美国甲状腺协会和临床内分泌医师协会2012年甲减诊治指南介绍

近期,美国甲状腺协会和临床内分泌医师协会联合发表了甲减诊治指南,该指南以循证医学为根据,对所涉及的15个方面的问题共提出了52条指南性的参考建议。该指南重点强调了促甲状腺激素对多数甲状腺功能减退症（甲减）患者的诊断价值,指出甲减的标准治疗方法是给予左旋甲状腺素,对于促甲状腺激素水平小于10 mIU/L的亚临床甲减患者,需要根据患者的个体情况决定治疗方案。     

甲状腺功能亢进症伴精神障碍52例临床分析

目的提高对甲状腺功能亢进症（甲亢）合并精神障碍患者的诊治认识。方法回顾性分析52例甲亢并精神障碍患者的临床特点、诊断及治疗情况。结果 28例单独治疗甲亢,有效26例,无效2例;14例治疗甲亢及加用抗精神障碍药物,有效12例,无效2例;单用抗精神药物治疗10例,有效0例,无效10例。3种治疗措施比较P〈0.01,具有极显著性意义。结论甲亢合并精神障碍以女性多见,以精神障碍为首发症状者不能忽略查甲状腺功能。治疗原发病是关键措施。     

131I治疗甲亢的现状和研究进展

甲状腺功能亢进症(甲亢)是由多种病因导致甲状腺激素分泌过多的自身免疫性疾病.治疗的方法目前主要包括:抗甲状腺药物治疗、131I治疗以及于术治疗.131I已被公认为治疗成人及儿童甲亢的有效、安全、简便的方法.目前,131I治疗甲亢的研究趋势主要集中在两个方面,即131I治疗甲亢存在的问题和远期安全性.     

对《131I治疗格雷夫斯甲亢指南（2013版）》有关问题的解答

2013年4月《131I治疗格雷夫斯甲亢指南（2013版）》（简称《指南》）发表。《指南》由中华医学会核医学分会组织的编写委员会在2010年发表的《131I治疗Graves甲亢专家共识（2010年）》基础上,吸收近年来国外出版的甲状腺疾病指南、权威教科书、循证医学文献的精华,结合我国131I治疗格雷夫斯甲亢的研究进展和临床实践总结编写而成,：匀求既适应临床工作的需求,又反映本领域当前最新进展,     

甲状腺疾病的介入诊治应深入研究慎重开展

甲状腺疾病的介入诊治有许多问题需要研究:如甲状腺的解剖基础,特别是甲状腺供血动脉的交通吻合、与疗效和并发症有关的介入解剖影像学研究;甲状腺栓塞治疗的适应证,现主要是作为传统经典疗法难于处理的Graves病的替代或补充方法,但也在作扩大适应证范围的探索;介入栓塞Graves病栓塞范围、栓塞水平和栓塞程度与疗效的关系;相对准确的个体量化指标;栓塞治疗甲状腺功能亢进(甲亢)主要是使甲状腺素的分泌腺减少,但同时也可能在甲状腺细胞增殖与凋亡的调节和免疫调节等诸多方面发挥综合性作用.由于甲状腺疾病介入治疗容易产生严重并发症,如脑梗死、甲亢危象、低钙血症、周期性麻痹等,需加强对并发症防治的探索与研究.甲状腺疾病介入治疗尚属起步,应采取积极慎重的态度深入开展研究.     

复合性甲状腺疾病的处理

复合性甲状腺疾病的诊治比较困难 ,自 1996年以来 ,我们治疗了 13例 ,现报告如下。1　临床资料(1)一般资料 :我院自 1996年 1月～ 1999年 10月 ,共收治甲状腺疾病 40 4例 ,其中复合性甲状腺疾病 13例 ,男2例 ,女 11例 ,占全部甲状腺疾病的 3 2 %。患者年龄 2 1～ 5 3岁 ,平均为 42岁。 (2 )术前诊断 :结节性甲状腺肿和原发性甲亢各 2例 ,结节性甲状腺肿继发甲亢 5例 ,甲状腺瘤 4例。 (3)实施手术 :诊断结节性甲状腺肿和原发性甲亢的 9例均实施了双侧甲状腺次全切 ;诊断甲状腺瘤的4例中 ,2例因诊断为单侧甲状腺瘤行 1侧甲状腺部分切除 ,2例诊…     

