 30 - 65 years with a history of primary hypothyroidism were included. They were euthyroid prior to hospitalization. LT4 continued to be administered orally in the same pre-admission daily dose. Serum, T4, T3, rT3, and TSH concentrations were determined on day of admission to the intensive care unit (ICU) for an acute illness. These were repeated during the first week on alternate days and again during a follow-up visit 1 week after discharge. Student's t-test, analysis of variance, and linear regression were used to analyze the data. RESULTS: Serum T4, T3 declined to a nadir and serum rT3 rose to its peak by day 3 of hospitalization before returning to pre admission euthyroid levels. Serum TSH declined initially but rose to supernormal levels on day 7 before normalization. Significant correlations were noted between TSH on one hand and T3/T4 (r = 0.76, p < 0.001) and rT3/T4 (r= - 0.64, p < 0.001) ratios. CONCLUSIONS: Alterations ensuing during a short stay in the hospital due to an acute illness in subjects with primary hypothyroidism rendered euthyroid with appropriate replacement therapy with Levothyroxine (LT4) are almost identical to those in normal subjects. These changes are probably secondary to altered thyroid hormone metabolism. The altered levels of thyroid hormones and TSH noted in these subjects are transient and therefore providers should refrain from initiating frequent changes in daily LT4 replacement dose during the acute illness in these subjects.     

Assessment of thyroid function in two hundred patients with beta-thalassemia major.

Despite improved hematologic care, multiendocrine dysfunction is a common complication of homozygous transfusion-dependent beta-thalassemia. In this study our goal was to estimate the prevalence of thyroid dysfunction in a large homogenous group of thalassemic patients. Two hundred patients with beta-thalassemia major (100 males and 100 females; mean age, 23.2 +/- 6.7 years; age range 11-43 years), regularly transfused and desferioxamine chelated, were randomly selected from a pool of approximately 800 patients with beta-thalassemia followed in our department. Thyroid function and iron-load status were evaluated by measurements of free thyroxine (FT4), free triiodothyronine (FT3), thyrotropin (TSH), and serum ferritin levels. Of the subgroup of patients who proved to have normal thyroid hormone values, 26 (12 males, 14 females; mean age, 23.6 +/- 6.8 years; age range, 15-36 years) were randomly selected and underwent a standard TRH stimulation test. Thyroid dysfunction was defined as follows: overt hypothyroidism: low FT4 and/or FT3, increased TSH levels; subclinical hypothyroidism: normal FT4, FT3, increased TSH levels; exaggerated TSH response: normal FT4, FT3, normal basal TSH, deltaTSH > or = 21 microIU/mL (TSH levels measured prior and 30 minutes after intravenous TRH administration). Normal thyroid hormone values were found in 167 (83.5%) of the 200 patients studied. Eight (4%) of the remaining patients had overt hypothyroidisim, and 25 (12.5%) had subclinical hypothyroidism. Exaggerated TSH response to TRH was revealed in 7 of the 26 patients with normal hormone values tested (26.9%). Antithyroglobulin and anti-thyroid peroxidase (TPO) antibody titers were negative in 191 patients (95.5%). Mean ferritin levels in hypothyroid and euthyroid patients were 2707.66 +/- 1990.5 mg/L and 2902.9 +/- 1997.3 mg/L, respectively, (p = 0.61), indicating no correlation between ferritin levels and thyroid functional status. Mean ferritin levels in the patients who responded normally to TRH stimulation and in those who overresponded, were 2,586 +/- 1791 mg/L and 3,228 +/- 2473 mg/L, respectively (p = 0.46; NS). Thyroid failure is a rather rare endocrine complication in patients with beta-thalassemic from Greece. In our series, no case of central hypothyroidism was observed. No correlation was found between thyroid functional status and ferritin plasma levels. Approximately 1 of 5 beta-thalassemic patients with normal thyroid hormone values showed an exaggerated TSH response to TRH test. It is to be investigated how many of these patients will establish overt or subclinical hypothyroidism in the future.     

Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients: when does L-T(4) therapy become mandatory?

