The effect of vitamin D on thyroid autoimmunity in euthyroid men with autoimmune thyroiditis and testosterone deficiency

BackgroundAutoimmune (Hashimoto’s thyroiditis) is characterized by a strong female preponderance, which may suggest that sex hormones have an impact on thyroid autoimmunity. The aim of this study was to investigate whether testosterone determines vitamin D action on thyroid antibody titers and thyroid function tests in men with autoimmune thyroiditis and low testosterone levels.MethodsThe study included 36 men with testosterone deficiency, 17 of whom had been treated for at least 26 weeks with oral testosterone undecanoate (120 mg daily). Because of coexistent euthyroid Hashimoto’s thyroiditis, all participants were then treated with vitamin D (100 μg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, serum levels of thyrotropin, free thyroid hormones, testosterone and 25-hydroxyvitamin D, as well as Jostel’s thyrotropin index, SPINA-GT and SPINA-GD were assessed before vitamin D treatment and 26 weeks later.ResultsWith the exception of testosterone levels, there were no significant differences between both study groups in serum hormone levels, antibody titers and thyroid function tests. All participants completed the study. In addition to increasing 25-hydroxyvitamin D levels, vitamin D increased SPINA-GT and reduced thyroid peroxidase and thyroglobulin antibody titers. In testosterone-treated men, vitamin D increased testosterone levels. Vitamin D did not affect serum levels of thyrotropin, free thyroid hormones, Jostel’s thyrotropin index and SPINA-GD. Treatment-induced changes in thyroid antibody titers and SPINA-GT were more pronounced in testosterone-treated than testosterone-naïve men.ConclusionsThe obtained results suggest that the beneficial effect on thyroid autoimmunity and thyroid secretory function is stronger in men receiving testosterone therapy.     

测定血清TGAb和TPOAb在自身免疫性甲状腺疾病中的临床价值

为探讨自身免疫性甲状腺疾病(AITD)患者血清TGAb和TPOAb浓度及临床价值,用RIA测定175例AITD组患者、64例非AITD组患者和57名对照组血清TGAb和TPOAb浓度.结果表明,AITD组中GD、HT患者血清TGAb和TPOAb浓度显著高于对照组(P<0.01),而非AITD组与对照组比较无显著性差异(P>0.05).本文认为检测TGAb和TPOAb有助于了解AITD的发病机制,对AITD的诊治及预后判断具有一定的临床价值.     

甲状腺过氧化物酶抗体在甲亢、甲状腺占位性病变诊治中的临床意义

目的观察不同临床治疗阶段甲亢、甲状腺占位性病变患者血清甲状腺过氧化物酶抗体(TPOAb)浓度的变化,探讨其临床指导价值。方法采用固相化学发光酶免疫分析法观察血清TPOAb浓度变化与甲状腺功能减退(化验室检查结果)的关系。结果89例患者中,有50例患者治疗前TPOAb正常或仅轻度增高,治疗后呈现阳性者31例,其中19例发生了甲减或亚临床型;39例治疗前TPOAb阳性,治疗后转阴2例,26例浓度降低,发生甲减3例,29例患者服用不同剂量的甲状腺片而未出现甲减或亚临床型。结论甲亢和甲状腺占位性病变患者在治疗过程可伴有TPOAb浓度的变化,TPOAb的明显增高,预示出现甲减的可能性大,TPOAb阳性的患者应被关注,高滴度TPOAb的甲亢患者治疗方案的选择要慎重。     

Graves病中甲状腺自身抗体的动态变化及相关性分析

目的：研究Graves病（GD）发病时及在抗甲状腺药物治疗过程中促甲状腺素受体抗体（TRAb）和甲状腺过氧化物酶抗体（TPOAb）的变化。方法：应用ELISA对初发的和应用甲巯咪唑治疗不同阶段（3,6,12,18及24月）的GD患者血清进行TRAb、TPOAb检测。同时,对游离甲状腺素（FT4）、游离三碘甲腺原氨酸（FT3）和促甲状腺素（TSH）进行检测,并对TRAb、TPOAb和甲状腺功能（FT4,FL3,TSH）进行相关性分析。结果：232例初发的GD患者血清TRAb检测值中位数为0．86（OD405）,阳性率为73．7％（171／232）;TPOAb检测值中位数为0．55（0D405）,阳性率为28．9％（67／232）。治疗过程中,TRAb水平及阳性率稳步逐渐下降,而TPOAb水平在12个月前逐步上升,TPOAb阳性率也显示了上升趋势,然后逐渐下降。TRAb和TPOAb之间未发现相关性,它们与甲状腺功能之间也未发现相关性。结论：尽管TRAb和TPOAb是GD中的自身抗体,但它们反晦的是不同的免疫异常,而且这种免疫异常独立于甲状腺功能。     