介入性栓塞治疗甲状腺机能亢进症

目的 :探索甲状腺动脉栓塞治疗甲状腺机能亢进 (简称甲亢 )的临床效果。材料和方法 :对 19例甲亢患者经甲状腺动脉超选择性插管 ,采用PVA ,硬脑膜微粒及钢圈栓塞治疗。结果 :甲状腺动脉超选择性插管、全部栓塞成功 ,13例甲亢症状缓解及T3、T4降至正常 ,所有的病例甲状腺体积有不同程度缩小 ,无严重并发症发生。结论 :甲状腺动脉栓塞治疗甲亢是安全、有效的方法。     

甲状腺机能亢进症192例外科治疗临床经验

目的　总结笔者近 10年甲状腺机能亢进症 (甲亢 )外科治疗的经验。方法　对 192例甲亢接受甲状腺次全切除病人的治疗和随访资料进行回顾性分析。结果　原发性甲亢 177例 ,继发性甲亢 11例和高功能腺瘤 4例。轻、中和重度甲亢分别为 6 6 (34% ) ,82 (4 3 % )和 44 (2 3 % )例。 10 0例 (5 2 % )存在心脏损害。术中保留甲状腺左右叶各 3～ 8克。 1例术后死于甲亢性心脏病心衰。无甲状腺危象和术后甲状腺功能低下发生。所有突眼性甲状腺肿病人均感到突眼不同程度减轻。 17例 (9% )术后出现低钙症状 ,是最常见并发症。结论　甲状腺次全切除治疗甲亢远期效果良好。术前准备以碘剂加普萘洛尔联合应用效果满意。多数病人采用局部或区域麻醉可满足手术要求。术中注意保留甲状腺被膜及下动脉可降低甲状旁腺功能低下的发生率。     

老年男性甲状腺结节调查

高清超声的广泛应用,使甲状腺结节的检出率明显增高,为甲状腺结节的早期诊治提供了有利条件,结合针吸细胞学检查,使甲状腺癌的早期诊治成为现实。文献报道甲状腺结节中约5%为恶性病变〔1〕。为规范甲状腺结节的诊治,美国临床内分泌医师学会、欧洲甲状腺学会、韩国甲状腺放射学学会和韩国放射学会均分别制定了各自的甲状腺结节诊治指南.     

131I治疗Graves甲亢专家共识（2010年）

前言 甲状腺功能亢进症（hyperthyroidism,简称甲亢）以Graves甲亢最多见,我国人群患病率约1.2%.Graves甲亢的主要治疗方法为抗甲状腺药物和131I治疗.近年来,用131I治疗Graves甲亢的患者呈增多趋势,为了进一步规范131I治疗,由多位核医学专家经多次共同商讨,数易其稿,历时2年,就有关131I治疗Graves甲亢临床相关问题形成此共识.     

Similarities and differences in follicular cell-derived thyroid cancer management guidelines used in Europe and the United States

The management of thyroid cancer has become more refined and complex over the last thirty years. In an effort to provide guidance to both clinicians and patients, several organizations have developed clinical management guidelines that provide specific advice regarding the diagnosis, treatment and follow-up of differentiated thyroid cancer. In this review, we compare and contrast the major management recommendations provided in the guidelines of the European Thyroid Association with those published by thyroid cancer specialty organizations in the United States (American Thyroid Association and National Comprehensive Cancer Network). By carefully examining treatment and management approaches that are applied in other areas of the world, we can identify equally effective alternative treatment or follow-up options that may find applicability to specific patients in our own practice. Despite significant difference in cultures, economies, and health care delivery systems, thyroid cancer management recommendations from the European experts and the American experts are far more similar than they are different. Each of the guidelines strongly endorses an initial management approach that is guided by individualized estimates of risk of recurrence and risk of death. Furthermore, follow up and additional therapeutic recommendations are based on revised risk estimates that reflect an individual patient's response to therapy.     