The effect on thyroid function of GH administration to 66 adult patients with severe GH deficiency was studied. Seventeen patients were euthyroid, and 49 had central hypothyroidism and were adequately treated with L-T(4). Forty patients were assigned to a low recombinant human GH (rhGH) regimen (3 microg/kg body wt.d for 3 months followed by 6 microg/kg body wt.d for another 3 months) and 26 to a higher one (6 microg/kg body wt.d for 3 months followed by 12 microg/kg body wt.d for another 3 months). Serum IGF-I, TSH, free T(4) (FT(4)), free T(3) (FT(3)), reverse T(3), T(4)-binding globulin, and antithyroid autoantibody (TgAb and TPOAb) were measured in basal condition and after 3 and 6 months of therapy. Normalization of IGF-I levels was obtained after 6-month rhGH treatment in 67% of patients, independently from the dose, whereas a significant reduction in FT(4) and reverse T(3) levels was recorded (P < 0.01), without variations in all the other parameters studied, including serum TSH, FT(3), and T(4)-binding globulin circulating levels. Antithyroid autoantibodies were detected in 11 of 66 patients (16.6%). Eight of 17 (47%) euthyroid subjects and 9 of 49 (18.3%) central hypothyroid patients, despite adequate substitution at baseline, showed FT(4) levels under the normal range at the end of the study. Altogether, 17 of 66 patients (25.7%) worsened their thyroid function. This study shows that GH deficiency masks in a consistent number of adult patients a state of central hypothyroidism. Therefore, during rhGH treatment, a careful monitoring of thyroid function is mandatory to start or adjust L-T(4) substitutive therapy.     

Hypothyroidism in patients with autoimmune pancreatitis

AIM To examine thyroid function and clinical features of hypothyroidism in autoimmune pancreatitis(AIP) patients.METHODS We examined thyroid function in 77 patients with type 1 AIP(50 males, 27 females; median age 68 years, range 33-85) diagnosed according to the Japanese diagnostic criteria for AIP 2011. We compared clinical and serological findings between patients with and without various categories of hypothyroidism. The change in hypothyroidism after steroid therapy was also examined. RESULTS Eight patients(10%) had hypothyroidism of 6 patients had subclinical hypothyroidism with a normal serum free thyroxine(FT4) and high thyroid stimulating hormone(TSH) level, and 2 patients had central hypothyroidism with low serum free triiodothyronine(FT3), FT4 and TSH levels. A significant goiter of the thyroid was not observed in any patient. There were no significant differences in age; male to female ratio; serum concentrations of IgG and IgG 4-related disease(IgG4-RD); presence of antithyroglobulin antibody, antinuclear antigen or rheumatoid factor; or presence of extrapancreatic lesions between the 6 patients with subclinical hypothyroidism and patients with euthyroidism. After steroid therapy, both subclinical and central hypothyroidism improved with improvement of the AIP.CONCLUSION Hypothyroidism was observed in 8(10%) of 77 AIP patients and was subclinical in 6 patients and central in 2 patients. Further studies are necessary to clarify whether this subclinical hypothyroidism is another manifestation of IgG4-RD.     

亚临床甲状腺功能减退症患者及甲状腺功能正常者甲状腺功能与血糖水平的关系

目的研究亚临床甲状腺功能减退症患者及甲状腺功能正常者甲状腺功能与血糖的关系。方法采用整群抽样法于2007年至2010年从沈阳市城市成年居民中招募2751名研究对象,行问卷调查,测量血压、身高、体重、腰围、促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、空腹血糖、口服葡萄糖耐量试验2h血糖、甘油三酯、总胆固醇和高密度脂蛋白胆固醇。将受试者分为亚临床甲状腺功能减退症组（n=193）及甲状腺功能正常组（n=2146）,甲状腺功能正常组又进一步分为促甲状腺激素低水平组（n=352,促甲状腺激素／〉0．3-〈1．0mU／L）、促甲状腺激素中水平组（n=916,促甲状腺激素≥1．0-≤1．9mU／L）、促甲状腺激素高水平组（n=944,促甲状腺激素1．9〈-≤4．8mU／L）。受试者根据血糖水平进一步分为糖耐量正常组、糖调节异常组、糖尿病组,分析甲状腺功能指标与血糖的关系。采用t检验及方差分析进行数据统计。结果亚临床甲状腺功能减退症组口服葡萄糖耐量试验2h血糖明显高于甲状腺功能正常组[（8．34-4．4）vs（7．74-4．2）mmol／L,t=一2．163,P〈0．05],2组糖调节异常及糖尿病的患病率差异无统计学意义。糖尿病组游离甲状腺素水平高于糖调节异常组和糖耐量正常组[分别为（16．8±2．1）、（16．3±2．1）、（16．2±1．9μmol／L,F=10．515,P〈0．01],女性中糖尿病组[15．3％（26／188）]及糖调节异常组[15．0％（34／227）]亚临床甲状腺功能减退症的患病率明显高于糖耐量正常组[9．5％（86／903）]（）（2值分别为7．165、5．685,均P〈0．05）,女性亚临床甲状腺功能减退症的患病率明显高于男性[11．1％（146／1318）VS4．6％（47／1027）,x2=31．852,P〈0．01]。多元线性回归分析显示,校正体质指数、腰围、血压、血脂后,总体受试者空腹血糖与游离甲状腺素呈正相关（β=2．748,P〈0．01）,男性受试者空腹血糖与游离甲状腺素亦呈正相关（口=2．346,P〈0．01）,女性受试者口服葡萄糖耐量试验2h血糖与游离甲状腺素呈正相关（／3=2．748,P〈0．01）。在正常范围内,游离甲状腺素水平越高,糖尿病的患病危险越大[总体：比值比（OR）=1．142,95％可信区间（cl）1．064-1．225,P〈0．01;女性：OR=1．147,95％C11．024-1．284,P〈0．05：男性：OR：1．142,95％C11．035-1．261,P〈0．01]。促甲状腺激素及游离三碘甲状腺原氨酸与糖尿病无关。结论女性糖调节异常和糖尿病患者亚临床甲状腺功能减退症的患病率增高;游离甲状腺素与血糖水平呈正相关,游离甲状腺素越高,糖尿病的患病风险越大。     

