Pattern of hypothyroid disorders in Ethio-Swedish Children's Hospital (ESCH)

All children with thyroid disorder attending the endocrinology clinic of the Ethio-Swedish Children's Hospital (ESCH), Addis Ababa in 1996 were included in this study. One hundred twenty six new patients from all over the country were referred to the clinic for thyroid disorder and 31 patients (24%) were found to have hypothyroidism. Seventeen (13%) had congenital hypothyroidism while the rest 14(11.5%) were categorised to have juvenile hypothyroidism. Thyroid dysgenesis is the commonest cause of permanent hypothyroidism. Mental retardation was the accompanied manifestation in all the cases with thyroid agenesis except in two children. Mental retardation being the commonest permanent sequelae in aplastic hypothyroidism is of utmost concern and its prevention is desirable, therefore high index of clinical suspicion with a close observation for early feature of congenital hypothyroidism is warranted for early intervention and in the future nation wide screening for hypothyroidism is recommended.     

甲减及亚临床甲减患者的血脂变化研究

目的观察研究甲状腺功能减退症(甲减)及亚临床甲状腺功能减退症(亚临床甲减)患者血脂的状况,并分析亚临床甲减患者促甲状腺素(TSH)值与血脂间的关系。方法收集2012年1月至2012年6月在我院分泌科门诊及病房就诊的患者279名,分为甲减组、亚临床甲减组,并收集同期在我科门诊或病房检查甲状腺功能正常者86例作为对照组,比较各组血脂指标的变化;将亚临床甲减组按TSH分层(分为TSH4.78～10μIU/L和TSH>10μIU/L)后与正常对照组比较。结果甲减组总胆固醇(CHO)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)高于对照组,高密度脂蛋白胆固醇(HDL-C)低于对照组,均有显著性差异;亚临床甲减组CHO、LDL-C均明显高于对照组,有显著性差异;分层后,TSH4.78～10uIU/L亚临床甲减组CHO与对照组有升高趋势,但无统计学差异,TSH>10uIU/L亚临床甲减组CHO、TG、LDL-C均明显高于对照组,有显著性差异。结论甲减及亚临床甲减患者血脂明显升高,且亚临床甲减患者血脂升高与TSH值升高有关,临床应予重视。     

碘—131治疗Graves病后发生甲低的分析

对于Ｇｒａｖｅｓ病患者接受一次或二次碘治疗后发生甲低的７０例进行了分析。将甲低分为近期、远期、一过性和永久性甲低，分析了各种甲低发生的情况并比较了甲状腺大小、性别、年龄、病程、是否用过抗甲状腺药物以及~（１３１）Ｉ剂量大小等因素与甲低发生的关系。通过分析发现甲状腺越小，甲低的发生率越高且容易成为永久性甲低；近期永久性甲低的发生率女性明显高于男性；甲低发生的本质是个体对~（１３１）Ｉ的辐射敏感性较高，但~（１３１）Ｉ剂量越大，可以使超过耐受限度的患者越多，因而甲低的发生率也就越高；甲低的发生与病程和年龄的关系不大；未用过抗甲状腺药物治疗者，一过性甲低的发生率明显增高，但永久性甲低的发生无明显差别。对于接受第二次~（１３１）Ｉ治疗的患者，甲低发生有增多的趋势。     

140例亚临床甲减对冠心病相关危险因素的影响

目的 探讨亚临床甲减对冠心病相关危险因素的影响,为采用抗甲减措施抑制冠心病提供依据.方法 选取本院2011年2月~2012年2月收治并行冠状动脉造影术（CAG）患者140例,以诊断出冠心病患者作为冠心病组,其余为对照组,监测游离T3、游离T4、促甲状腺素、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白Al、载脂蛋白B,诊断亚临床甲减、高血压、糖尿病、高血脂,进行因素分析.结果 冠心病组与对照组合并高血压、高血脂、糖尿病差异无统计学意义（P＞0.05）;亚临床甲减与高血压、高血脂存在相关性,亚临床甲减与冠心病存在相关性（OR=2.236,P=0.015）;经过多因素分析,亚临床甲减、高血压、TG、HDL与冠心病高度相关.结论 亚临床甲减与冠心病存在正相关,与冠心病相关危险因素存在关联,直接或间接成为冠心病的危险因素,加强对甲减的监控,有利于疾病的防治.     

