妊娠中期妇女甲状腺功能筛查结果分析

目的 探讨妊娠中期妇女甲状腺功能筛查的重要性,为妊娠中期妇女甲状腺疾病的诊疗提供依据.方法 选择277例妊娠中期妇女为妊娠组,162位非妊娠育龄妇女为对照组.采用放射免疫法(RIA)检测FT3、FT4,采用免疫放射法(IRMA)检测TSH.结果 ①妊娠组甲状腺疾病总患病率为14.08％ (39/277),对照组甲状腺疾病总患病率为8.02％(13/162),两组比较差异有统计学意义(P＜0.05).②妊娠组中甲亢(包含亚临床甲亢)患病率为1.44％(4/277),和甲减(包含亚临床甲减)患病率为12.64％(35/277)比较,差异有统计学意义(P＜0.05).对照组甲亢(包含亚临床甲亢)患病率为1.23％(2/162),和甲减(包含亚临床甲减)患病率为6.79％(11/162),差异有统计学意义(P＜0.05).妊娠组甲减(包含亚临床甲减)患病率较对照组升高,差异有统计学意义(P＜0.05).③两组FT3、FT4、TSH结果比较,妊娠组FT4水平低于对照组,差异有统计学意义(P＜0.05);妊娠组TSH水平低于对照组,差异有统计学意义(P ＜0.05);FT3水平无显著差异(P＞0.05).结论 妊娠中期妇女甲状腺疾病患病率增高,以甲减(包含亚临床甲减)居多,对妊娠中期妇女甲状腺功能进行筛查具有重要意义,妊娠期特异性甲状腺激素参考值范围有待明确.     

某院医务人员甲状腺功能检测结果分析

目的 调查我院医务人员甲状腺功能情况。方法 选取2016年1月~2018年12月在我院进行甲状腺功能检测的医务人员168名,采用化学发光分析仪检测促甲状腺素（TSH）、血清三碘甲状腺原氨酸（T3）、血清甲状腺素（T4）、血清游离三碘甲状腺原氨酸（FT3）及血清游离四碘甲状腺原氨酸（FT4）,并根据性别、岗位及年龄进行分类,比较不同性别、年龄及岗位医务人员的甲状腺功能状况。结果 168例受检者中,甲状腺功能异常34例（20.23%）,其中亚甲减所占比例最高;男性甲状腺功能异常检出率为8.06%（5/62）,女性甲状腺功能异常检出率为27.36%（29/106）,女性高于男性,差异有统计学意义（P＜0.05）;医生甲状腺功能异常检出率为11.70%（11/94）,护士甲状腺功能异常检出率为31.08%（23/74）,护士高于医生,差异有统计学意义（P＜0.05）;≥35岁男性的TSH水平为（2.94±1.90）μIU/ml,高于＜35岁男性的 (1.71±0.79) μIU/ml,差异有统计学意义（P＜0.05）;＜35岁女性TSH水平为（3.08±2.75）μIU/ml,高于＜35岁男性的 (1.71±0.79) μIU/ml,差异有统计学意义（P＜0.05）;＜35岁女性FT3为（2.75±0.45）pg/ml,FT4为（12.78±1.96）pg/ml ,低于＜35岁男性的FT3（3.02±0.59）pg/ml、FT4（13.97±1.90）pg/ml,差异有统计学意义（P＜0.05）。结论 我院医务人员甲状腺功能紊乱发病率较高,以亚甲减为主,其中女性发病率高于男性,护士发病率高于医生,年龄因素对甲状腺疾病有一定影响。     

