大理白族健康成人TT_3、TT_4、TSH正常值调查

放射免疫分析 (RIA)血清总T3 (TT3 )、总T4 (TT4 )、促甲状腺激素 (TSH)是判断甲状腺功能及垂体对甲状腺功能调节的灵敏而相对可靠的指标。自采用RIA以来均用厂家提供的参考正常值。为较准确而客观使用该指标 ,对白族健康成人进行TT3 、TT4 、TSH测定 ,确定了本地区正常值     

TT3,TT4,TSH（RAI）与FT3,FT4,sTSH对判断甲状腺功能的研究

过去,对于甲状腺功能的判断,一直用旧三项[TT3、TT4、TSH(RIA)],随着医学的发展,逐渐发现一些非甲状腺疾病中的旧三项也有变化,其在诊断甲状腺疾病中的缺陷也日渐明显.现在新三项[FT3、FT4、sTSH]的测定在临床上得到广泛的应用,对于甲状腺功能的判断明显优于旧三项,本文对这二者在甲状腺功能的判断方面作了对比研究,现报道如下:对象和方法 1对象 1.1对照组 138例,其中男45例,女93例,年龄15～78岁,平均年龄40±10.2岁.均经体检及相关检查,未发现原发性甲状腺疾病.     

TSH-RIMA在评估甲状腺功能状态中的价值

为了不断提高正确判断甲状腺功能状态的手段，我院于1992年开展单克隆抗体免疫放射分析法(IRMA)测定，同时检测TT3，TT4、TSH(RIA)，部分病例加测FT3、FT4，现将结果报告如下。     

FT3、FT4、TSH检测对甲状腺功能分析

甲状腺功能的体外试验从TT3、TT4逐渐发展到FT3、FT4，TSH等，由于它们在体内的浓度变化能准确的反映甲状腺功能状态，因此现已得到临床的广泛应用。我院应用这些分析项目检测了正常人和甲状腺疾病患者305例，现将结果总结如下。     

糖尿病患者TT3、TT4、TSH的检测与分析

我们对64例糖尿病患者进行了TT3，TT4、TSH的检测，其结果表明血清甲状腺激素浓度与糖尿病患者的病情、预后有较密切的关系。     

TT3、TT4、TSH(RIA)与FT3、FT4、sTSH对判断甲状腺功能的研究

过去,对于甲状腺功能的判断,一直用旧三项[TT3、TT4、TSH(RIA)],随着医学的发展,逐渐发现一些非甲状腺疾病中的旧三项也有变化,其在诊断甲状腺疾病中的缺陷也日渐明显.现在新三项[FT3、FT4、sTSH]的测定在临床上得到广泛的应用,对于甲状腺功能的判断明显优于旧三项,本文对这二者在甲状腺功能的判断方面作了对比研究,现报道如下:对象和方法 1对象 1.1对照组 138例,其中男45例,女93例,年龄15～78岁,平均年龄40±10.2岁.均经体检及相关检查,未发现原发性甲状腺疾病.     

100例甲亢患者FT3、FT4，TT3，TT4和ART-V．P．时值测定比较

本文对100例甲亢患者同时进行血清游离T3(FT3)、游离T4(FT4)、总T3(TT3)、总T4(TT4)和腱反射V．P．时值(ART-V．P．时值)测定，并作诊断价值比较。     

重症SIRS患者的正常甲状腺病态综合征

目的：探索全身炎症反应综合征（SIRS）患者的正常甲状腺病态综合征（ESS）的发生规律。 方法： 测定50例SIRS病人的总三碘甲状腺原氨酸（TT3）、总四碘甲状腺原氨酸（TT4）、游离三碘甲状腺原氨酸（FT3）、游离四碘甲状腺原氨酸（FT4）、促甲状腺素（TSH），并根据是否多脏器功能障碍综合征（MODS）分组。计算急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分，记录病人转归以及从发病到检测的时间（患病时间）。 结果： TT3或FT3降低的45例。TT3与APACHEⅡ评分呈对数负相关（r＝－0.330，P<0.05）,TT3/TT4与患病时间呈对数负相关（r=－0.316, P<0.05）。MODS组的TT3、TT4、FT3水平显著低于无MODS组（P<0.05）。 结论： SIRS和MODS病人发生低T3、低T4可能性大，反映炎症反应对甲状腺轴的影响，随着病情加重、患病时间延长，影响进一步深化。     

106例肺心病患者血清甲状腺激素水平测定及其临床意义

甲状腺激素与细胞密切相关,血清甲状腺激素浓度异常并非甲状腺疾病所特有.本文采用RIA对106例慢性肺心病急性发作期和缓解期血清三碘甲状原氨酸(TT3)、甲状腺素(TT4)、促甲状腺激素(TSH)进行了测定, 以探讨缺氧程度对肺心病患者甲状腺功能的影响及缺氧与TT3、TT4和TSH的相互关系.     