亚临床甲状腺功能减退症与心血管疾病相关性的研究进展

摘要： 亚临床甲状腺功能减退症 （亚临床甲减） 是一种仅有促甲状腺素水平升高而甲状腺素水平正常的代谢性疾病。国内外已有大量研究表明, 亚临床甲减可能与动脉粥样硬化以及左室舒张功能障碍相关, 从而导致心血管疾病的发生率和死亡率增加。亚临床甲减会影响脂质代谢异常、 高血压、 凝血功能异常、 血管内皮功能损伤及糖代谢异常等, 并与同型半胱氨酸、 C 反应蛋白及脂蛋白等存在相关性, 从而加速动脉粥样硬化的形成。近年来亚临床甲减与心血管疾病之间的关系越来越受到关注, 本文就有关两者相关性的研究进行综述。     

2010～2012年某市新生儿先天性甲状腺功能低下的筛查分析

目的为了解贵港市新生儿先天性甲状腺功能低下的情况。方法对2010～2012年贵港市新生儿先天性甲状腺功能低下筛查资料按年度进行统计分析。结果 2010～2012年贵港市新生儿先天性甲状腺功能低下筛查共132 482例,筛查阳性551例,筛查阳性率为0.42%;筛查阳性551例中召回389例,占筛查阳性的70.60%;召回389例中,有52例确诊为先天性甲状腺功能低下,占召回的13.36%,52例均得到了治疗。结论加强先天性甲状腺功能低下筛查宣传力度、增加公益资金投入,提高筛查率及阳性召回率是早发现、早治疗先天性甲状腺功能低下新生儿的有效方法。     

Overt and subclinical hypothyroidism: who to treat and how

Hypothyroidism denotes deficient production of thyroid hormone by the thyroid gland and can be primary (abnormality in thyroid gland itself) or secondary/central (as a result of hypothalamic or pituitary disease). The term 'subclinical hypothyroidism' is used to define that grade of primary hypothyroidism in which there is an elevated thyroid-stimulating hormone (TSH) concentration in the presence of normal serum free thyroxine (T4) and triiodothyronine (T3) concentrations. Subclinical hypothyroidism may progress to overt hypothyroidism in approximately 2-5% cases annually. All patients with overt hypothyroidism and subclinical hypothyroidism with TSH >10 mIU/L should be treated. There is consensus on the need to treat subclinical hypothyroidism of any magnitude in pregnant women and women who are contemplating pregnancy, to decrease the risk of pregnancy complications and impaired cognitive development of the offspring. However, controversy remains regarding treatment of non-pregnant adult patients with subclinical hypothyroidism and serum TSH values ≤10 mIU/L. In this subgroup, treatment should be considered in symptomatic patients, patients with infertility, and patients with goitre or positive anti-thyroid peroxidase (TPO) antibodies. Limited evidence suggests that treatment of subclinical hypothyroidism in patients with serum TSH of up to 10 mIU/L should probably be avoided in those aged >85 years. Other pituitary hormones should be evaluated in patients with central hypothyroidism, especially assessment of the hypothalamic-pituitary-adrenal axis, since hypocortisolism, if present, needs to be rectified prior to initiating thyroid hormone replacement. Levothyroxine (LT4) monotherapy remains the current standard for management of primary, as well as central, hypothyroidism. Treatment can be started with the full calculated dose for most young patients. However, treatment should be initiated at a low dose in elderly patients, patients with coronary artery disease and patients with long-standing severe hypothyroidism. In primary hypothyroidism, treatment is monitored with serum TSH, with a target of 0.5-2.0 mIU/L. In patients with central hypothyroidism, treatment is tailored according to free or total T4 levels, which should be maintained in the upper half of the normal range for age. In patients with persistently elevated TSH despite an apparently adequate replacement dose of LT4, poor compliance, malabsorption and the presence of drug interactions should be checked. Over-replacement is common in clinical practice and is associated with increased risk of atrial fibrillation and osteoporosis, and hence should be avoided.     

