慢性充血性心力衰竭患者甲状腺素的变化

目的 研究甲状腺激素(thyroid hormone,TH)水平与慢性充血性心力衰竭(congestive heart failure,CHF)的关系.方法 应用微粒子发光法检测100例老年慢性充血性心力衰竭住院患者及50例健康对照者的血清三碘甲腺原氨酸(FT3)、总三碘甲腺原氨酸(TT3)、游离甲状腺素(FT4)、总甲状腺素(TT4)、反三碘甲腺原氨酸(rT3)及促甲状腺素(TSH)结果老年慢性充血性心力衰竭患者甲状腺素T3水平明显低于健康对照组,低T3综合征的老年CHF患者心力衰竭程度严重.结论 在早期慢性心力衰竭的患者,其T3水平是降低的,且与心力衰竭的严重程度有关.     

The effects of ranitidine on pituitary-thyroid function.

Although several studies have examined the effects of cimetidine on pituitary-thyroid function, few have investigated ranitidine in this respect. We found no changes in thyroid-stimulating-hormone (TSH) or prolactin responses to TSH-releasing-hormone (TRH) in 10 patients with peptic ulcer disease given oral ranitidine. Serum total and free thyroxine (TT4 and FT4) concentrations declined slightly, whereas total and free triiodothyronine (TT3 and FT3) increased slightly following ranitidine. None of these changes achieved statistical significance. Both the ratio of TT4/TT3 and FT4/FT3, however, declined (P less than 0.05) following ranitidine. Thus ranitidine may have a minor influence on peripheral deiodination of thyroxine but has little effect on hormone production from the thyroid gland. The diagnostic value of biochemical tests of thyroid function is not seriously compromised in patients receiving ranitidine.     

老年2型糖尿病甲状腺激素水平与代谢指标相关性分析

目的分析老年2型糖尿病甲状腺激素水平与代谢指标的相关性。方法选择2010年1月至2012年6月于我院就诊的300例老年2型糖尿病患者作实验组,并按照糖化血红蛋白水平分为四组。选择健康体检者300例作正常对照组。分别检测所有试验者的甲状腺素总量（TT4）、游离甲状腺素（FT4）、游离甲腺原氨酸（FT3）、促甲状腺激素（TSH）和血清三碘甲腺原氨酸总量（TT3）,并对其进行比较。结果实验组患者的FT3、TT3均明显低于正常对照组,差异有统计学意义（P〈0．05）;GHbAIc〈6．5％组患者的Fr3、Tr3明显高于GHbAl（6．5％-7．5％）组、GHbAle（7．6％-10．0％）组、GHbAlc〉10．0％组,差异有统计学意义（P〈0．05）。各组患者的TT4、FT4、TSH比较,差异无统计学意义（P〉0．05）。结论准确检测患者的甲状腺激素代谢指标对老年2型糖尿病患者的病情控制有重要意义。     

Thyroid hormone concentrations in epileptic patients

Summary Anticonvulsants are associated with decreased serum thyroid hormone concentrations. We have studied thyroid function in 54 epileptic patients on a variety of drugs (19 on carbamazepine, 13 on phenytoin, 10 on sodium valproate, 12 on polypharmacy). For comparison, 14 untreated epileptics and 11 healthy unmedicated volunteers were included as controls.Total thyroxine (T₄) concentrations were reduced in patients taking enzyme-inducing drugs (carbamazepine and/or phenytoin) compared with both controls and patients taking sodium valproate. Similar differences were shown with each individual drug. All nine patients whose circulating T₄ was below the lower limit of the reference range were taking enzyme inducers. Free thyroxine concentrations were also reduced in individuals treated with carbamazepine and phenytoin with five values falling beneath the reference range. Tri-iodothyronine and thyrotropin appeared unaffected by anticonvulsant administration. Thyrotropin releasing hormone stimulation revealed no true hypothyroidism.The lowering effect of anticonvulsant drugs on circulating total and free T₄ was not exhibited by the non-inducing sodium valproate. These data support the influence of enzyme induction as a likely mechanism for reduced thyroxine concentrations in treated epileptic patients.     