Do iodine-containing contrast media induce clinically relevant changes in thyroid function parameters of euthyroid patients within the first week?

Little is known about the reaction of normal thyroid glands to the iodine load given by x-ray dyes. We have therefore investigated the short-term effects of high doses of iodine on thyroid parameters in euthyroid patients. We measured free triiodothyronine (FT3), free thyroxine (FT4), and thyrotropin (TSH) serum concentrations before and daily for 1 week after parenteral application of x-ray dyes (coronary angiography: n = 16; computed tomography [CT] of either thorax or abdomen: n = 6; iodine dose range from 300-1221 mg of iodine per kilogram). Inclusion criteria were as follows: normal FT4, normal TSH, negative thyroid antibodies, urinary iodine excretion below 30 microg/dL, no palpable goiter and no euthyroid sick syndrome. All but one patient reacted with a TSH increase. Mean TSH values increased significantly 3-5 days after the iodine load within the normal range. Four patients (18%) had a TSH increase above normal, the maximal observed value being 6.4 microU/mL. Basal TSH values of these four patients were above 2 microU/mL. The day peak TSH concentrations were reached varied from day 1 to day 7, the majority (32%) having the peak on day 3. Peak TSH was significantly correlated with basal TSH values (r = 0.794, p < 0.0001). FT4 and FT3 remained unchanged and there was no significant correlation between the dose of iodine and the TSH reaction. In conclusion, iodine-containing contrast media can induce transiently subclinical hypothyroidism even in euthyroid patients. The TSH reaction seems to depend on the preexisting state of thyroid function.     

Serum Ghrelin Levels in patients with Hashimoto's thyroiditis.

OBJECTIVE: Hypothyroidism is associated with changes in appetite and body weight. Ghrelin is an orexigenic peptide, and it stimulates appetite and increases food intake. However, the potential relationship between circulating ghrelin levels, hypothyroidism, and thyroid antibodies has not been adequately studied. DESIGN: Forty-seven patients with hypothyroidism due to Hashimoto's thyroiditis and 48 euthyroid subjects were enrolled in the study. Thyroid hormones and antibodies, insulin, glucose, ghrelin levels, and lipid parameters were measured in all the subjects. MAIN OUTCOME: Hypothyroid group showed significantly decreased serum levels of ghrelin and ghrelin=body mass index (BMI) compared to euthyroid group (31.9 +/- 21.5 pg/mL vs. 50.5 +/- 34.8 pg/mL, p < 0.001; and 1.24 +/- 0.93 vs. 2.12 +/- 1.53, p < 0.0001). In hypothyroid group, 6 months after treatment, ghrelin levels and ghrelin/BMI remained lower than euthyroid group (33.2 +/- 21.1 pg/mL vs. 50.5 +/- 34.8 pg/mL, p < 0.001; and 1.27 +/- 0.86 vs. 2.12 +/- 1.53, p < 0.0001). Ghrelin levels were decreased in hypothyroid patients with high thyroid peroxidase antibody (TPOAb) titre compared to hypothyroid patients with low TPOAb titre (19.1 +/- 23.1 pg/ mL vs. 35.3 +/- 17.4 pg/mL, p < 0.01). Ghrelin levels correlated positively with free triiodothyronine (FT3) and free thyroxine (FT4), and negatively with age, thyroglobulin antibody (TAb), TPOAb, total cholesterol (T-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TG) in hypothyroid group. In euthyroid group, circulating ghrelin levels correlated negatively with age, FT3, FT4, TG, and VLDL-C levels. No significant correlation was observed between ghrelin and homeostasis model assessment for insulin resistance (HOMA-IR) and between ghrelin and quantitative insulin sensitivity check index (QUICKI) in both groups. Regression analysis revealed that FT3 level is the most important predictor of ghrelin levels. CONCLUSION: Thyroid hormones and antibodies seem to have a potential effect on serum ghrelin levels in patients with hypothyroidism.     

