A study on dyslipidaemia in subclinical hypothyroidism

Subclinical hypothyroidism is characterised by elevated serum thyroid stimulating hormone (TSH) concentrations in association with normal free thyroid hormones. The aim of the study was to evaluate the prevalence and pattern of serum lipid alterations in patients with stable subclinical hypothyroidism in comparison to age- as well as sex-matched euthyroid group and also subgroup analysis between them in regard to age of presentation, sex, antithyroperoxidase (anti TPO) positivity, and TSH value. In this study, 100 patients of SCH were recruited, age ranged 17-68 years, majority (78%) being females, presenting mainly with non-specific symptoms and compared with 52 euthyroid control regarding lipid parameters. Of the subclinical hypothyroidism patients, only 10% had goitre and anti TPO was positive in 52% cases. Serum lipoprotein (a) above the age of 20 years, and total cholesterol, triglyceride and low density liporpotein cholesterol in the age group of 40-50 years were significantly elevated. In addition, total cholesterol, triglyceride and low density lipoprotein cholesterol levels in anti TPO positive cases and serum triglyceride and low density lipoprotein cholesterol in anti TPO negative patients showed statistically significant higher levels. In males only lipoprotein (a), but in females total cholesterol, triglyceride, low density lipoprotein cholesterol and liproprotein (a)--all were significantly elevated.     

88例亚临床甲状腺功能异常患者的2年随访分析

目的 总结亚临床甲状腺功能减退症(亚临床甲减)和亚临床甲状腺功能亢进症(亚临床甲亢)患者的自然转归.方法 对2002年9-12月在我院门诊体检的人员进行问卷调查,并测定血清促甲状腺素(TSH)、甲状腺激素(TT3和TT4.)、过氧化物酶抗体(TPOAb),筛选出亚临床甲减58例,亚临床甲亢30例.随访2年,2年后重复上述检查.结果 58例亚临床甲减者中13例(22.4%)甲状腺功能转为正常.44例(75.9%)仍为亚临床甲减.1例(1.7%)进展为临床甲减.甲状腺明显肿大及血清TSH浓度是影响亚临床甲减转归的危险因素(P均＜0.05);30例亚临床甲亢中22例(73.3%)转为正常,2例(6.7%)仍为亚临床甲亢,1例(3.3%)发展为临床甲亢,5例(16.7%)转为亚临床甲减.血清TSH浓度可能影响亚临床甲亢的转归(P＜0.05).结论 在2年内仅有少数亚临床甲状腺功能异常患者进展为临床状态.甲状腺明显肿大、初始血清TSH浓度＞10 mU/L是促使亚临床甲减进展为临床甲减的高危因素;而初始血清TSH浓度≤0.15 mU/L的亚临床甲亢向异常转归的可能性较大.     

~(131)碘治疗弥漫性甲状腺功能亢进远期并发甲状腺功能减退的临床及实验室观察

本文总结我院64例~(131)碘治疗弥漫性甲亢的随访结果,男性17例,女性47例,年龄从31～63岁。随访项目包括TT_4、TT_3、TSH、TRH兴奋试验、MCA、TGA、血清胆固醇、甘油三酯及ECG等。甲减的诊断及分型按Evered标准加以修改。远期甲减发病率:2～5年随访为25％,6～10年随访为50％,11～15年随访为58.8％,总的发病率为52.1％。甲减组和非甲减组甲状腺重量及接受~(131)碘的毫居里数未见统计差别;亚临床型甲减及轻型甲减之间除TT_3外,TT_4,TSH均值未见有意义差别。最后,作者就甲减的发病率、亚临床甲减的诊断和治疗、~(131)碘治疗弥漫性甲亢发生甲减的机理进行了讨论。     

Confirming congenital hypothyroidism identified from neonatal screening

All patients identified in the neonatal screening programme for congenital hypothyroidism in Northern Ireland between 1983 and 1993 were reviewed. 131 infants were recalled because of TSH elevation of whom 85 proved to have true permanent congenital hypothyroidism, while 44 had transient TSH elevation and 2 cases died before the diagnosis could be confirmed. TSH elevation at presentation was milder in the transient group and these infants were more likely to be unwell and/or suffering from congenital malformation.     