糖尿病患者血清T3、T4、TSH RIA的结果分析

近年来，非甲状腺疾病对甲状腺激素的影响越来越受到人们的重视，许多非甲状腺疾病可引起甲状腺功能异常，出现低T3(T4)综合征。为了了解糖尿病患者甲状腺功能的变化，我们对71例经我院明确诊断为糖尿病的患者进行了血清T3、T4、TSH RIA测定，现报告如下。     

A prospective critical evaluation of in vitro thyroid function tests

A number of 2 325 serum samples from a population of in- and outpatients were collected during a six-month period in order to evaluate the usefulness of various thyroid function tests in the clinical laboratory routine. The samples were analysed with the following thyroid function tests: total triiodothyronine (T3) (TT3), total thyroxine (T4) (TT4), free T3 index (FT3I), free T4 index (FT4I) and thyrotropin (TSH). One to two years after the primary evaluation, a follow-up was performed and the final diagnoses were checked in the patients' records. The values of these parameters in the diagnosis of hyperthyroidism were: FT3I greater than FT4I greater than TT3 greater than TT4. The corresponding results in the diagnosis of hypothyroidism were: TSH greater than FT4I greater than FT3I = TT3. No single test could detect both hyper- and hypothyroidism effectively. The only one-step strategy for thyroid evaluation in patients without apparent clinical signs of hyper- or hypothyroidism would therefore be the combined determination of T3 and TSH. The study also showed distinct differences between the reference values of the healthy population and patients without thyroid disorders.     

治疗范围锂浓度对老年难治性抑郁症患者甲状腺功能的影响

目的观察治疗范围内血锂浓度对老年难治性抑郁症和非老年难治性抑郁症患者甲状腺功能影响的差异并进行对比分析。方法选择使用碳酸锂治疗的不同年龄组难治性抑郁症患者共60例作为研究对象,以60岁为界分为老年组28例和非老年组32例,治疗过程中监测血锂浓度处于治疗范围,在入组时及治疗期开始后各阶段(2、4、6、8、10、12周)检测两组患者甲状腺系列(TSH、T3、T4)并对各项指标的变化进行组间组内比较。结果治疗各周老年组甲状腺系列TSH(t=0.21,P0.05;t=6.80,6.48,7.88,5.81,9.13;P0.01)、T3(t=5.77,8.60,12.20,13.92,14.09,15.01;P0.01)、T4(t=2.24,2.07,P0.05;t=2.96,2.79,3.94,3.08;P0.01)与入组时比较出现快速、显著、持久的改变,非老年组呈轻度、一过性、可逆性变化;两组患者TSH、T3、T4各项指标组间各周比较存在显著差异TSH(t=0.22,P0.05;19.74,5.09,12.00,6.07,9.51;P0.01)、T3(t=5.00,5.05,10.90,16.24,14.51,14.50;P0.01)、T4(t=2.73,P0.01;0.74,P0.05;t=3.98,3.99,3.71,3.77;P0.01)。结论治疗范围内血锂浓度降低难治性抑郁症患者甲状腺功能,对老年患者的影响较非老年患者迅速、严重而持久。     