肝硬化病人下丘脑-垂体-甲状腺轴的功能变化及临床意义

目的 探讨不同级别肝硬化(LC)病人下丘脑-垂体-甲状腺轴的变化及临床意义.方法 91例LC病人按Child-Turcotte-Pugh(CTP)计分评级分为三组:LC-A组25例,LC-B组35例,LC-C组31例;另选27名健康人作为对照组.血清总三碘甲状腺原氨酸(TT3)、游离T3(FT3)、反T3(rT3)、总甲状腺素(TT4)、游离甲状腺素(FT4) 及促甲状腺激素(TSH) 均采用化学发光法检测,肝功能生化指标用RXL生化分析仪检测,凝血酶原时间(PT)用全自动血凝仪(血凝固法)检测.结果 从LC-A组到LC-C组随着肝硬化级别的增加,血清TT3和FT3水平逐渐降低,rT3渐次增高,TT4/rT3比值顺次下降,血清TT3分别与白蛋白、前白蛋白、载脂蛋白-A1和胆碱酯酶呈显著正相关(df=89,r值分别为0.568,0.260,0.317和0.599,P<0.05),与CTP分值及PT呈显著负相关(df=89,r值分别为-0.447和-0.297,P<0.01),TSH在各组间差异无统计学意义.共26例LC病人出现低T3综合征,LC-A组为0,LC-B组8例(22.9%),LC-C组18例(58.1%).经保肝、支持治疗1~2周后,随着肝功能好转低T3综合征也随之消失.心得安试验仅见FT4有所下降(16.84±3.16)vs (14.00±2.45) pmol·L-1,地塞米松试验未见甲状腺激素及TSH有明显变化.结论 肝硬化失代偿期随着肝功能的下降,发生低T3综合征的比例增多,与甲状腺激素转运蛋白合成功能减退、T4向T3转化减少有关,但随着病情好转低T3综合征便逐渐消失,无须补充甲状腺素.心得安或地塞米松试验对甲状腺功能未产生明显的影响,提示短期适量应用此类药物是安全的.     

原发性高血压病人血清甲状腺激素水平的改变

目的 研究原发性高血压病人血清甲状腺激素水平的改变。方法 用放射免疫分析法测定38例高血压病人和20例健康对照者的血清甲状腺激素水平。结果 原发性高血压病人的血TT3、FT3值明显低于正常人,rT3值明显高于正常人,而TT4、FT4、TSH水平与正常组相比差异无显著意义;血TT3、FT3值的和rT3值的升高与高血压病的严重程度有关而与病程无关。结论 原发性高血压常伴有低血清TT3、FT3水平,且随着高血压病情的加重而逐渐降低。     

早产儿暂时性甲状腺功能障碍分析与治疗

目的探讨早产儿暂时性甲状腺功能障碍的情况及左旋甲状腺素治疗的疗效。方法对165例早产儿进行血清FT4、T4、FT3、T3、TSH检测,对FT4、T4降低的早产儿按甲状腺功能低下症状有无分为观察组与对照组,对T3降低的早产儿随机分为观察组与对照组,观察组予左旋甲状腺素治疗,定期复查血清FT4、T4、FT3、T3、TSH。结果①早产儿暂时胜甲状腺功能障碍发生率为47．27％,胎龄越小,发生率越高。其中胎龄28～30周发生率为77．27％,30。32周75％,32—34周39．47％,34～36周32．47％。②低甲状腺素血症观察组早产儿经左旋甲状腺素治疗后症状消失,血清FT4及T4恢复正常时间较对照组快。生后14天观察组FT4、T3 100％恢复正常,对照组44．4％恢复正常,P=0．00。③低T3综合征早产儿观察组与对照组的TSH、T3恢复正常所需时间无差别。生后28天观察组TSH、T315％恢复正常,对照组10％恢复正常,P=1．00。结论早产儿生后甲状腺功能暂时性低下,胎龄越小,功能越低。对于有甲状腺功能低下临床症状的早产儿予短期左旋甲状腺素治疗有助于改善甲状腺功能。     

皮质醇增多症治疗控制对促甲状腺素和甲状腺激素水平的影响

观察10例皮质醇增多症未治患者和8例治疗控制患者血中促甲状腺素（TSH）和甲状腺激素浓度的改变。结果显示未治组平均TSH、TT3、FT3血浓度明显低于正常低限，TT4稍低于正常，FT4略高于正常低限。治疗控制组平均TSH、TT3、FT3浓度明显上升，与未治组比较差别有显著性意义；TT4、FT4稍上升，与未治组比较差别无挺着性意义。在治疗技制组除TT3略低于正常外，TSH、FT3、TT4平均值均恢复正常。提示皮质醇增多症治疗控制后，合并存在的下丘脑－垂体－甲状腺轮功能紊乱可随之恢复。     