2型糖尿病合并亚甲减对微血管并发症的影响

目的 探讨亚临床甲状腺功能减退对2型糖尿病(T2DM)患者微血管并发症的影响.方法 根据是否合并亚临床甲状腺功能减退将入组的280例T2DM患者分为单纯T2DM组(228例)和糖尿病合并亚临床甲减(SCH)组(52例),并且根据不同促甲状腺激素(TSH)水平将SCH组分为两组,即SCH1组(4.2≤TSH≤10 μIU/ml,45例)和SCH2组(TSH≥10μIU/ml,7例),分析TSH水平与糖尿病肾病及视网膜病变的相关性.结果 SCH组总胆固醇、低密度脂蛋白、TSH水平高于DM组,SCH组DM肾病和视网膜病变的发生率显著高于DM组(P＜0.05),且SCH2组DM肾病和视网膜病变的发生率高于SCH1组(P＜0.05);Logistic回归分析结果显示亚临床甲状腺功能减退为T2DM患者糖尿病肾病及视网膜病变的危险因素.结论 T2DM合并亚临床甲减患者其糖尿病肾病及视网膜病变的发生率明显增高,且T2DM合并高水平TSH的患者发生糖尿病微血管并发症的风险更高,提示亚临床甲减是T2DM患者微血管病变独立的危险因素.     

Thyroid failure and protirelin (thyrotropin-releasing hormone) test abnormalities in depressed outpatients

Forty-four consecutive outpatients referred to a psychiatric hospital for evaluation of depression and anergia were assessed by means of the protirelin (thyrotropin-releasing hormone) test. Nineteen patients (43%) had a blunted thyrotropin (TSH) response to protirelin, while six patients (13.5%) had augmented TSH responses indicating some degree of hypothyroidism. One patient had a low thyroxine level, while three patients had elevated basal TSH levels. Five of the six patients with augmented TSH responses were found to have antithyroid antibodies. These results suggest that a majority of depressed outpatients have abnormalities on the protirelin test and that the TSH response to protirelin is useful in both confirming a diagnosis of major depression and assessing thyroid status.     

原发性甲状腺功能减退致垂体增生两例报告及文献复习

目的:探讨原发性甲状腺功能减退致垂体增生的临床特点、发病机制、诊断和处理原则。方法:结合文献回顾性分析2例原发性甲状腺功能减退致垂体增生的临床资料。结果:2例均表现为促甲状腺激素(TSH)及泌乳素(PRL)增高,FT3及FT4减少,MRI示垂体增大,甲状腺素替代治疗6个月后,垂体体积恢复正常,内分泌检查亦恢复正常。结论:原发性甲状腺功能减退致垂体增生具有影像学特征,结合患者的临床症状、病史及内分泌检查可明确诊断。治疗首选甲状腺素替代治疗,而不宜行手术治疗。     

Ningbo thyroid dysfunction prevalence study: a cross-sectional survey in an employees-cohort

Background The prevalence and the spectrum of thyroid dysfunction in the mainland of China are not adequately understood. We performed a population-based study to determine the prevalence of major thyroid dysfunctions including overt and subclinical hyper- and hypothyroidism in a stable cohort. Methods All active and retired employees aged 20 years and older （11 067） of Sinopec Zhenhai Refining ＆ Chemical Company in Ningbo participated in the cross-sectional survey with a questionnaire and blood samples. Results A total of 10 405 individuals attended for screening. Using biochemical definitions 95.5% were euthyroid. The prevalence of former diagnosed hyperthyroidism was 1.1% in females and 0.4% in males, hypothyroidism 1.7% and 0.3%, and thyroid surgery 1.2% and 0.3%, respectively. In both sex the prevalence increased with age. Twenty-four percent of individuals with thyroid surgery or medications had abnormal thyroid-stimulating hormone （TSH） levels. In individuals without a history of thyroid disease, the prevalence of pathological TSH values in females and males were TSH 〉10 mU/L 0.60% and 0.29%; TSH 4.8-9.9 mU/L 5.71% and 2.25%; TSH 〈0.3 mU/L 0.87% and 0.41%, respectively. Overt hyper- and hypothyroidism were uncommon （0.2%, 0.3%, respectively）. The prevalence of subclinical hyper- and hypothyroidism was 0.4% and 3.4%, respectively. Subclinical hypothyroidism was more common in females （male 2.4% vs. female 5.8%, P 〈0.001） and with increasing age （P 〈0.001）. Conclusions The prevalence of thyroid dysfunction is 4.5% in the cohort. Among individuals with thyroid medications or surgery, only 75.7% were within the normal range of TSH. These results indicate that thyroid dysfunction is common in Chinese adults.     