Thyroid function of former opioid addicts on naltrexone treatment

In order to assess thyroid function in former opioid addicts undergoing adjunctive naltrexone (NA) p.o. treatment, we studied 24 subjects (BMI +/- SD: 23.3 +/- 3.2 kg/m2) on 50 mg NA p.o. daily for 15 days to 14.5 months continuously. Measurements included thyrotropin (TSH), total thyroxin (TT4), total triiodothyronine (TT3), while the TT3/TT4100 ratio was calculated as a marker of peripheral conversion of T4 to T3. Reverse T3 (rT3) and serum interleukin-6 (IL-6) levels were also measured. Statistical analysis of thyroid parameters among them, of thyroid parameters versus duration of NA use as well as of thyroid parameters versus BMI was done with linear regression. All the subjects received NA well. The thyroid hormone work-up showed that all the subjects on NA were overall euthyroid. Mean +/- SD levels for TSH were 1.59 +/- 0.29 mU/L, TT4: 171.17 +/- 14.07 nmol/L, TT3: 2.01 +/- 0.27 nmol/L, TT3/TT4100: 1.18 +/- 0.19, rT3: 0.26 +/- 0.07 nmol/L and IL-6: 20.3 +/- 36.6 pg/mL. The duration of NA use was positively correlated with TT3 (r = +0.72, p < 0.001) and TT3/TT4 x 100 (r = +0.77, p < 0.001) and negatively, but not statistically significant, with TT4 (r = -0.38, p = 0.065) and with TSH (r = -0.39, p = 0.062). No significant correlations were found between TT3 and BMI, duration of NA use and rT3 and IL-6. Although few subjects were studied, there are indications that the duration of naltrexone may be positively correlated with TT3 and the ratio of T4 to T3 conversion.     

Total and free thyroid hormone levels in chronic renal failure.

The levels of serum total thyroxine (TT4), triiodothyronine (TT3), free T3, (FT3) free T4 (FT4) and thyrotropin (TSH) were measured in 127 clinically euthyroid patients with varying grades of chronic renal failure (CRF); and 97 healthy individuals. They were grouped as: Group I containing 93 patients on conservative management; Group II containing 34 patients on regular dialysis therapy; and Group III (normals). Group I patients showed significant decrease in TT3, TT4 and FT3 levels (p less than 0.001) as compared to Group III, whereas FT4 and TSH values in group I were not significantly altered. TT3, TT4 and FT3 levels reduced as the severity of renal damage increased. Variations in TT3, TT4, FT3, FT4 and TSH levels in Group II patients were similar to those in Group I, except for a decrease in TSH levels (p less than 0.05) as compared to normals. Several thyroid function tests are abnormal in CRF patients, however, finding of normal FT4 and TSH levels would indicate functional euthyroid status.     

Thyroid function tests

About 80% of thyroid disease consists of thyroid-specific autoimmune diseases, Hashimoto's disease and Grave's disease. To diagnose thyroid diseases, testings for (1) thyroid function and (2) pathogenetic autoantibodies are indispensable. To assess thyroid function, serum hormone concentrations, such as TSH, FT4 and FT3 are measured. Among these hormones, serum TSH concentrations are the most reliable and informative regarding thyroid function, correcting indicating a hyperthyroid, euthyroid or hypothyroid state. Therefore, TSH measurement appears to be the first choice in selecting the hormone determination. Reference intervals for normal healthy subjects of TSH are around 0.4-5.0 microU/ml. The second choice for thyroid function assessment are FT4 which supersedes total T4(TT4). TT4 is affected by changes in serum thyroid hormone binding proteins(TBG, TTR, Albumin). For example, euthyroid pregnant women whose serum TBG are physiologically higher than those of non-pregnant women show augmentation of TT4. However, FT4 depicts within reference intervals, although measurement of FT4 alone is unable to detect any abnormality of thyroid hormone binding proteins. According to its plasma concentration and binding affinity, FT3 measurement deserves no more significance than T3. Another important test for thyroid diseases is to detect serum autoantibodies against thyroid tissues, such as TgAb, TPOAb. Much more important is TSH receptor antibody which differentiates Graves' disease from Hashimoto's thyroiditis. In patients who show hyperthyroidism and some very uncommon hypothyroidism, TSH receptor antibodies should be measured. Three indicators are available as routine tests; TRAb measured by radioreceptor assay; TSAb determined by bioassay using cultured porcine thyroid cells. Usually, TRAb activity clinically correlates well with TSAb. TSBAb was initially discovered in patients with severe hypothyroidism with atrophic thyroid gland. TSBAb blocks thyroid stimulating activity of TSH and consequently causes severe hypothyroidism. TRAb and TSAb are very useful to diagnose and follow patients with Grave's disease.     