原发性胆汁性胆管炎患者血清甲状腺激素水平和抗甲状腺抗体阳性率变化*

目的 探讨原发性胆汁性胆管炎(PBC)患者血清甲状腺激素水平和抗甲状腺抗体阳性率变化。方法 2018年1月～2020年1月我院收治的PBC患者94例,其中肝硬化50例(Child-Pugh A级29例,B级15例,C级6例)和胆管炎44例,另选择同期于我院健康体检者60名,采用化学发光免疫法测定血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平及血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)。结果 胆管炎患者血清FT3、FT4和TSH水平分别为(2.4±0.5)ng/L、(1.4±0.2)ng/L和(8.9±2.3)ng/L,血清TPOAb和TGAb阳性率分别为77.3%和81.8%,肝硬化患者血清FT3、FT4和TSH水平分别为(1.9±0.3)ng/L、(1.0±0.1)ng/L和(19.7±4.9)ng/L,血清和TPOAb和TGAb阳性率分别为70.0%和64.0%,而健康人血清FT3、FT4和TSH水平分别为(2.8±0.8)ng/L、(1.8±0.3)ng/L和(3.4±1.2)ng/L,血清TPOAb和TGAb阳性率均为0.0%,肝硬化和胆管炎患者血清FT3和FT4水平显著低于,血清TSH水平显著高于健康人(P＜0.05),而肝硬化患者血清FT3和FT4水平显著低于,血清TSH水平显著高于胆管炎患者(P＜0.05),肝硬化和胆管炎患者血清TPOAb和TGAb阳性率比较,无统计学差异(P＞0.05);在肝硬化患者中,Child-Pugh A级患者血清FT3和FT4水平显著高于,血清TSH水平显著低于Child-Pugh B级或C级患者(P＜0.05),而Child-Pugh B级患者血清FT3和FT4水平显著高于,血清TSH水平显著低于Child-Pugh C级患者(P＜0.05),不同肝功能分级的肝硬化患者血清TPOAb和TGAb阳性率比较,无统计学差异(P＞0.05)。结论 原发性胆汁性肝硬化和胆管炎患者血清FT3、FT4和TSH水平显著不同于健康人,血清TPOAb和TGAb阳性率较高,其临床意义值得进一步观察和研究。     

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。     

碘致甲状腺功能减退症的流行病学对比研究

目的：研究不同碘摄入量人群的临床甲减和亚临床甲减患病率,方法：选择盘山,彰武和黄骅3个农村社区（分别为低碘,适碘和高碘地区（）,在入户问卷调查的基础上行采样调查,共问卷调查16287人,采样3761人,所有采样对象接受体格检查,,测定血清TSH,甲状腺过氧化的酶抗体（TPOAb),甲状腺球蛋白抗体（TGAb)和甲状腺球蛋白（TG）,测定尿碘浓度及进行甲状腺B超检查,TSH异常者测定FT4,FT3和TSH受体抗体（TRAb)。结果：盘山,彰武和黄骅社区成人尿碘水平分别为103．1ug/L,374.8ug/L和614.6ug/L,盘山,彰武和黄骅社区临床甲减患病率分别为0．27％,0．95％和2．05％, 临临床甲减的患病率分别为0．91％,2．90％,和5．96％,引起临床甲减的主要原因是自身免疫性甲状腺炎,亚临床甲减中三分之一患者甲状腺自身抗体阳性,结论：横断面的流行病学对比研究证实碘摄入量增加有可能导致甲状腺功能减退症患病率增加。     

