贵州儿童甲状腺肿消长情况追踪调查与分析

目的 探讨实施全民食盐加碘(USI)措施后，贵州省儿童甲状腺肿(甲肿)及其消长规律。方法 2001年4月采用点面结合的“典型调查”方法调查贵州省儿童的甲状腺肿情况，2003年10月采用群体追踪调查的方法，对2001年调查的同一人群开展甲肿消长情况的流行病学现况追踪调查。结果 2003年共有效追踪调查了1702名学生。其中在240例原检出Ⅰ度甲肿的学生中，139例转变为正常，转变率57．92％。15例转变Ⅱ度，转变率为6．25％。86例未改变，占35．83％。在28例原检出Ⅱ度甲肿的学生中，7例转为正常，2例转为I度，总体转变率42．86％。在追踪调查的1434名正常学生中，新发甲肿率为6．69％。结论 贵州省8～10岁儿童甲肿率逐年下降，但降幅非常缓慢，儿童甲肿多数会随时间推移自行减轻或恢复正常，只有少数会加重。     

Compressive optic neuropathy (CON) in Graves’ disease caused by hypertrophy of levator and superior rectus muscles: A case report

Rationale:Enlargemento of the medial rectus is the most predominant factor of compressive optic neuropathy (CON) in Graves‘ disease. This case report indicates that CON could develop only from the hypertrophic superior levator and superior rectus (SL/SR) muscle in a patient with poorly controlled Graves‘ disease, and described the possible risk of FT₃-thyrotoxicosis with a prominent goiter to develop the current rare case with a review of the literature.Patient concerns:A 66-year-old woman undergoing endocrine management of hyperthyroidism with prominent goiter visited the Department of Ophthalmology due to right-eye upper-eyelid retraction.Diagnoses:At initial presentation, the right and left margin reflex distance-1 (MRD-1) was 3.2 mm and 2.1 mm, respectively, and no proptosis or visual dysfunction was observed. Despite insufficient hormonal regulation, she refused to undergo goiter removal. The upper eyelid retraction gradually worsened to 7.7 mm of MRD-1, followed by the onset of 20 prism diopters (PD) of the right hypertropia, resulting in right-eye CON after 6 months. Her free thyroxin level was 3.88 ng/dl and free triiodothyronine was 24.90 pg/ml. Computed tomography and magnetic resonance imaging showed only SL/SR enlargement in the right orbit.Interventions:Intravenous steroid and radiation therapy resulted in visual improvement; however, a prominent upper eyelid retraction and 35PD of hypertropia remained in her right eye. Orbital decompression, upper retraction repair, and superior rectus recession were performed to prevent the recurrence of CON and correct any disfigurement.Outcomes:The combination of conventional intravenous steroid pulse therapy, radiotherapy, and orbital decompression was effective, and no recurrence was observed for more than 1.5-years postoperatively.Lessons:Enlargement of the SL/SR muscle complex may independently induce the CON. We believe that strict attention should be paid to patients with triiodothyronine thyrotoxicosis with progressive eyelid retraction and hypertropia.     

An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

Radioiodine ((131)I) treatment for nontoxic and toxic multinodular goiter (MNG) is an alternative therapeutic procedure used especially for patients with contraindication for surgery. Several studies have been conducted in recent years assessing the use of recombinant human TSH (rhTSH) in increasing (131)I uptake in MNGs. This procedure also decreases the activity level of the administered (131)I, changes the distribution of (131)I in the thyroid, lowers the absorption dose, and dramatically reduces the volume of the goiter (50-75% of the baseline volume). A major disadvantage, however, is the induction of hypothyroidism in a relatively large number of patients. A transient increase in thyroid volume and tenderness was noted in the first week of treatment. Also a short period (2-4 weeks) of hyperthyroidism was observed in most patients with potential consequences particularly for the elderly. Still, there has been no evidence to date that the adverse effects outweigh the positive results of using rhTSH. The use of rhTSH in benign goiter disease has not yet been approved worldwide, but its positive activity in MNG is remarkable and promising.     

Enlargement of Intrathoracic Goiter with Unilateral Phrenic Nerve Paralysis Leading to Cardiopulmonary Arrest

As an intrathoracic goiter expands, it causes airway stenosis and phrenic nerve paralysis, and slight respiratory stimuli can trigger sudden life-threatening hypoventilation. A 78-year-old obese woman with a large intrathoracic goiter was found unconscious with agonal breathing in her room early in the morning. Cardiopulmonary resuscitation restored spontaneous circulation. She underwent surgical removal of the goiter; however, she required long-term mechanical ventilation because of atelectasis due to phrenic nerve paralysis. In patients with large intrathoracic goiters, difficulty breathing on exertion and diaphragm elevation on chest X-ray may be significant findings predicting future respiratory failure.     