原发性甲状腺功能减退症77例临床分析

目的探讨原发性甲状腺功能减退症的临床特点。方法回顾性分析海南医学院附属医院住院诊断的77例原发性甲状腺功能减退症的临床资料。结果本研究原发性甲状腺功能减退症的病因主要有131I治疗、甲状腺手术和慢性自身免疫性甲状腺炎。贫血32例（41.6%）。69例行血脂检查,总胆固醇升高26例（37.7%）,低密度脂蛋白胆固醇升高34例（49.3%）,甘油三酯升高14例（20.3%）,高密度脂蛋白胆固醇升高27例（39.1%）,高密度脂蛋白胆固醇降低9例（13.0%）。64例行肌酶检查,肌酸激酶增高29例（45.3%）,乳酸脱氢酶增高21例（32.8%）。心电图检查发现窦性心动过缓13例（16.9%）。39例行心脏彩超检查,8例（20.5%）发现心包积液。结论本病临床表现复杂,窦缓、贫血、高脂血症、肌酶增高的患者应注意排除甲减。原发性临床甲状腺功能减退症的诊断主要根据低FT4、高TSH。甲减的治疗简单且有效,多数患者需要终身甲状腺激素替代治疗。     

化学发光法检测甲状腺激素的临床应用

目的:探讨化学发光法检测甲状腺激素的临床应用价值。方法:选择我院收治的甲状腺机能亢进患者140例作为甲亢组,甲状腺功能低下患者68例作为甲减组,在我院进行健康检查的,无甲状腺疾病及其他内分泌疾病的受试者152例作为健康对照组,采集外周静脉血,采用化学发光法检测甲状腺激素,比较分析三组受试者TT3、TT4、TSH、FT3、FT4的检测含量以及诊断符合率。结果:与健康对照组相比,甲亢组患者的TT3和TT4以及FT3和FT4的检测含量均显著提高,TSH检测含量显著降低,而甲减组患者的TT3和TT4以及FT3和FT4的检测含量均显著降低,TSH检测含量则显著提高,差异均具有统计学意义(P<0.05)。FT3和FT4对甲亢组患者与甲减组患者的诊断符合率要优于TT3和TT4,且TSH对甲亢组患者与甲减组患者的诊断符合率均较高。结论:化学发光法对甲状腺激素的检测具有较高的敏感性,为甲状腺疾病的临床早期诊断提供了重要的参考依据。     

Primary hypothyroidism with paradoxically elevated plasma thyroxine due to thyroxine-binding antibody

Investigation of an elderly patient with clinical hypothyroidism revealed a low serum triiodothyronine (T3) but markedly raised levels of total thyroxine (TT4) and free thyroxine (fT4) when measured by radio-immunoassay (RIA). Primary hypothyroidism was suggested by an elevated basal thyroid stimulating hormone (TSH) and confirmed by a low fT4 when measured by a commercial microencapsulated antibody method. The paradoxically elevated levels of fT4 and TT4 were due to the presence of an antibody which specifically bound T4 and grossly interfered with the RIA thus complicating the diagnosis and later the assessment of replacement therapy. The sensitive immunoradiometric TSH assay proved of value in resolving these problems.     