妊娠期甲状腺功能减退与妊娠期糖尿病对妊娠结局的影响及相关性分析

目的 探讨妊娠早期甲状腺功能减退(甲减)对妊娠期糖尿病(GDM)发病率、糖脂代谢及妊娠结局的影响.方法 选择2014年1月-2016年2月海军总医院收治的孕妇1865例,均于首次产检行甲状腺功能检查,孕24 ～ 28周行口服葡萄糖耐量试验(OGTT)筛查,根据检查结果将其分为正常组1538例、单纯甲减组131例、单纯GDM组168例、甲减合并GDM组28例,观察甲减对GDM发病率、糖代谢和胰岛功能、脂代谢及妊娠结局的影响.结果 甲减组GDM患病率高于甲状腺功能正常组(P＜0.05);甲减合并GDM组OGTT 2 h和糖化血红蛋白水平高于单纯GDM组(P＜0.05);甲减合并GDM组空腹胰岛素、餐后2h胰岛素、胰岛素抵抗指数均高于单纯GDM组,胰岛素敏感指数水平低于单纯GDM组(P＜0.05);甲减合并GDM组胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均高于单纯GDM组,高密度脂蛋白胆固醇低于单纯GDM组(P＜0.05);单纯甲减组和单纯GDM组妊娠并发症和不良妊娠结局均明显高于正常组,且甲减合并GDM组均明显高于单纯甲减组、单纯GDM组及正常组(P＜0.05);甲减合并GDM与妊娠并发症和不良妊娠结局发生率呈正相关(P＜0.05).结论 孕早期甲减可增加GDM发生率,对妊娠结局有不良影响,在临床中要重视孕早期甲状腺功能筛查及血糖监测并合理干预,从而改善妊娠结局.     

Subclinical hypothyroidism and cognitive dysfunction in the elderly

While overt hypothyroidism is associated with reversible dementia in the elderly, the relationship of subclinical hypothyroidism with cognition remains a controversial issue. Our aim was to investigate the correlation between subclinical hypothyroidism and cognition in the elderly, with particular reference to long term memory and selective attention. We selected 337 outpatients (177 men and 160 women), mean age 74.3 years, excluding the subjects with thyroid dysfunction and those treated with drugs influencing thyroid function. The score of Mini Mental State Examination (MMSE) was significantly lower in the group of patients with subclinical hypothyroidism than in euthyroid subjects (p < 0.03). It was observed that patients with subclinical hypothyroidism had a probability about 2 times greater (RR = 2.028, p < 0.05) of developing cognitive impairment. Prose Memory Test (PMT) score resulted significantly lower in subjects with subclinical hypothyroidism (p < 0.04). Considering the Matrix Test (MT) score, the performance was slightly reduced in subclinical hypothyroidism (NS). Furthermore, TSH was negatively correlated with MMSE (p < 0.04), PMT (p < 0.05) and MT score (NS). No correlation was found between FT4 and FT3 and MMSE, PMT and MT score. In the elderly, subclinical hypothyroidism is associated with cognitive impairment, and its impact on specific aspects of cognition (long term memory and selective attention) is less evident.     