江门市新会区人群甲状腺功能状况调查

目的探讨新会地区人群的甲状腺功能状况与甲状腺疾病发病情况。方法采用地方性抽样调查与实验室检测分析相结合，于2005年4月至2006年9月抽取新会区会城镇、崖门镇、罗坑镇和杜阮镇的居民以及新会区中医院的体检者和就诊病人，共12036人，进行其甲状腺功能状况调查，以甲状腺功能检测异常值结合临床诊断来判断甲状腺疾病的发病率及与性别、年龄等的关系。结果各项指标异常总检出率为：4镇居民（A组）的T3和T4均为8．5％，FT3和FT4均为7．6％、TSH为21．5％，就诊体检者（B组）的T3为19．0％，T4为18．4％，FT3为16．8％，FT4为16．0％，TSH为30．8％。4个镇的发病率依次是：崖门镇（26．5％），罗坑镇（21．6％）．会城镇（19．6％），杜阮镇（13．6％），4镇居民总发病率（21．5％）低于就诊体检者（29．8％）：4镇居民和就诊体检者均以31-40岁发病率最高；两组总发病例数男782例，女2199例，总发病率男女比为1：2．8，其中甲亢男女比约为1：4。结论新会地区人群的甲状腺功能异常者较多，甲状腺疾病发病率比较高，究其原因可能与高碘饮食等有一定关系。     

甲状腺疾病患者血清TSH,PRL对TRH兴奋试验反应的临床探讨

促甲状腺激素释放激素（TRH）兴奋试验是临床常用的检查下丘脑-垂体-甲状腺轴功能的方法。近年来发现TRH不仅能促使垂体释放TSH、PRL,而且释放PRL比释放TSH更为显著。为全面地了解TRH兴奋试验的意义,我们对处于不同功能状态时甲状腺疾病患者血清TSH、PRL进行了临床观察。 对象和方法 一、对象:经确诊的甲状腺疾病患者共85例（男35,女50）,年龄在20～60岁之间,平均为41.81±13.64岁。按甲状腺功能状态分成4组:原发性甲状腺机能亢进者40例,甲亢治疗后甲功正常者10例,亚临床甲减者10例,原发性甲减者25例。     

甲状腺功能检查诊断亚临床甲状腺疾病的意义

甲状腺疾病是内分泌系统常见的疾病 ,亚临床甲状腺疾病是指患者没有或几乎没有甲状腺功能紊乱的临床表现 ,而血清甲状腺激素或血清促甲状腺激素 (TSH) ,或二者的浓度有异常。由于甲状腺功能变化微小 ,它所引起的代谢和器官功能的改变常常持续多年。因此认识亚临床甲状腺疾病对于甲状腺疾病的早期诊断和治疗具有重要意义。本文就336 0例患者来我院门诊做甲状腺功能检测的结果进行统计分析 ,对其发病率及临床意义进行一定的探讨。对象和方法一、对象 :分析我院 2 0 0 2年 1月～ 12月门诊 336 0例 (男15 12 ,女 184 8) ,甲状腺功能的检查结果…     

空泡蝶鞍中老年患者甲状腺激素测定的临床价值

目的 探讨甲功检测在空泡蝶鞍中老年患者中的临床价值.方法 选取2019年1月至2019年12月我院影像科CT或MRI诊断为空泡蝶鞍的40～80岁患者100例,选取体检中心40～80岁健康体检人员407例作为对照,化学发光法检测FT3、FT4、T3、T4及TSH水平.结果 空泡蝶鞍患者的FT3、FT4、T3、T4的水平低于健康体检人群,TSH水平稍低但差异无统计学意义;空泡蝶鞍患者甲状腺功能减退的发生率高于健康体检人群(51.0％vs 38.3％),且以原发性甲减和继发性甲减为主(分别为14.0％vs 4.9％,21.0％vs 3.4％),健康体检人群以亚临床甲减为主.结论 影像学上考虑空泡蝶鞍的中老年患者甲减发生率高,应该及时检测甲状腺功能.     

亚临床甲状腺功能减退症对于糖尿病及其并发症的影响分析

目的 探讨亚临床甲状腺功能减退症对于糖尿病及其并发症的影响.方法 选取临床资料较为完整的407名2型糖尿病患者根据其是否合并有亚临床甲状腺功能减退将其分为亚临床甲减组以及非亚临床甲减组,对患者的基本资料(病史、合并的并发症、生化指标)予以回顾性分析.结果 合并亚临床甲减组患者的糖尿病慢性并发症DN、DR、DP、DPF的发病率与对照组相比明显增高,合并亚临床甲减组患者的生化指标FBS以及HbA1c水平相比于对照组明显下降,TC、TG、UAER、TSH水平相比于对照组明显升高,组间比较具有统计学差异(P＜0.05).结论 2型糖尿病与亚临床甲减疾病有着紧密联系,糖尿病患者必须定期检查甲状腺功能,以便于早期对亚临床甲减作出诊断和干预,从而预防以及延缓糖尿病并发症的发生和发展.     