Screening for thyroid disease and iodine deficiency

The high global prevalence of iodine deficiency and autoimmune thyroid disorders and the mental and physical consequences of these disorders creates a huge human and economic burden that can be prevented, in large part, by early detection and appropriate preventative or therapeutic measures. The availability of sophisticated, sensitive and accurate laboratory testing procedures provides an efficient and effective platform for the application of screening for these disorders. Measurement of urine iodine concentration (UIC) in school children or pregnant women is the recommended indicator for screening populations for iodine deficiency. The severity of the iodine deficiency is classified according to the UIC. Measurement of serum thyrotropin (TSH) as an indicator for population iodine deficiency is used only in neonates and is supplementary to UIC screening. Other indicators such as goitre rates, thyroid function and serum thyroglobulin levels are useful adjunctive but not frontline process indicators. The human and economic benefits of screening for congenital hypothyroidism by measurement of heel-prick TSH have been well documented and justify its universal application. Using this measurement for monitoring population iodine intake is recommended by the World Health Organization but further validation is required before it can be universally recommended. Subclinical thyroid dysfunction is readily detected by current highly sensitive serum TSH assays and its prevalence appears to increase with age, varies with iodine intake and ethnicity and may occur in up to 20% of older age people. Subclinical hyperthyroidism is the less common disorder and screening cannot be justified because of its low prevalence and minimal or insignificant clinical effects. The argument for screening for subclinical hypothyroidism in middle-aged and older women is stronger but lacks evidence of benefit from randomised controlled trials or cost benefit analyses of therapeutic intervention, so it cannot currently be recommended. The publication of recent Clinical Practice Guidelines for management of thyroid disease in pregnancy from the American Endocrine Society and American Thyroid Association provide persuasive arguments for early detection and treatment of overt and subclinical hypothyroidism to prevent obstetric complications and potential neurocognitive disorders in the offspring. Given the indisputable benefits of therapy, the sooner thyroid dysfunction is detected, before or as early as possible in gestation, the more likely there will be a better outcome. Because of the limitations of targeted case detection in women at risk of subclinical hypothyroidism, there has been a gradual shift in opinion to universal TSH screening of all women as soon as practicable in pregnancy. While a positive association exists between the presence of anti-thyroid antibodies and increased pregnancy loss, universal screening of all pregnant women for underlying autoimmune thyroid disease is difficult to justify until there is evidence of beneficial outcomes from randomised controlled trials. Vigorous and liberal targeted case detection remains the recommended strategy to address this problem.     

血清TGAb、TPOAb检测在自身免疫性甲状腺疾病诊断中临床意义

目的探讨血清中抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化酶抗体(TPOAb)浓度在自身免疫性甲状腺疾病(AITDs)诊断中的临床意义。方法以Graves病(GD)120例、桥本甲状腺炎(HT)130例、健康对照90例样本为试验材料,采用电化学发光免疫分析法测定血清中TGAb、TPOAb浓度。结果 TGAb、TPOAb绝对含量和阳性率在各组间差异均有统计学意义(P<0.05),其中HT组最高。将血清TGAb、TPOAb单项检测结果用于Graves病(GD)临床诊断时,ROC曲线面积分别为0.866和0.990;用于桥本甲状腺炎(HT)临床诊断时,ROC曲线面积分别为0.960和0.991;在GD组与HT组间比较时(GD比HT),TGAb、TPOAb的Youden指数为0.333和0.549。结论血清中TGAb和TPOAb浓度测定均可用于GD和HT疾病的临床诊断,TPOAb优于TGAb,但它们对区分GD与HT的临床诊断价值低。     

碘摄入量不同地区人群甲状腺自身抗体的流行病学研究

为了研究不同碘摄入量人群的甲状腺自身抗体的变化以及甲状腺自身抗体阳性人群甲状腺功能的变化 ,我们在三个不同碘摄入量的农村社区盘山、彰武和黄骅进行甲状腺疾病入户问卷调查共 16 2 87人 (≥ 14岁 ) ,对其中的 376 1人进行体格检查并采血、尿标本及甲状腺B超检查。检测全部尿样的尿碘含量 ;所有血清标本均应用固相化学发光酶免疫分析方法测定甲状腺过氧化物酶抗体 (TPOAb )和甲状腺球蛋白抗体 (TGAb )及血清第三代TSH水平。结果显示盘山、彰武和黄骅社区的尿碘中位数分别为 10 3 15 μg/L、 374 76 μg/L和 6 14 6 1μg/L (P <0 0 1)。我们发现盘山、彰武和黄骅社区TPOAb和TGAb阳性率均无显著差异 (P >0 0 5 )。在TPOAb阳性的人群中 ,黄骅和彰武社区出现临床或亚临床甲状腺功能减退的比率明显高于盘山社区 (P <0 0 1)。虽然三社区TPOAb和TGAb阳性率无显著差异 ,但是高碘社区存在甲状腺自身免疫异常者发生甲状腺功能减退的危险性显著增加 ,特别是甲状腺自身抗体呈高水平的患者     