化学发光免疫法与免疫放射法检测血清TSH的临床价值比较

目的 :比较化学发光免疫分析 (CLIA)及免疫放射分析 (IRMA)检测血清促甲状腺激素 (TSH)对诊断甲状腺机能亢进 (甲亢 )及甲状腺机能减低 (甲减 )的临床价值。方法 :用CLIA与IRMA对 1 1 2例正常人、1 2 0例甲亢病人、5 8例甲减病人血清标本TSH含量进行测定。结果 :两法的相关性良好 (r=0 .98,P <0 .0 1 ) ,但CLIA对甲亢及甲减的诊断临床符合率比IRMA高 ,且CLIA的精密度 (批内变异 )和重复性 (批间变异 )均优于IRMA。结论 :CLIA对甲亢及甲减的诊断优于IRMA。     

Normal thyrotrophin response to intravenous thyrotrophin releasing hormone administration: the best index of optimal L-thyroxine therapy in primary hypothyroidism

Normalization of basal thyrotrophin (TSH) level is used as the endpoint in L-thyroxine (L-T4) therapy of primary hypothyroidism. However, several reports have questioned the reliability of this index because of seasonal variation of TSH. Therefore, we studied 85 consecutive patients with primary hypothyroidism over a period of 3.5 y. In these patients, TSH response (delta TSH) to intravenous thyrotrophin releasing hormone (TRH) administration was examined when basal TSH was normalized with L-T4 therapy. Eight patients showed a blunted response (delta TSH less than 5 microU), whereas 27 patients demonstrated an exaggerated response (delta TSH greater than 25 microU). Thus, 42% of patients were apparently on inappropriate L-T4 dosage. These abnormal TSH responses normalized on adjusting the L-T4 dosage alone; prolonged therapy with the same dose failed to normalize TSH responses. Minor seasonal variations of basal TSH were observed in 30% of patients. However, TSH response to TRH remained normal. Hence, no adjustment of L-thyroxine dose was required. This study, therefore, demonstrates that normalization of TSH response to TRH administration rather than basal TSH may be the best index of adequate L-thyroxine therapy in primary hypothyroidism.     

Diagnostic value of thyrotrophin releasing hormone tests in elderly patients with atrial fibrillation

A prospective study was carried out to compare clinical and biochemical thyroid states with responses of thyroid stimulating hormone (TSH) to thyrotrophin releasing hormone (TRH) in elderly patients with either atrial fibrillation (n = 75; mean age (SD) 79.3 (6.0) years) or sinus rhythm (n = 73; mean age 78.4 (5.6) years) admitted consecutively to the department of geriatric medicine. No patient in either group had symptoms or signs of hyperthyroidism. Overall, the TSH responses to TRH did not differ significantly between the two groups. Ten (13%) of the patients with atrial fibrillation (of whom four had raised thyroid hormone concentrations) and five (7%) of the patients with sinus rhythm showed no TSH response to TRH while 26% of each group (20 and 19 patients, respectively) showed a much reduced response. Only one of 13 patients with apparently isolated atrial fibrillation showed no TSH response to TRH, and none of these 13 patients was hyperthyroid. In particular, three patients (two with atrial fibrillation and one with sinus rhythm) who showed no TSH response to TRH at presentation exhibited a return of TSH response to TRH at follow up six weeks later. In conclusion, reduced or absent TSH responses to TRH are common in sick elderly patients whether they have atrial fibrillation or sinus rhythm and whether they are euthyroid or hyperthyroid biochemically. An absence of response is therefore an uncertain marker of hyperthyroidism in these groups of patients, and diagnosis and ablative treatment should be based at least on the presence of raised circulating free triiodothyronine or free thyroxine concentrations, or both.     

CONGENITAL HYPOTHYROIDISM CLINICAL ANALYSIS OF 30 CASES

30 cases of congenital hypothyroidism arc ana- Iysed. The female to male ratio was l.7:1 and the age ranged from newborn t0 12 years, 12 being infants below 2 years. Most cases had classical symptoms and signs. In 25 cases with serum T4 radioimmuno assay T4 was less than normal in 23, and in 13 cases having serum TSH determinations TSH was elevated before thyroid therapy. Combined use oF thyroid scan with technetium-99m pertcchnetate and low dose i3iI thyroidal uptake in the anatomic diagnosis of etiology and assessment of thyroid activity was stressed. In the series the misdiagnosis rate was 16.6%. It is imperative to recognize the compen sated form of congenital hypothyroidism, since the clinical manifestations may be subtle, with near normal serum T4 and T3, but definitely increassed serum TSH. Owing to the instability of the con- tent of desiccated thyroid and patient individual requirements and reactivity, dosage should be in- dividualized. Concomitant infections should be treated in time, special precautions should be taken against latent myxedematous heart disease in hypo thyroid infants in whom daily fluids should be re- stricted with conservative doses of thyroid general- ly at the beginning of treatment. The results of treatment were excellent in our series.     