亚临床甲状腺功能减低患者血脂及血尿酸改变的临床分析

目的探讨亚临床甲状腺功能减低患者血脂、血尿酸水平变化及其可能原因。方法收集2008年2月至2011年6月诊断为甲状腺功能减低（甲减组）患者21例,亚临床甲状腺功能减低（亚甲减组）患者25例,体检甲状腺功能正常者（对照组）20例,同时测定各组TC、TG、LDL—c、HDL—c、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、血尿酸水平。结果①与对照组比较,甲减组及亚甲减组促甲状腺激素（TSH）水平明显增高,差异有统计学意义（P〈0．01）,甲减组TSH较亚甲减组增高,差异有统计学意义,P〈0．05;②与对照组比较,甲减组及亚甲减组患者的TG、TC、LDL、ApoB、尿酸升高,HDL减低,差异有统计学意义（P〈0．05或P〈0．01）;与亚甲减组比较,甲减组患者HDL、ApoA减低,TG、TC、LDL、ApoB、尿酸升高,差异有统计学意义（P〈0．05或P〈0．01）;③TsH与TC、TG、HDL、LDL、ApoA、ApoB、血尿酸均呈正相关（r值分别为0．781、0．686、0．648、0．341、0．429、0．519、0．351,均P〈0．01）,FT3与TC、TG、HDL、LDL、ApoA、ApoB、血尿酸均呈负相关（r值分别为-0．723、-0．641、-0．716、-0．327、-0．415、-0．571、-0．368,均P〈0．01）,n与TC、TG、HDL、LDL、ApoA、ApoB、血尿酸均呈负相关（r值分别为-0．742、-0．-675、-0．697、-0．317、-0．403、-0．537、-0．324,均P〈0．01）。结论亚临床甲状腺功能减退患者的血脂异常及血尿酸改变的原因可能与甲状腺激素的水平及其功能,TSH水平均有关系,因此在亚临床甲状腺功能减退阶段,合理的应用甲状腺素对于防治心血管事件有重要的意义。     

甲状腺功能减退症46例临床分析

目的分析甲状腺功能减退症的临床特征、病因及主要误诊原因。方法对46例甲状腺功能减退症患者的临床资料进行回顾性分析。结果在46例甲状腺功能减退症患者中,女38例(82.60%)、男8例(17.40%)、男∶女=1∶4.75;40岁以上30例(65.21%);原发性甲状腺功能减退症43例(93.48%)、中枢性甲状腺功能减退症3例(6.52%);其中,在原发性甲减中,甲亢服放射性核素131I后20例(46.51%)、乔本氏甲状腺炎10例(23.26%)、甲亢药物治疗后4例(9.30%)、甲亢手术治疗后3例(6.98%)、其他尙有甲状腺癌手术后、颈部放疗后等,均较少见。有21例误诊为其他疾病,误诊率(45.65%)。结论甲状腺功能减退症好发于40岁以上的中老年人,尤以女性多见。发病原因繁多复杂,临床表现不典型,极易造成误诊或漏诊,应引起高度重视。     

Evolution of atenolol kinetics when hypothyroidism is corrected

Summary A single oral dose of atenolol 100 mg was given to 7 hypothyroid patients (4 F, 3 M), before and after correction of hypothyroidism, mean delay 3.5 months (2 to 6.5 months).There was no change in the elimination parameters of atenolol, but the maximal plasma atenolol concentration was increased (1.66 to 7.37 mg·l^–1) as was the AUC (14.9 to 52.1 mg·l^–1·h) when the hypothyroidism had been treated. Only one patient differed: he had had a supra-selective vagotomy, and had similar curves before and after treatment of the hypothyroidism, both being similar to the plasma concentration curves found in the other patients after correction of the hypothyroidism.The results suggest an increase in the bioavailability of atenolol when hypothyroidism is corrected. The findings in the patient with vagotomy suggest that the decreased bioavailability during hypothyroidism might be related to changes in intestinal pH. Further studies are needed of the impact of hypothyroidism on gastric and pancreatic or biliary function and its consequences for drug absorption, and drug pharmacokinetics.     