亚临床甲状腺功能减低症与代谢综合征组分相关性的研究

目的 调查体检人群中亚临床甲状腺减低症的患病率,探讨血甲状腺功能水平与代谢综合征(metabolic syndrome,MS)及其组分的相关性.方法 通过对1337名在健康管理研究院进行健康查体者的体检结果进行分析,根据促甲状腺激素水平分为亚临床甲减组与甲功正常组,比较两组间的差异.结果 亚临床甲减总检出率9.1％;MS总检出率为18.8％,且亚临床甲减组与甲功正常组在MS组分中的血脂异常的检出率有统计学差异,特别是血脂中的甘油三脂水平.结论 亚临床甲减与MS的组分密切相关,其中血脂异常是发生亚临床甲减的相关因素.     

老年SH患者甲状腺激素水平与冠心病相关性探讨

目的:探讨老年亚临床甲状腺功能减退症血清甲状腺激素与冠心病病变程度的相关性.方法:70例冠心病患者根据冠脉造影结果分为造影正常组30例,单支病变组15例,多支病变组35例,采用放射免疫分析检测TT3,TT4,FT3,FT4,TSH水平.结果:多支病变组的亚临床甲减发生率明显高于造影正常对照组和单支病变组(P＜0.05),亚临床甲减与冠心病多支病变具有相关性(OR=2.20). 结论:亚临床甲状腺功能减退症是冠心病多支病变的危险因素之一.     

妊娠合并甲状腺功能减的研究进展

甲状腺疾病是常见的疾病,近年来我国发病率呈上升趋势,而育龄妇女是甲状腺疾病的高发人群。甲状腺功能减退是大多数甲状腺疾病的最终转归,妊娠合并甲状腺减退症（甲减）,由于症状隐匿,往往被忽视。妊娠合并甲减的发生率0．2％～0．3％,其中临床甲减的发生率2％-3％,亚临床甲减占甲减患者的90％。越来越多的研究证明：甲减对妊娠可造成不良影响,甚至影响胎儿的脑发育。     

Graves'病患者血清骨钙素测定及临床意义

目的：探讨Graves’病患者血清骨钙素（BGP）水平变化特点及临床意义。方法：对158例Graves’病患者血清BGP水平进行分析，并与甲状腺功能主要指标（T3、T4、FT3、FT4、TSH、TGA、TMA）进行相关分析。结果：Graves’病患者血清BGP水平明显高于正常对照组；Graves’病患者血清BGP水平与T3、T4、FT3、FT4呈正相关，而与TSH、TGA、TMA无明显相关。结论：血清BGP可作为监测Graves’病患者骨代谢状况及Graves’病骨病发生的重要指标之一。     

TPO-Ab在甲状腺自身免疫性疾病中的应用

目的：探讨甲状腺过氧化物酶抗体（TPO-Ab）在甲状腺功能亢进（甲亢）、甲状腺功能减退（甲减）、单纯性甲状腺肿大患者的临床价值。方法：采用放射免疫分析检测甲状腺疾病患者血清TGA、TMA、TPO-Ab浓度及血清FL、FT4、TSH水平，分析TPO-Ab在69例甲亢、53例甲减及45例单纯性甲状腺肿的阳性率。结果：TPO-Ab的阳性率（82％-92．5％）明显高于同组的TGA（44．2％）、TMA（69．8％），甲减组TPO-Ab的阳性值（平均57．4％）明显高于甲亢组（31．2％）和单纯甲状腺肿组（17．6％），差异有显著意义（P〈0．01）。结诊!TPO-Ab对自身角癌件甲状腺疾病的诊断、治疗和预后评估具右一定的临床价值．     