孕期TPOAb和TgAb阳性对新生儿甲状腺功能的影响

目的:探讨孕期妇女甲状腺过氧化物酶抗体(TPOAb)与甲状腺球蛋白抗体(TgAb)阳性对新生儿甲状腺功能的影响.方法:264例妊娠期妇女根据TPOAb、TgAb检测结果分为TPOAb阳性组与阴性组、TgAb阳性组与阴性组,分别对比TPOAb阳性组与阴性组、TgAb阳性组与阴性组新生儿足跟血促甲状腺激素(TSH)水平、亚临床甲减发生率,并分析孕妇TPOAb、TgAb与新生儿TSH相关性.结果:TPOAb阳性组与TgAb阳性组新生儿TSH水平、亚临床甲减发生率均显著高于TPOAb阴性组与TgAb阴性组;孕妇TPOAb及TgAb水平均与新生儿TSH水平呈显著正相关.结论:孕期TPOAb与TgAb阳性孕妇的新生儿TSH水平及亚临床甲减发生率明显增高,应加强孕期TPOAb与TgAb阳性孕妇所产新生儿的早期甲状腺功能筛查,并及干预,降低临床甲减发生率,促使患儿健康发育成长.     

左旋甲状腺素片对甲状腺功能正常TPOAb阳性的妊娠期妇女妊娠结局的影响

目的探讨甲状腺功能正常甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性的妊娠期妇女应用左旋甲状腺素片(L-thyroxine tablets,L-T4)治疗后的妊娠结局情况。方法选择2016年3～12月于我院建册分娩的800例甲状腺功能正常TPOAb阳性的孕妇,按随机数表法平均分为两组,其中一组给予50μg/d的L-T4干预治疗(干预组),另一组给予相同剂量的安慰剂(单纯组)。将同期于我院建册分娩的103例正常孕妇为参照组。比较三组妊娠结局和新生儿情况,干预组和单纯组干预前后促甲状腺激素(thyroid stimulating hormone,TSH)水平。结果与单纯组比较,干预组和参照组早产、胎儿生长受限、胎儿窘迫、胎膜早破、妊娠期糖尿病、妊娠期高血压、妊娠贫血、产后出血和新生儿肺炎的发生率明显较低,Apagar和婴幼儿发育量表(bayley scales of infant development,BSID)评分明显较高(P0.05)。干预2周后,干预组TSH水平明显下降,且明显低于单纯组(P0.05),但两组FT3和FT4水平比较无明显差异(P0.05)。结论 L-T4治疗甲状腺功能正常TPOAb阳性的妊娠期妇女可有效降低不良妊娠结局和新生儿并发症的发生率,改善新生儿的生长发育情况,还能进一步调整孕妇的TSH水平。     

亚临床甲状腺功能减退及其抗体阳性对妊娠结局的影响

目的：明确亚临床甲状腺功能减退（ SCH）及其过氧化物酶抗体（ TPOAb）阳性对妊娠结局的影响。方法收集2014年1月至2015年8月在首都医科大学附属北京友谊医院妇产科产检的2750例孕早期单活胎产妇病历资料,分为SCH＋TPOAb阳性组,SCH＋TPOAb阴性组,单纯TPOAb阳性组和对照组,比较分析4组孕妇妊娠结局和新生儿状况。结果与对照组相比,SCH＋TPOAb阳性组妊娠期糖尿病（ GDM）、妊娠期高血压及临床甲状腺功能减退症、早产、自发性流产及足月低体重儿发生率均明显增加（χ2值分别为12．07、4．17、433．89、9．95、8．28、5．78,均P＜0．05或P＜0．01）;SCH＋TPOAb阴性组临床甲状腺功能减退症,自发性流产发生率均明显增加（χ2值分别为152．35、5．80,均P＜0．05或P＜0．01）;单纯TPOAb阳性组妊娠期高血压、SCH、临床甲状腺功能减退症、早产发生率均明显增加（χ2值分别为7．23、38．55、39．73、8．96,均P＜0．01）;SCH＋TPOAb阳性组临床甲状腺功能减退症及早产发生率明显高于SCH＋TPOAb阴性组（χ2值分别为10．23、5．16、均P＜0．05或P＜0．01）。四组非瘢痕子宫剖宫产、未足月胎膜早破（ PPROM）、产后出血、子痫前期、胎儿窘迫、巨大儿、1分钟Apgar评分＜7分的发生率均无统计学差异（χ2值分别为4．33、1．33、3．79,均P＞0．05）。结论甲状腺功能正常孕妇孕早期促甲状腺激素（TSH）水平升高和（或） TPOAb阳性可明显增加产妇妊娠并发症及新生儿不良结局的发生率,应定期筛查,及早干预。