Enzyme-amplified immunoassays

The sensitivity of enzyme immunoassays may be enhanced by the use of enzyme-amplification. This technique uses the enzyme label in the immunoassay to provide a trigger substance for a secondary system that can generate a large quantity of coloured product. Two examples of enzyme amplifiers are described, using either a substrate cycle with phosphorylated hexose sugars, or a redox cycle involving the coenzyme NAD⁺. The redox enzyme-amplifier has a detection limit of less than one attomole for the enzyme label, alkaline phosphatase.

The limited dynamic range of enzyme-amplified immunoassays may be overcome by kinetic analysis of the colour development in the enzyme-amplifier, to add at least a further order of magnitude to the range of directly measured analyte concentrations in the immunoassay. This is illustrated in an enzyme-amplified immunoassay for human thyroid stimulating hormone. Amperometric measurement of the enzyme-amplifier provides a method to extend the dynamic range still further and compares favourably with the performance of a gamma counter, a luminometer or a fluorimeter.     

甲状腺相关眼病患者的眼球病理改变

甲状腺相关眼病(TAO)是一种眼眶常见的自身免疫性疾病,其发病机制尚未完全阐明.目前已有大量研究报道了TAO可累及眼球不同部位,但尚无一个系统的归纳总结.本研究将结合目前国内外研究报道,对TAO眼球各部位受累的证据进行归纳梳理,以探讨TAO患者眼球不同结构的病理改变.     

Combined prognostic value of preoperative serum thyrotrophin and thyroid hormone concentration in papillary thyroid cancer

BackgroundA growing number of studies have found a close association between thyroid hormones and thyrotrophin (TSH), and they also have prognostic significance in some cancer types; this study aimed to investigate the prognostic value of free triiodothyronine (fT3), free thyroxine (fT4), fT3/fT4, TSH, and their combination in patients with papillary thyroid carcinoma (PTC).MethodsThis study retrospectively analyzed the relevant data of 726 newly diagnosed PTC patients. Both univariate and multivariate analyses were used to predict the recurrence rate, and a risk score was established. In addition, with the use of a random survival forest, a random forest (RF) score was constructed. After calculating the area under the curve (AUC), the diagnostic efficacy of risk score, RF score, and four indicators was compared.ResultsfT3, fT4, fT3/fT4, and TSH were strongly associated with some invasive clinicopathological features and postoperative recurrence. Patients with high expression of fT4 and TSH have a high risk of recurrence. By contrast, patients with high expression of fT3 and fT3/fT4 have a low risk of recurrence. At the same time, the combined use of various indicators is more helpful for establishing an accurate diagnosis. By comparison, we found that the RF score was better than the risk score in terms of predicting the recurrence of PTC.ConclusionThe diagnostic accuracy of a combination of fT3, fT4, fT3/fT4, and TSH can help improve our clinical estimate of the risk of recurrent PTC, thus allowing the development of a more effective treatment plan for patients.     

Management of medullary carcinoma of the thyroid: a review

Medullary thyroid carcinoma (MTC) is an uncommon malignancy of neuroendocrine origin derived from the parafollicular C cells. Although infrequent, the interest in this cancer exceeds its incidence owing to its distinctive features and its characteristic association with other endocrine tumors. Although the majority of MTCs are sporadic, hereditary varieties occur in isolation or as a part of multiple endocrine neoplasia type 2 syndrome (MEN 2). Currently, complete surgical resection of the tumor and nodal metastases with a curative intent remains the mainstay of therapy. The role of adjuvant therapy is limited, although radiotherapy and newer targeted therapies are routinely used for metastatic disease. The lack of consensus in the available guidance regarding the most appropriate diagnostic, therapeutic and follow-up strategies has caused substantial variability in clinical practice. Therefore, this review summarizes the latest available evidence and guidelines on the management of MTC with an emphasis on diagnosis, surgical treatment and follow-up.     

Thyroid papillary carcinoma with the ‘snowstorm appearance’: a clinicopathological analysis of three cases

This current case report presents the detailed clinicopathological analysis of three patients with papillary thyroid carcinoma, each of which presented with the ‘snowstorm appearance’ on ultrasonography. Ultrasonography of this tumour typically shows a diffusely enlarged thyroid with hypoechoic and heterogeneous internal echoes, and diffusely scattered microcalcifications, which form the ‘snowstorm appearance’. Microscopically, case 1 had a large number of psammoma bodies, infiltration of lymphocytes, formation of lymphatic follicles and extensive squamous metaplasia, leading to the diagnosis of a diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Case 2 was diagnosed with follicular papillary thyroid carcinoma. Their tumour had numerous calcifications in the stroma and follicles. Case 3 was diagnosed with a multifocal papillary thyroid carcinoma in the background of Hashimoto''s thyroiditis. Their tumour showed calcification in the stroma and follicles, together with cervical lymph node metastasis. DSVPTC is a rare variant of thyroid papillary carcinoma. It has the ‘snowstorm appearance’ on ultrasound, but this can also be found in follicular papillary carcinoma and multifocal thyroid papillary carcinoma. Papillary thyroid carcinoma with the ‘snowstorm appearance’ has a large number of peripheral lymph nodes metastases, thus requiring radical surgery and postoperative adjuvant therapy.     