老年性疾病患者TSH、T3、T4、FT3、FT4测定的临床应用

目的：探讨老年性疾病患者血清TSH、T3、T4、FT3、FT4测定的临床应用。方法：选择30例无老年性疾病和233例患有冠心病（CHD）、慢性阻塞性肺病（COPD）、糖尿病（DM）、脑梗、慢性支气管炎老年性疾病的患者,分别用化学发光免疫法（CLIA）测定血清促甲状腺激素（TSH）、三碘甲腺原氨酸（L）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。结果：常见老年性疾病患者T3、FT3水平明显低于健康对照组水平（P〈0．01）,并与病情程度成相关关系,尤以T3值更为显著降低。TSH根据各病情、年龄的不同较健康对照组有所改变,而各组T4、FT4水平与健康对照组无明显差异（P〉0．05）。结论：常见老年性疾病呈现低T3、FT3,而TSH略有上升易误诊为甲减,其实为低T3综合征,即甲状腺正常的疾病综合征（SES）。同时动态观察血清甲状腺激素的变化,有一定的反映病情状况及观察预后的作用。     

Role of FNA in the medical management of minimally enlarged thyroid

Fine-needle aspiration (FNA) of thyroid is a cost-effective and simple diagnostic tool in the initial screening of patients with thyroid nodules. But, its role in a clinically normal thyroid or a minimally enlarged thyroid in a symptomatic patient suspected of having thyroid dysfunction is unknown. With our 2-yr experience in a setup of a tertiary health care hospital in a developing country, we have aimed to implement a management protocol using FNA thyroid done without ultrasound guidance and TSH estimation done during the same visit in symptomatic patients suspected of having thyroid pathology but presenting with no goiter or having minimally enlarged thyroid with no palpable nodules. The thyroid enlargement in 172 cases were graded with the criteria endorsed by WHO, Pan American Health Organization, and International Council for Control of Iodine Deficiency Disorders into grade 0, 1, and 2. The cases were evaluated cytologically and correlated with TSH values according to the algorithm formulated by the authors. FNA was diagnostic in 86.6, 98, and 100% in grade 0, 1, and 2 goiters, respectively. 52.3% (n = 90), 19.8% (n = 34), 16.9% (n = 29) of cases were diagnosed as Hashimoto's thyroiditis (HT), colloid goiter (CG), and lymphocytic thyroiditis (LT). Sixteen had a combination of LT and CG (n = 6), HT and CG (n = 6), papillary carcinoma (n = 2), and diffuse hyperplasia (n = 2). No statistically significant difference (P = 0.4586) was noted between the groups of patients with grade 0 and grade 1-2 goiter, who underwent FNAC. 38.95% of patients (n = 67) with TSH values greater than 10 microIU/ml and considered hypothyroid showed features of HT/LT at FNA. 23.83% (n = 41) having TSH values between 5 and 10 microIU/ml (subclinical hypothyroidism) also showed features of HT/LT at FNA. Both groups were treated with thyroxine. 35.46% (n = 61) of cases with TSH values within normal range (0.5-5.1 microIU/ml) and considered euthyroid showed a spectrum of lesions at cytology other than HT and LT. They are being followed up to detect them at an early stage of subclinical hypothyroidism. Only 13 cases (7.5%) who were serologically euthyroid showed HT/LT and are being followed-up. Thus, the authors advocate FNA of the thyroid as a single simple cost-effective office procedure in the medical management of all nonpalpable/minimally enlarged thyroid in patients suspected of having thyroid pathology and/or in combination with TSH values. FNA helps in early detection of subclinical hypothyroidism, which is of utmost importance in pregnant women and further makes possible availability of baseline values for future reference. With the implementation of this protocol of FNA thyroid without imaging, we affirm that the practice of cytology which differs in different geographic areas and from country to country depending on economy and availability of infrastructure can be made more user-friendly.     