A radiologist’s guide to the clinical scales used in the 2015 Endovascular Stroke Trials and the Revised American Heart Association/American Stroke Association Guidelines for Endovascular Stroke Treatment

In 2015, five trials demonstrated the efficacy of endovascular treatment for acute stroke, culminating in the revised American Heart Association/American Stroke Association (AHA/ASA) recommendations for stroke management. The different clinical scales used in these trials may be unfamiliar to emergency and on-call radiologists. The modified Rankin Scale was used to describe patient disability for prestroke assessment in three of the trials and for the 90-day follow up in all five trials. The Barthel index was used in one trial to score prestroke ability to perform activities of daily living. The NIH Stroke Scale was used as part of eligibility criteria in four of the stroke trials to assess pre-existing neurological deficits. Also, the modified Rankin Scale and the NIH Stroke Scale are used in the revised AHA/ASA recommendations. By understanding these scales, emergency and on-call radiologists will better appreciate the stroke patient’s condition and will be able to more actively collaborate in the care of acute stroke patients.     

Assessment of the impact of 2015 American Thyroid Association guidelines in management of differentiated thyroid cancer patients

The 2015 American Thyroid Association (ATA) guideline have suggested modifications in the risk stratification (RS) for differentiated thyroid cancer (DTC) patients, introduced the concept of dynamic risk stratification (DRS) and redefined the role of radioactive iodine (RAI) in treatment algorithm. The aim of this retrospective audit was to assess the practical implications of these modifications in management of DTC. A total of 138 DTC patients were stratified according to ATA 2009 and 2015 guidelines into low (LR), intermediate (IR) and high (HR) risk groups. Change in RS and in intention of RAI use was calculated. Deviation in administered RAI dosage from the guidelines was assessed. 1-year follow-up data was audited to assess how the DRS modified the initial risk estimate. A total of 11.6% of patients changed their RS categories in 2015 guidelines. A total of 10.1% got upstaged to HR, and 1.4% got downstaged to LR. In 2.17% of patients’ intention of RAI use changed to remnant ablation from adjuvant therapy and 65% of the LR patients won’t require any RAI therapy. A total of 26.7% of patients had received significantly more RAI dosage according to ATA 2015. At 1-year follow-up according to DRS 84% of LR, 75% of IR and 44% of HR patients showed excellent response (ER). More patients changed RS to HR than to LR. Intention of RAI use changed in only a small number of patients. Significantly higher dosage of RAI is being administered to patients in current practice. The effect of DRS in modifying the initial RS was most prominent in IR, with most showing ER to initial therapy.     

甲状腺本身病变所致甲亢的核素显像特征

目的甲状腺功能亢进症具有多种病因、临床表现和治疗方法。应用核素显像对甲状腺自身病变所致甲状腺功能亢进症病因进行正确的诊断,指导选择相对应合适的治疗方法。方法319例临床拟诊甲亢患者,治疗前进行甲状腺显像（thyroid radionuclide imaging）,对甲亢病因做分型。结果甲状腺显像特征分类Grave’s病（GD）259例（合并结节66例）,81．2％;毒性腺瘤（TA）36例,11．3％;毒性多结节性甲状腺肿（TMNG）9例,2．8％;亚急性甲状腺炎15例,4．7％。结论甲状腺核素显像在甲状腺功能亢进症的分类和指导治疗中起重要的基础作用,可为临床提供合理及最佳的临床实践。     

Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association

OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. PROCESS: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.     

加强多学科合作提高甲状腺疾病放射性核素治疗水平

甲状腺疾病足最常见的内分泌疾病,治疗手段包括内科、外科和核医学治疗方法.131Ⅰ是甲状腺功能亢进症的重要治疗方法之一,重视多学科密切合作,可获得理想的治疗效果.     

Should a woman taking propylthiouracil breast-feed?

Thyroid function was tested in mother and her son. The mother was taking propylthiouracil for treatment of hyperthyroidism, and she was breast-feeding. Thyroid function was normal in both.     

2015美国心脏协会心肺复苏及心血管急救指南核心更改解读

发布的《2015美国心脏协会心肺复苏及心血管急救指南更新》主要更新点涉及多个方面的内容,包括新增院内成人生存链、修改成人基础生命支持流程、优化了胸外按压的速率及深度、简化复苏药物的使用等方面。作者就最主要的更新点进行解读。