An increase of oxidative stress markers and the alteration of the antioxidant enzymatic system are associated with spleen damage caused by methimazole-induced hypothyroidism

Methimazole is the most widely used antithyroid drug in Europe and North America, but it causes several undesirable side effects, such as hematological dysfunctions and immunosuppression. Our aim in this work was to compare, over a time course, markers of oxidative stress, the redox environment, the antioxidant enzymatic system, and the glutathione cycle in the spleen of rats with methimazole- or thyroidectomy-caused hypothyroidism. We used 70-male Wistar rats divided into four groups: 1) euthyroid; 2) sham thyroidectomy; 3) thyroidectomy-caused hypothyroidism, with parathyroid reimplant; and 4) methimazole-caused hypothyroidism. Five rats of the euthyroid- and methimazole-caused hypothyroidism groups were killed at the end of weeks 1, 2, 3, and 4 after treatment, and 5 rats of the sham thyroidectomy and thyroidectomy-caused hypothyroidism groups were killed at the end of weeks 2, 4, and 8 after the surgical procedure. Each spleen was excised and stored at -70°C until oxidative stress, REDOX environment, and the antioxidant enzymatic-system markers were tested. The histological study showed that only methimazole-induced hypothyroidism caused cell damage. This damage was associated with an increase of oxidative-stress markers that were not compensated for by the antioxidant system. The increase of the glutathione-cycle enzymes was insufficient to prevent oxidative-stress markers. Methimazole causes oxidative stress and cell damage in the spleen, whereas hypothyroidism per se does not cause cell damage in this organ. Therefore, it is necessary to develop new antithyroid drugs without causing oxidative stress and cellular damage.     

Similar distribution changes of GABAergic interneuron subpopulations in contrast to the different impact on neurogenesis between developmental and adult-stage hypothyroidism in the hippocampal dentate gyrus in rats

Hypothyroidism affects neurogenesis. The present study was performed to clarify the sensitivity of neurogenesis-related cellular responses in the hippocampal dentate gyrus between developmental and adult-stage hypothyroidism. An exposure study of methimazole (MMI) as an anti-thyroid agent at 0, 50, 200?ppm in the drinking water was performed using pregnant rats from gestation day 10 to postnatal day (PND) 21 (developmental hypothyroidism) and adult male rats by setting an identical exposure period from PND 46 through to PND 77 (adult-stage hypothyroidism). Offspring with developmental hypothyroidism were killed at PND 21 or PND 77, and animals with adult-stage hypothyroidism were killed at PND 77. Proliferation and apoptosis were unchanged in the dentate subgranular zone by either developmental or adult-stage hypothyroidism. With regard to precursor granule cells, a sustained reduction of paired box 6-positive stem or early progenitor cells and a transient reduction of doublecortin-positive late-stage progenitor cells were observed after developmental hypothyroidism with MMI at 50 and 200?ppm. These cells were unchanged by adult-stage hypothyroidism. With regard to γ-aminobutyric acid (GABA) ergic interneuron subpopulations in the dentate hilus, the number of parvalbumin-positive cells was decreased and the number of calretinin-positive cells was increased after both developmental and adult-stage hypothyroidism with MMI at 50 and 200?ppm. Fluctuations in GABAergic interneuron numbers with developmental hypothyroidism continued through to PND 77 with 200 ppm MMI. Considering the roles of GABAergic interneuron subpopulations in neurogenesis and neuronal differentiation, subpopulation changes in GABAergic interneurons by hypothyroidism may be the signature of aberrant neurogenesis even at the adult stage.     

Drug therapy reviews: management of hypothyroidism.

The therapeutic management of hypothyroidism caused by deficient thyroid hormone production is discussed. The therapeutic use of the following thyroid agents is reviewed: levothyroxine sodium, Thyroid USP, thyroglobulin, liotrix, and liothyronine sodium. Myxedema coma, neonatal hypothyroidism, primary hypothyroidism, and secondary and tertiary hypothyroidism are specific hypothyroid states for which drug therapy is discussed. Levothyroxine sodium is the preferred agent because of consistent potency, restoration of normal, constant serum levels of thyroxine (T4) and triiodothyronine (T3) and ease of interpretation of thyroid hormone levels. Other agents, because they contain T3, result in postabsorptive elevated T3 serum concentrations that may cause thyrotoxic symptoms and reduction of T4 levels. This, in turn, may give rise to misleading estimates of thyroid dosage. Patients with the sick euthyroid or low T3 syndromes are not candidates for thyroid hormone therapy.     