急性心肌梗死患者甲状腺功能检测的临床价值

目的 探讨急性心肌梗死患者甲状腺功能检测的临床意义.方法 回顾性分析72例急性心肌梗死（AMI）患者的血清甲状腺激素水平,以30例健康的退休职工为对照组.结果 急性心肌梗死组有4例合并有甲状腺疾病,34例出现正常甲状腺功能病态综合征,急性心肌梗死组（68例）与对照组相比血清总三碘甲状腺原氨酸（TT3）下降,差异有统计学意义（P＜0.001）,总甲状腺素（TT4）,游离三碘甲状腺原氨酸（FT3）下降也有显著性差异（P＜0.01）,游离甲状腺素（FT4）,促甲状腺素（TSH）与对照组比较差异无统计学意义（P＞0.05）.结论 对于急性心肌梗死患者,应该常规检测甲状腺功能,以便更好的进行治疗和预后判断.     

初诊2型糖尿病患者甲状腺激素水平与糖代谢水平的关系研究

目的 探究初诊2型糖尿病(T2DM)患者甲状腺激素水平与糖代谢水平的关系及其临床价值.方法 选取2014年6月至2016年6月我院内分泌科收治的96例T2DM患者,测定所有患者甲状腺激素水平和糖代谢水平,采用Spearman相关分析其相关性.结果 不同性别在甲状腺激素水平及糖代谢指标及血脂指标差异不具有统计学意义(P＞0.05).随着FPG升高,TSH、T3等激素水平降低,差异具有统计学意义(P＜0.05).随着TSH水平升高,FPG、2h PG、HbA1c、HoMA-IR、TC和TG差异具有统计学意义(P＜0.05).FT3与BMI、FPG、2h PG、HbA1c呈负相关(r=-0.453、-0.522、-0.621、-0.461,P＜0.05),FT3、FT4和TSH与HoMA-IR呈正相关(r=0.861、0.701和0.746,P＜0.05),TSH与HbA1c呈负相关(r=-0.622,P＜0.05),TT3和TT4与BMI、FPG、2h PG、HbA1c、HoMA-IR、TC和TG无相关性(P＞0.05).结论 初诊2型糖尿病患者甲状腺激素水平对患者糖代谢水平评估具有重要意义.     

消化道肿瘤患者血清甲状腺激素水平的变化及临床意义

目的:探讨消化道肿瘤患者血清甲状腺激素谱的变化.方法:应用放射免疫分析(RIA)检测33例消化道肿瘤患者的血清T3、FT3、T4、FT4和TSH,并与健康人群(对照组)40例作对照.结果:恶性消化道肿瘤患者血清T3、FT3值均明显降低,与正常对照组相比有显著性差异(P＜0.01);T4和FT4值轻度降低,但与对照组无显著性差异(P＞0.05),TSH值无明显变化(P＞0.05).晚期恶性肿瘤患者与早期相比,T3、FT3、T4、FT4值均明显降低(P＜0.01),TSH轻度降低,但差异不显著(P＞0.05).结论:监测消化道肿瘤患者血清甲状腺激素谱改变对判断疾病的严重程度及预后估计有积极意义.     

Audit of hyperthyroxinaemia and thyrotoxicosis using a sensitive TSH assay

The aim of this study was determine (a) the causes of hyperthyroxinaemia and (b) the biochemical profile of thyrotoxicosis in a general hospital laboratory for one year using a sensitive TSH assay. Total T4 (TT4) and TSH were measured in all 8,382 samples and TT3, free T4, free T3 and thyroxine binding globulin (TBG) in selected cases. TT4 was elevated in 215 (2.6%). 159 (74%) were due to thyrotoxicosis; 41 (19%) to elevated TBG and 15 (7%) non-thyroidal illness. Thyrotoxicosis (serum TSH less than 0.15m U/1) occurred in 223 (2.7%) of all patients and was diagnosed with high TT4 in 159 (71%), normal due to intercurrent illness. 352 (4%) patients had suppressed TSH while all thyroid hormone values were normal. Thus TT4 may be elevated from causes other than thyrotoxicosis sufficiently frequently to necessitate routine TSH measurements. While Normal TSH measurements nearly always excludes thyrotoxicosis, suppressed values are insufficient to establish a diagnosis or monitor thyroxine replacement therapy.