2002年中国8～10岁儿童甲状腺肿大率分析

目的 了解和掌握中国基本实现消除碘缺乏病阶段目标后的防治现状，完善可持续防治策略。方法 采用触诊和B超方法检测8～10岁儿童甲状腺，由省级专业机构负责进行。结果 按触诊法的加权结果评价，儿童甲状腺肿大率（甲肿率）新疆、西藏、重庆、贵州、陕西5个省份在10％以上，甘肃、辽宁、海南、北京、内蒙古、黑龙江、上海、浙江、安徽、江西、山东、河南、四川、云南、青海15个省份儿童甲肿率在5％～10％之间，其余省份在5％以下。结论 自1995～2002年，8～10岁儿童甲肿率，无论是B超法还是触诊法及Ⅱ度甲状腺肿大率都不同程度地逐年下降，说明全国碘缺乏病的干预效果明显。     

TSHR第三胞内袢基因突变与毒性多结节性甲状腺肿发病的相关研究

目的探讨促甲状腺激素受体(TSHR)第三胞内袢基因突变在毒性多结节性甲状腺肿(TMG)自主高功能性形成中的作用。方法将16例TMG患者手术切除标本及其作为对照的甲状腺正常组织,用酚-氯仿-异戊醇法提取基因组DNA,对目的基因片断进行聚合酶链反应(PCR)及行DNA测序。结果在16例TMG 标本中,发现3例为622位密码子的点突变。异亮氨酸被苯丙氨酸置换(I622F,ATT→TTT),2例为单碱基插入性突变,在1928位和1929位核酸之间播入了一个鸟嘌呤核苷酸(G),使该密码子609位以后氨基酸发生了移码突变。在对照组中,未发现TSHR基因突变。结论 TSHR第三胞内袢基因突变,可能在TMG发病中起重要作用。     

Epidemiology of nodular paragranuloma (Hodgkin's disease with lymphocytic predominance,nodular)

Summary The age and sex distribution and the localization of excised lymph nodes from 206 patients with a nodular variant of Hodgkin's disease with lymphocytic predominance, called nodular paragranuloma, are presented and compared with data on other types of Hodgkin's disease. The age curve of nodular paragranuloma showed a peak in the fourth decade, which was clearly separated from the peak in the third decade exhibited by the nodular sclerosis type of Hodgkin's disease and from the peak in the sixth and seventh decades of the mixed cellularity type. The peak in the age curve of nodular paragranuloma resulted from the high frequency in men in the fourth decade; the female age curve had no peaks. The overall male-to-female ratio was 2.4:1. The age and sex distribution of diffuse paragranuloma was nearly identical to that of nodular paragranuloma, whereas the age and sex distribution of cases of the lymphocytic predominance type other than paragranuloma resembled that of the mixed cellularity type. These data indicate that the lymphocytic predominance type of Hodgkin's disease is not a uniform group and support the view that paragranuloma is a separate entity.     

口服不同剂量的碘化油微囊防治地方性甲状腺肿的疗效及有效期观察

本文报告1990～1991年在缺碘性疾病流行区新疆托克逊县观察了一次性口服不同剂量(400、300和200mg)碘化油微囊的防治疗效及尿碘排泄。结果表明,在服药后半年和1年甲状腺肿患病率在不同剂量组均有不同程度的下降,治愈率均有不同程度的提高,但与对照组比较无论患病率还是治愈率均无显著差异(P>0.05)。不同剂量组之间服药后1月内尿碘排泄有随剂量增大相应增高的趋势(P<0.01),但至第三个月时无论是不同剂量组之间还是与对照组之间均未见显著差异(P>0.05)。从而提示,口服碘化油微囊能否作为防治缺碘性疾病的长效补碘方法,很值得商榷。     

单纯甲状腺肿瘤患者术后并发症的观察及护理对策研究

目的 探究单纯甲状腺肿瘤患者术后并发症的发生情况以及护理对策.方法 选取248例进行手术治疗的单纯甲状腺肿瘤患者作为研究对象,观察并分析患者术后并发症的发生情况以及相对应的护理措施情况.结果 248例单纯甲状腺肿瘤患者术后有30例发生并发症,其中呼吸困难和窒息8例(清创止血、葡萄糖酸钙静推治疗有效8例,有效率为100％)、乳糜漏6例(开放引流治疗有效6例,有效率为100％)、甲状旁腺功能低下5例(葡萄糖酸钙静推治疗有效4例,有效率为80％)、术后出血8例(止血并严密观察生命体征治疗有效8例,有效率为100％)、喉返或喉上神经损伤3例(积极判断神经损伤并及时纠正治疗有效2例,有效率为66.7％).结论 对单纯甲状腺肿瘤患者术后密切观察病情及实施相对应的护理干预措施,可减少患者术后并发症的发生,提高治疗效果,提升患者满意度.