Dose-response and time course of hypothyroxinemia and hypoinsulinemia and characterization of insulin hypersensitivity in 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-treated rats

Male Sprague-Dawley rats were administered i.p. various doses of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in corn oil. At several time points thyroid stimulating hormone (TSH), total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), reverse triiodothyronine (rT3) and insulin were determined in serum using radioimmunoassays, and glucose was measured by the glucose oxidase method. TSH and TT3 were not affected by any dose at any time point of measurement. TT4 and FT4 were decreased in a somewhat dose-dependent manner by days 2 to 4 after dosing. Return of TT4 and FT4 to normal values by day 32 after TCDD dosage also occurred in a dose-dependent manner, except in rats that died later. rT3 was also decreased at each dose level early and returned to normal levels in a somewhat dose-dependent fashion. Rats in the 2 highest dose groups became hypoinsulinemic and in the highest dose group also hypoglycemic by day 8 after dosing. Serum insulin and glucose remained suppressed in non-survivors of TCDD until death ensued. In survivors, serum insulin returned to normal values by day 32 after dosing. The hypoinsulinemic state was further characterized by hypersensitivity towards insulin, i.e. injection of an otherwise non-toxic dose of insulin 3 days after administration of 125 micrograms/kg TCDD was lethal to 80% of the rats within 24 h. Insulin hypersensitivity preceded both hypoglycemia and hypoinsulinemia. These findings suggest that hypothyroxinemia and hypoinsulinemia may be part of an adaptive process whereby rats attempt to diminish the toxic insult of TCDD.     

Sustained release disopyramide compared to plain capsules after change-over from intravenous infusion

1 The effect of different combinations of liver microsomal enzyme inducing drugs on thyroidal hormone steady state concentrations was investigated. Three groups of healthy volunteers were given daily either antipyrine 1200 mg together with phenobarbitone 100 mg, antipyrine 1200 mg combined with rifampicin 600 mg or rifampicin 600 mg alone for a period of 14 days. 2 Before and after each treatment the total body clearance of antipyrine, gamma-glutamyl transferase (gamma-GT), 6 beta-OH-cortisol as in vivo parameters of liver microsomal enzyme activity were measured. In addition, thyroxine (T4), free thyroxine (FT4), T3 resin uptake, tri-iodothyronine (T3) reverse T3 (rT3) and TSH were estimated. 3 After rifampicin administration there was a 60% increase in antipyrine clearance while following combinations of antipyrine-phenobarbitone or antipyrine-rifampicin an 80% and 128% increase respectively occurred. 4 A marked decrease of T4, FT4 and rT3 was seen in all groups while T3 remained stable in all groups investigated. This effect may be partly due to an increase in extrathyroidal metabolism of T4 as found previously by a kinetic turnover study using 125I-T4. It also depends on the extent of the liver microsomal enzyme inducing capacity rather than on the nature of the drugs used. The striking disparity of liver enzyme induction of T4 and rT3 disposal on the one hand and T3 metabolism on the other is a unique phenomenon whose pathogenesis is not clear at the present time.     

Relationships between plasma levels of organochlorines, retinol and thyroid hormones from polar bears (Ursus maritimus) at Svalbard

Associations were determined between retinol and the thyroid hormones thyroxine (T4) and triiodothyronine (T3), respectively, and the organochlorine contaminants (OCs) polychlorinated biphenyls (PCBs), 1, 1-dichloro-2,2-bis-(4-chlorophenyl)ethylene (DDE), hexachlorobenzene (HCB), and hexachlorocyclohexanes (HCHs) in blood plasma from polar bears (Ursus maritimus) caught at Svalbard. The blood samples were collected from free-ranging polar bears of different age and sex in 1991-1994. The retinol concentration and the ratio of total T4 (TT4) to free T4(FT4) (TT4/FT4 ratio) decreased linearly with increasing concentrations of PCBs and HCB. Retinol was also negatively associated with HCHs, while the TT4/FT4 ratio was positively associated with DDE. The concentrations of retinol and thyroid hormones were significantly higher in females than in males. However, the TT4/FT4 and TT3/FT3 ratios were significantly higher in males than in females. The concentrations of thyroid hormones were negatively correlated with age in male bears, while in females, thyroid hormones did not change with age. The OCs were found to explain 12, 30, and 7% of the variation of retinol concentrations and the TT4/FT4 and TT3/FT3 ratios, respectively, after correcting for age and sex. The potential consequence of these associations for the individual and the population is unknown.     