93例亚临床甲状腺功能减退症的随访研究

目的 研究不同碘摄入量地区亚临床甲状腺功能减退症(甲减)的流行病学特点和影响转归的因素。方法 选择盘山、彰武和黄骅3个农村社区(分别为低碘、适碘和高碘地区)，在入户调查的基础上行采样调查。测定血清TSH、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、尿碘浓度及进行甲状腺B超检查，TSH异常者测定FT3、FT4，筛选出118例亚临床甲减患者。盘山和彰武社区于2年后、黄骅社区于1年后进行随访，再次进行以上检查。结果 盘山、彰武和黄骅社区亚临床甲减的患病率分别为0．73％、2．90％和5．96％。亚临床甲减的病因33．1％是自身免疫性甲状腺疾病。在随访到的93例亚临床甲减患者中有4例女性进展为临床甲减。结论 随着碘摄入量的增加亚临床甲减的患病率增加，但无明显性别差异。随访研究证实女性、甲状腺自身抗体阳性是亚临床甲减患者进展至临床甲减的危险因素，碘摄入量与亚临床甲减的转归无关。     

Euthyroid submedian free t4 and subclinical hypothyroidism may have a detrimental clinical effect in down syndrome

Background: Aberrant thyroid function is highly prevalent in Down syndrome (DS). We aimed to find whether subclinical hypothyroidism (SCH) or low-normal free T4 (FT4) are associated with a detrimental clinical outcome in untreated DS patients. Methods: 157 patients assessed at Hadassah Down Syndrome Center between 2004 and 2010 by comprehensive clinical evaluation and tests for hemoglobin, FT4 and thyroid-stimulating hormone (TSH) were subdivided into subgroups including: clinical hypothyroidism, SCH, euthyroid submedian or supramedian FT4, and alternatively for euthyroidism and TSH levels (submedian or supramedian TSH). Results: Hypothyroidism was found in 21.7% and SCH in another 14.9% of the patients. Moderate/severe hypotonia were more frequent among SCH patients compared to euthyroid patients (52.6 vs. 16.4%, p = 0.002). Patient's hemoglobin levels were lower in the euthyroid submedian FT4 group compared to the euthyroid supramedian FT4 group (10.9 vs. 0% below the normal range, p = 0.001). Interestingly, FT4 levels correlated negatively with increasing age among euthyroid DS patients (Pearson's correlation coefficient = -0.324, p = 0.009). Conclusion: SCH and euthyroid submedian FT4 may have significant clinical sequelae, such as hypotonia and anemia. Interventional studies with L-thyroxine replacement may be indicated in these subpopulations. Our finding that FT4 levels decrease with age in DS (contrasting the general population trend) may indicate redefining the normal FT4 levels range in DS.     

Prevalence of thyroid disease and abnormal thyroid tests in older hospitalized and ambulatory persons

To determine the utility of laboratory tests for diagnosing thyroid disease in the hospitalized elderly, we measured serum thyroid-stimulating hormone (TSH), thyroxine (T4), free thyroxine index (FT4I), triiodothyronine (T3), and free triiodothyronine index (FT3I) in 125 geriatric inpatients, mostly men, and compared the results to those in elderly ambulatory patients. Hypothyroidism (TSH greater than 10 microU/mL with a low T4 and FT4I or clinical findings) was present in 7.8% (nine of 116) of male inpatients compared to only 0.7% of male ambulatory controls (P less than 0.01). Only a few women were studied but 17% (two of 12) were hypothyroid compared to 2.4% of ambulatory elderly women. Three of the hypothyroid inpatients had no clinical clue to their hypothyroidism. Further, decreased thyroid reserve or subclinical hypothyroidism (TSH greater than 10 microU/mL with a normal T4 and FT4I and no overt clinical findings), a condition which may lead to overt hypothyroidism, was more common in male inpatients (4.3%) than in male ambulatory controls (1.8% [P less than 0.01]). Thus, a clearly elevated serum TSH (greater than 10 microU/mL) was more common in inpatient (12.1%) than in ambulatory (2.4%) elderly men (P less than 0.01). Four inpatients and nine ambulatory controls had an elevated T4 and FT4I, but in only one (0.8%) inpatient and one (0.6%) control was a final diagnosis of hyperthyroidism made; the others had no clinical findings and a normal or low T3 and FT3I.(ABSTRACT TRUNCATED AT 250 WORDS)