化学发光免疫法与免疫放射法检测血清TSH的临床价值比较

OBJECTIVE: To compare the clinical value between chemiluminescent immunoassay (CLIA) and immunoradiometric assay (IRMA) in detecting TSH in patients with hyperthyroidism and hypothyroidism. METHODS: The TSH levels in serums were detected by CLIA and IRMA in 112 normal persons, 120 hyperthyroidism patients and 58 hypothyroidism patients. RESULTS: CLIA was significantly correlated with IRMA (r = 0.98, P < 0.01). CLIA had higher coincidence rate than IRMA in the diagnosis of hyperthyroidism and hypothyroidism, and CLIA was more accurate and repetitive than IRMA. CONCLUSION: CLIA is more valuable than IRMA in diagnosing both hyperthyroidism and hypothyroidism.     

中国不同人群亚临床甲状腺功能减退症检出率的横断面调查分析

目的：调查我国8～10岁儿童、18～45岁成人、哺乳妇女和孕妇4类人群亚临床甲状腺功能减退症(SH)的检出情况,分析不同尿碘水平和不同免疫状态人群的SH检出率状况,为我国碘缺乏病防治提供新的监测指标。方法：于2009年4月-2010年4月采用典型调查方法对我国6类地区4类目标人群（8～10岁儿童633人、18～45岁成...     

Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes

In a clinic population of 509 type 1 diabetic patients aged 16-45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and Addison's disease was present in four patients (0.8%, one male). In all patients, type 1 diabetes preceded the diagnosis of the other autoimmune disorder. The clinical presentation of hypothyroidism was usually insidious with few symptoms, although an increased frequency of hypoglycaemic symptoms and/or raised serum cholesterol levels often prompted thyroid function testing. In contrast, the patients with thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg), palpable goitres, increasing insulin requirements, and low cholesterol levels. Six patients did not achieve remission or had recurrent thyrotoxicosis after oral antithyroid treatment and required 131I or thyroid surgery. A family history of autoimmune disease was present in 25% of patients with thyroid disorders (seven thyrotoxic and one hypothyroid) and in three of the four patients with Addison's disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and Addison's disease should be carried out if there is clinical suspicion and/or unexplained changes in diabetic metabolic control or serum cholesterol. Careful follow-up of patients with a family history of these conditions is recommended.     

原发性甲状腺机能减退症41例临床分析

本文对41例原发性甲状腺机能减退症进行了回顾性分析。结果提示:血清TT_4及TSH测定对甲减诊断符合率分别为98％和100％,较血清TT_3和甲状腺吸~(131)Ⅰ百分率测定灵敏,可靠。合适替代剂量系以临床症状消失以及血清TT_4和TSH值恢复正常为准。其量为甲状腺片60～180mg/d。     

Prevalence of hypothyroidism and importance of cholesterol estimation in patients suffering from major depressive disorder

The coexistence of hypothroidism and depression is already reported and both of these conditions are known to share some common clinical symptoms. Serum cholesterol level is known to be altered in either condition considered separately. But, no report is obtained regarding serum cholesterol level when both the conditions coexist. In this study, 78 patients (61 females and 17 males, age ranged 19 to 67 years) suffering from major depressive disorder were included. Serum T3, T4, TSH and cholesterol levels were estimated in all of them. Sixty-two patients were found to be euthyroid and 16 patients (11 females, 5 males) were found to be hypothyroid. Among female patients, 6 had subclinical hypothyroidism and 5 had overt hypothyroidism. Among male patients 3 had subclinical hypothyroidism and 2 had overt hypothyroidism. The overall prevalence of hypothyroidism in major depressive disorder was estimated as 20.5%. Mean serum cholesterol level in 62 euthyroid patients was found to be 150.9% +/- 16 mg% and that of 16 hypothyroid patients to be 190.7 +/- 12 mg% showing a significant difference (p < 0.01). Thus estimation of cholesterol in major depressive disorder patients may give an idea regarding their thyroid status and vice-versa.