Thyroid function in multidrug-resistant tuberculosis patients with or without human immunodeficiency virus (HIV) infection before commencement of MDR-TB drug regimen

BackgroundMycobacterium tuberculosis and human immunodeficiency virus (HIV) are known to cause abnormal thyroid function. There is little information on whether HIV infection aggravates alteration of thyroid function in patients with MDR-TB.ObjectivesThis study was carried out to determine if HIV co-infection alters serum levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) in patients with MDR-TB patients and to find out the frequency of subclinical thyroid dysfunction before the commencement of MDR-TB therapy.MethodsThis observational and cross-sectional study involved all the newly admitted patients in MDR-TB Referral Centre, University College Hospital, Ibadan, Nigeria between July 2010 and December 2014. Serum levels of thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were determined using ELISA.ResultsEnrolled were 115 patients with MDR-TB, out of which 22 (19.13%) had MDR-TB/HIV co-infection. Sick euthyroid syndrome (SES), subclinical hypothyroidism and subclinical hyperthyroidism were observed in 5 (4.35%), 9 (7.83%) and 2 (1.74%) patients respectively. The median level of TSH was insignificantly higher while the median levels of T3 and T4 were insignificantly lower in patients with MDR-TB/HIV co-infection compared with patients with MDRT-TB only.ConclusionIt could be concluded from this study that patients with MDR-TB/HIV co-infection have a similar thyroid function as patients having MDR-TB without HIV infection before commencement of MDR-TB drug regimen. Also, there is a possibility of subclinical thyroid dysfunction in patients with MDR-TB/HIV co-infection even, before the commencement of MDR-TB therapy.     

TMA与TGA检测对甲状腺疾病的临床诊断价值

根据174例疑诊患者的TMA、TGA，T3，T4放射免疫测定结果及其临床表现进行诊断，结果表明桥本氏甲状腺炎和甲亢所占的比例(分别为38．51％及31．61％）显著高于甲减和亚急性甲状腺炎(分别为6．32％和4．02％)，P＜0．05。甲减患者TGA TMA的阳性率（81．82％)显著高于甲亢(50．91％)，桥本氏甲状腺炎(50．75％)及亚急性甲状腺炎(57．14％)，P＜0．05。单项抗体阳性者以TMA较TGA为多。本文结果提示在甲状腺疾病中TMA，TGA的阳性结果存在相互重叠现象，与T3、T4联检并结合临床表现进行综合分析有助于甲状腺疾病的鉴别诊断并正确指导治疗。     

The measurement of the serum sex-hormone binding globulin in various thyroid diseases

Synthesis of "sex-hormone binding globulin" (SHBG) is influenced by thyroid hormones and its concentration in the serum of female subjects may be a marker of thyroid hormone effect at the peripheral tissue (liver) level. Compared to the levels found in euthyroid females (n = 46), the mean (+/- S.D.) serum SHBG concentration was found elevated in overt hyperthyroidism (Graves' disease: n = 56; 141.6 +/- 37.6 vs. 48.3 +/- 16.2; toxic nodular goiter: n = 16; 119.9 +/- 50.7 vs. 48.3 +/- 16.2 nmol/l; P less than 0.001). In contrast, it was decreased in manifest hypothyroidism (n = 25; 24.9 +/- 14.8 vs. 48.3 +/- 16.2; P less than 0.001). In the group of preclinical hyperthyroidism (n = 43), despite suppressed TSH secretion, the serum value of SHBG was normal (47.4 +/- 16.8), while its serum level approached the lower border of the normal range in subclinical hypothyroidism (n = 10; 33.6 +/- 6.1 vs 48.3 +/- 16.2 nmol/l; P less than 0.01). Data indicate that the pituitary responds more sensitively than the liver to a slight change of the serum thyroid hormone level. During thyroid hormone replacement for hypothyroidism, measurement of serum SHBG may provide help to assess the response of the target organ to the given therapy. In patients with generalized resistance to thyroid hormone, the serum SHBG level is within the normal range (51.3 +/- 9.8 nmol/l), thus, its determination supports the diagnosis of this disease.     