Relationships Between Plasma Levels of Organochlorines,Retinol and Thyroid Hormones from Polar Bears (Ursus maritimus) at Svalbard

Associations were determined between retinol and the thyroid hormones thyroxine (T4) and triiodothyronine (T3), respectively, and the organochlorine contaminants (OCs) polychlorinated biphenyls (PCBs), 1,1-dichloro-2,2-bis-(4-chlorophenyl)ethylene (DDE), hexachlorobenzene (HCB), and hexachlorocyclohexanes (HCHs) in blood plasma from polar bears ( Ursus maritimus ) caught at Svalbard. The blood samples were collected from free-ranging polar bears of different age and sex in 1991-1994. The retinol concentration and the ratio of total T4 (TT4) to free T4(FT4) (TT4/FT4 ratio) decreased linearly with increasing concentrations of PCBs and HCB. Retinol was also negatively associated with HCHs, while the TT4/FT4 ratio was positively associated with DDE. The concentrations of retinol and thyroid hormones were significantly higher in females than in males. However, the TT4/FT4 and TT3/FT3 ratios were significantly higher in males than in females. The concentrations of thyroid hormones were negatively correlated with age in male bears, while in females, thyroid hormones did not change with age. The OCs were found to explain 12, 30, and 7% of the variation of retinol concentrations and the TT4/FT4 and TT3/FT3 ratios, respectively, after correcting for age and sex. The potential consequence of these associations for the individual and the population is unknown.     

Measurement of free thyroid hormones in patients on long-term phenytoin therapy

Summary Total thyroxine and triiodothyronine levels are often reduced in long-term phenytoin therapy, a finding at variance with the euthyroid clinical state of these subjects. We have measured free (biologically active) thyroid hormone levels in 31 patients on phenytoin therapy and have found a significant reduction in measurements of both free thyroxine and free triiodothyronine. In contrast, addition of phenytoin to normal serum in vitro resulted in an increase in free thyroxine and free triiodothyronine concentrations. The findings in vitro are consistent with displacement of thyroid hormones from thyroxine binding globulin while the reduced free hormone levels in vivo confirm that the effects of phenytoin are not confined to binding inhibition and suggest that phenytoin has induced a change in the cellular metabolism of thyroid hormones.     

甲状腺功能亢进症合并肝功能损害的临床分析

目的 探讨甲状腺功能亢进症(甲亢)合并肝功能损害的临床特点及影响因素.方法 选取2010年1月至2015年6月本院50例甲亢合并肝功能损害患者作为研究组,同期50例甲亢无肝功能损害患者作为对照组,检测两组患者血清甲状腺激素水平及肝功能指标.结果 研究组患者血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)及游离甲状腺素(FT4)分别为(6.16±1.54) nmol/L、(265.36±24.56) nmol/L、(20.13±3.65) pmol/L、(56.82±7.55) pmol/L,均高于对照组,组间比较差异有统计学意义(t=6.922 6、18.632 3、10.647 2、14.331 1,P＜0.001),两组患者促甲状腺素(TSH)比较差异无统计学意义(t=2.142 9,P＞0.05).研究组患者常见的肝功能异常指标为ALP、TBIL、ALT、AST和γ-GT,所占比例分别为54.0％、10.0％、22.0％、20.0％和12.0％.结论 甲状腺功能亢进症与肝损伤相互影响,甲亢性肝损害与患者甲状腺激素水平密切相关.     