甲状腺素对甲状腺功能减低大鼠子代海马突触素表达的影响

目的:探讨不同剂量甲状腺素对甲状腺功能减低孕鼠子代海马突触素表达的影响.方法:选取断乳1个月的Wistar大鼠160只,雌雄各半.将雌性大鼠随机分为正常组,甲低对照组,甲低孕鼠妊娠1～17 d(妊早期甲低)补充甲状腺素高、中、低剂量组,甲低孕鼠妊娠18～20d(妊晚期甲低)补充甲状腺素高、中、低剂量组共8组,每组10只.各组均饲以低碘饲料,对照组饮用碘酸钾溶液,总碘摄入量相当于大鼠生理碘需要量,其余7组饮用去离子水.3个月后与正常雄性大鼠交配.高、中、低剂量组每100 g体质量每天分别补充甲状腺素3.5、2.0、0.5 μg.分别于新生当天、生后7、14、21及28 d,取8组子代大鼠的右侧大脑半球,应用免疫组织化学SABC法及图像分析技术检测海马突触素的表达.结果:正常组的突触素表达水平均高于同时期甲低对照组(P＜ 0.01).在新生当天,妊晚期甲低中剂量组与甲低对照组比较差异无统计学意义(P＞0.05),妊早、晚期甲低低剂量组突触素表达水平均低于甲低对照组(P＜0.01);妊早期甲低中、高剂量组,妊晚期甲低高剂量组突触素表达水平均高于甲低对照组(P＜0.01).生后7、14、21及28 d,妊早、晚期甲低低剂量组与甲低对照组比较差异无统计学意义(P＞0.05),其他各组的突触素表达水平均高于甲低对照组(P＜0.01).结论:孕鼠甲低导致子代大鼠海马突触素表达下降,甲低孕鼠子代大鼠海马突触素的表达受补充甲状腺素剂量及孕期的影响.     

甲状腺机能亢进和甲状腺功能减退症患者的血糖及血脂代谢异常

目的了解甲状腺机能亢进症(甲亢)与甲状腺功能减退症(甲减)患者血糖及血脂代谢异常状况,同时了解甲亢和甲减患者治疗后血糖及血脂情况分析。方法 40例甲亢和甲减患者治疗前后均空腹12h以上,于清晨抽静脉血检测血糖(GLU)、血脂(甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)水平,进行对比分析。结果 40例甲亢和甲减患者治疗前后血糖及血脂对比:甲亢患者GLU明显降低,血脂明显升高;甲减患者GLU明显升高,血脂明显降低。结论甲亢或甲减患者经过积极治疗,甲状腺功能恢复正常后,其血糖、血脂水平均恢复正常,提示甲状腺激素浓度的异常变化会直接和间接影响患者体内血糖、血脂代谢。     

Iodinated glycerol-induced hypothyroidism

This report describes an adverse reaction to iodinated glycerol, an organic form of iodine prescribed as a mucolytic-expectorant. In a patient with a previous history of severe potassium iodide-induced hypothyroidism, administration of iodinated glycerol resulted in mild subclinical hypothyroidism. There is one report in the literature of goiter resulting from iodinated glycerol and physicians should be aware of the potential for hypothyroidism with this agent. Iodinated glycerol should be added to the list of iodine-containing organic compounds that interfere with thyroid function.     

36例亚临床甲减伴高脂血症患者治疗前后血脂变化的分析

目的探讨亚临床甲状腺功能减退症(简称亚临床甲减)合并高脂血症患者,使用左旋甲状腺素治疗前后血脂水平的变化。方法检测36例亚临床甲减合并高脂血症患者促甲状腺素(TSH)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇水平(LDL-C),使用左旋甲状腺素钠(L-T4)替代治疗,剂量平均50-75μg/d,以TSH调整在正常范围为合适剂量,12周后复查TSH及血脂水平,观察12周后的血脂改善情况。结果亚临床甲减伴高脂血症患者经治疗后血脂改善明显,与治疗前相比存在显著性差异(P<0.05)。结论亚临床甲减伴高血脂症患者经左旋甲状腺素治疗后,血脂情况明显改善。