Screening for thyroid disorders in a working population

Summary Subclinical thyroid disorders have received increasing attention in recent years due to refined laboratory methods and a stronger emphasis on the role of preventive medicine. We performed a screening for thyroid-stimulating hormone (TSH) on 6884 persons in a working population. In cases in which TSH was not within the normal range we also measured the levels of triiodothyronine (T₃), thyroxine (T₄), and thyroxine-binding globulin (TBG). All persons who did not present with exclusion criteria or other nonthyroidal illnesses (n = 59) and the controls (n = 39) were submitted to thyrotropin-releasing hormone (TRH)-testing. Additionally, sonography of the thyroid was performed on 120 persons (59 subjects with abnormal hormone levels and 61 controls) to determine thyroid size and rule out morphological abnormalities. Based on the TRH test and T₃, T₄, and TBG measurements we found a prevalence of 0.03% (2/6884) for overt hyperthyroidism, 0.33% (23/6884) for subclinical hyperthyroidism, 0.09% (6/6884) for subclinical hypothyroidism, and 0.015% (1/6884) for overt hypothyroidism in the healthy population. In subjects with overt or subclinical hyperthyroidism the prevalence of goiters (thyroid volume > 18 ml in women, > 25 ml in men) was 28%. Of this group 48% had structural abnormalities. All persons with goiters and/or structural abnormalities were over 35 years of age. Among the euthyroid, 20% had thyroid enlargement, and the same proportion presented with structural abnormalities. There were no differences between the two age groups. In the group with overt/subclinical hypothyroidism 47% presented with structural abnormalities of the thyroid; however, none presented with thyroid enlargement. Thyroid nodules were found only in older persons (> > 35 years) with euthyroidism or hypothyroidism. These data confirm the relatively high prevalence of functional and morphological abnormalities of the thyroid. An early substitution with iodine is warranted to prevent functional and morphological disorders of the thyroid in older age. People with subclinical hyperthyroid disorders must avoid exposure to iodine, which can cause an exacerbation of the disease.Abbreviations TBG thyroxine-binding globulin - TRH thyrotropin-releasing hormone - TSH thyroid-stimulating hormone - T₃ triiodothyronine - T₄ thyroxine Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

Graves‘甲亢^131I治疗前后TGA,TMA的变化及临床意义

本文对502例Graves'病患者的甲状腺功能及TGA、TMA水平进行了观察,按治疗前TGA、TMA水平分为两组,第一组为阳性组(TGA>30%,TMA>15%),第二组为阴性组。结果显示,阳性组早发甲低率明显高于阴性组(p<0.01),其临床治愈率也高于阴性组(p<0.01);而阴性组治疗后临床症状缓解不全者明显高于阳性组。提示Graves'甲亢~(131)Ⅰ治疗前后,测定TGA、TMA有一定的临床指导意义,对于治疗前设计剂量方案及预测甲低的发生均有一定的参考价值。     

Graves’病患者^131I治疗前后TMA、TGA的变化与甲状腺大小的关系

目的：探讨Graves’病患者131I治疗前后TGA、TMA的变化与甲状腺大小之间的关系。方法：327例Graves’病患者按甲状腺大小分为三组。甲状腺Ⅰ°肿大组97人。甲状腺Ⅱ°肿大组128人;甲状腺Ⅲ°肿大组102人。用化学发光法测定患者治疗前及治疗后第6月的TGA、TMA值,并进行比较。结果：甲状腺Ⅰ°肿大组治疗前后TGA、TMA值变化不明显（P〉0.05）,早发甲减率21.44%;甲状腺Ⅱ°肿大组,治疗后TGA、TMA值比治疗前升高（P〈0.01）,早发甲减率27.15%;甲状腺Ⅲ°肿大组,治疗后TGA、TMA值比治疗前明显升高（P〈0.01）,早发甲减率30.07%。结果还显示,治疗后TGA、TMA值随着治疗前甲状腺越大,值的升高越明显,早发甲减几率越高。结论：Graves’病患者甲状腺越大,131I治疗后TGA、TMA升高越明显,早发甲减几率越高。