小儿原发性肾病综合征的血清甲状腺激素水平临床分析

目的研究小儿原发性肾病综合征同血清甲状腺激素水平间的关系。方法选择本院64例原发性肾病综合征患儿,作观察组,同期入院体检的64例同龄健康儿童作对照组,检测两组儿童的血清甲状腺激素水平和蛋白水平,对比分析检测结果。结果观察组患儿的血清游离三碘甲腺原氨酸（FT3）和血清游离甲状腺素（FT4）水平均要明显低于对照组,促甲状腺激素（TSH）水平明显高于对照组,上述差异具有统计学意义（P〈0.05）;经直线相关分析,FT3和FT4同血清白蛋白水平呈正相关,同24h尿蛋白呈负相关,TSH同血清蛋白水平无显著相关性。结论 FT3、FT4同血清蛋白有着密切的联系,甲状腺激素水平的检测利于原发性肾病综合征的临床治疗。     

甲状旁腺腺瘤大小与甲状旁腺功能及甲状腺功能的相关性研究

目的　分析甲状旁腺腺瘤（PTA）患者合并甲状腺疾病的情况,探讨PTA的大小与甲状旁腺功能及甲状腺功能的关系。方法　选取华北理工大学附属医院收治的100例PTA患者,依据是否合并甲状腺疾病将患者分为合并甲状腺疾病组（n=55）和非合并甲状腺疾病组（n=45）。收集患者临床资料,分析年龄、病程以及术前碱性磷酸酶（ALP）、校正血钙、血磷、肌酐、总三碘甲状腺原氨酸（TT3）、总甲状腺激素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、甲状旁腺激素（PTH）水平与PTA大小的相关性。采用Logistic回归分析偏大腺瘤的危险因素,绘制受检者工作特征（ROC）曲线分析术前指标预测偏大腺瘤的临床价值。结果　合并甲状腺疾病组患者较非合并甲状腺疾病组患者腺瘤的病程短（P＜0.05）。PTA大小与校正血钙、PTH、血肌酐及病程呈正相关,与FT4呈负相关（P＜0.01）;术前PTH与校正血钙、ALP、肌酐水平及病程呈正相关,与血磷、TT4和FT4呈负相关（P＜0.01）;术前TT4水平与校正血钙、ALP、肌酐水平及病程呈负相关,与血磷、FT4水平呈正相关（P＜0.05）;术前FT4水平与校正血钙、FT3水平及病程呈负相关（P＜0.01）。Logistic回归分析显示术前PTH高及病程长为预测偏大腺瘤的危险因素。ROC曲线提示术前PTH及病程联合检测可进一步提高预测偏大腺瘤的敏感度。结论　PTA大小与术前PTH水平呈正相关性,术前PTH水平及病程的联合考虑可成为偏大PTA的预测因子,推测甲状旁腺功能亢进对甲状腺的功能起到抑制性的作用。     

脓毒症患者甲状腺激素动态变化和预后分析

目的探讨脓毒症患者血清甲状腺激素水平变化后预后关系。方法对117例脓毒症患者总T3(total T3,TT3)、游离T3(free T3,FT3),总T4(total T4,TT4)、游离T4(free T4,rT4),垂体促甲状腺激素(thyroid-stimulating hormone,TSH)浓度水平与APACHEⅡ评分和死亡病例的相关性进行分析。结果脓毒症患者血清TT3、FT3、TT4、FT4均低于正常值,APACHEⅡ≤19分组与APACHEⅡ≥20分组比差异有统计学意义(P<0.05),死亡组与生存组比差异有统计学意义(P<0.05),TSH无明显改变。结论脓毒症患者血清甲状腺减激素水平与脓毒症病情危重程度呈负相关,病情越严重,血清TT3、FT3、TT4、FT4越低,死亡风险越大,可以作为脓毒症患者预后的临床参考指标。     

Effect of phenytoin therapy on thyroid function

1 Serum total and free fraction of thyroxine and triiodothyronine and urinary losses of unconjugated hormones in normal subjects and in patients treated long-term with therapeutic doses of phenytoin have been measured.

2 Decreases in serum total hormone concentrations with increased free fractions and resultant significant increase in the concentration of free thyroxine but not triiodothyronine were apparent in phenytoin-treated subjects. However, serum free hormone concentrations remained within the euthyroid range.

3 These changes in serum free hormone concentration were reflected by an increased urinary loss of unconjugated thyroxine, but normal excretion of unconjugated triiodothyronine.

4 Phenytoin in therapeutic doses displaces thyroxine and to a lesser extent, triiodothyronine from binding proteins in serum and thus increases peripheral clearance of thyroid hormones.