Assessment of the Effect of Selenium Supplementation on Production of Selected Cytokines in Women with Hashimoto’s Thyroiditis

The impact of selenium on the course of Hashimoto’s thyroiditis (HT) was mainly assessed by monitoring the titer of antithyroid autoantibodies in most of the studies conducted hitherto. On the other hand, the imbalance in activity of T cells such as Th1, Th2, Th17, and Treg may be relevant in the pathogenesis of this disease. Hence, the assessment of changes in the secretion of cytokines by these cells during selenium supplementation in patients with HT seems to be an important issue and was the main goal of this study. A further aim was to search for correlations among these cytokines, as well as markers of thyroid function, selenium/iodine status in the body, and other biochemical parameters. The group of 29 women with newly diagnosed Hashimoto’s thyroiditis was supplemented with selenium in a dose of 100 µg/day for 6 months. Immunological parameters: interferon γ, tumor necrosis factor α, chemokine CXCL10, interleukin 4, interleukin 1β, interleukin 17, transforming growth factor β, and C-reactive protein, as well as selenium status parameters were determined in serum twice, i.e., before and after supplementation. Selenium supplementation was associated with a change in the production of two cytokines: interferon γ and interleukin 1β, for which a decrease and an increase in concentration were observed, respectively. The partial least squares (PLS) model revealed the presence of many relevant correlations among analyzed parameters. The stage of HT development, degree of thyroid dysfunction, and selenium supplementation of diet are interdependent factors which shape the profile of some cytokines secreted by cells participating in the autoimmunity process.     

甲状腺乳头状微小癌合并桥本甲状腺炎的临床病理分析

目的研究甲状腺乳头状微小癌（PTMC）合并桥本甲状腺炎（HT）的临床病理特点,为临床诊治提供参考。方法：收集我院2010年10月-2013年9月收治并经手术病理证实为PTMC患者的临床病理资料,以是否合并HT分组比较,并进行回顾性分析。结果 119例PTMC中,男女比例1：2.6,年龄（44.4±12.4）岁,术前甲状腺功能正常者97例（81.5%）,肿瘤平均最大径（6.8±2.3）mm,有颈部淋巴结转移36例（30.3%）,合并HT 41例（34.5%）。与未合并HT组相比,合并HT组中女性更多,发病年龄较小,术前促甲状腺激素（TSH）较高,肿瘤最大径较小,相互比较存在统计学差异（P〈0.05）。合并HT组的颈部淋巴结转移率（36.6%）稍高于未合并HT组（26.9%）,且与年龄、肿瘤最大径显著相关。结论 PTMC合并HT在较年轻的女性、术前血TSH水平偏高者中较常见。起病年龄较小、癌灶最大径≥7.0 mm时更易发生颈淋巴结转移。     

甲状腺眼病的免疫治疗

目的 对比观察传统与新型免疫抑制剂对自身免疫性甲状腺眼病的疗效。方法 ３３例甲状腺眼病分别用糖皮质类固醇（大、小剂量）、雷公藤制剂或霉酚酸酯（ＭＭＦ）治疗,疗程１２～２０周。结果 ＭＭＦ组和大剂量糖皮质激素组有效率为１００％,其中ＭＭＦ组显效比较高达５／６。结论 ＭＭＦ治疗甲状腺眼病疗优于小剂量糖皮质激素和雷公藤总萜片。     

提高异位甲状腺诊断符合率的方法

目的 :探讨提高异位甲状腺诊断符合率的方法。方法 :对 11例异位甲状腺的临床资料作回顾性分析。结果 :11例异位甲状腺患者都经99m锝 (99mTc)扫描甲状腺扫描而确诊 ;甲状腺功能低下者 (T3 、T4降低 ,TSH升高 ) 7例 ;行B超和穿刺细胞学检查 3例 ,结果与99mTc扫描一致。结论 :99mTc甲状腺扫描是诊断异位甲状腺的最好方法 ;细胞学检查是其确诊方法 ;B超是诊断该病有用的辅助方法