精神分裂症服用氯氮平能降低其甲状腺素水平的对照分析

目的探索氯氮平治疗是否影响T3、T4和TSH水平.方法对17例精神分裂症患者,给予氯氮平治疗第4天和第4周末分别测定T3、T4和TSH水平.结果治疗第4周末的T3(3.309±0.689)、T4(9.449±1.941)水平比第4天的T3(3.915±0.850)、T4(11.178±2.180)水平明显降低(P均＜0.05).结论氯氮平治疗能降低甲状腺素水平.     

The Effect of Acute and Chronic Exercise on Thyroid Hormones in Obesity

Abstract Thyroid hormones were measured before, during and after acute exercise (60 min) or physical training (3 months) in obese women. Thyroid stimulating hormone concentration increased during acute work and decreased immediately after. No changes were seen during the two following days. An increase was seen after ten days as well as after three months of physical training. Thyroxine concentrations showed no changes. 3,5,3′-Triiodothyronine decreased slightly immediately after acute exercise, and after three months of physical training, 3,3′,5′-triiodothyronine (reverse triiodothyronine) increased slowly during and after acute exercise. A negative correlation was found between changes in fasting insulin and thyroxine and a positive correlation between changes in blood pressure and triiodothyronine after training. Lack of agreement in previous reports is probably due to methodological differences such as methods more or less susceptible to fatty acid interference, and thyroid hormones changing differently during acute work and before and after physical training. The duration of the study may also be of importance, even 3 months possibly being too short for attaining equilibrium in thyroid homeostasis.     

亚临床甲状腺功能减退症患者TSH与肾上腺皮质功能的关系

目的分析亚临床甲状腺功能减退症患者促甲状腺激素(TSH)与肾上腺皮质功能的关系。 方法选取150例亚临床甲状腺功能减退症患者为研究组,甲状腺功能正常的健康人群150例为对照组。比较两组TSH、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、皮质醇(CORT)和促肾上腺皮质激素(ACTH)水平。采用Pearson法分析亚临床甲状腺功能减退症患者TSH水平与ACTH、CORT水平的相关性。 结果与对照组比较,研究组患者TSH、ACTH水平升高,CORT水平降低(P＜0.05)。Pearson分析结果显示,亚临床甲状腺功能减退症患者TSH水平与ACTH水平呈正相关(P＜0.05),与CORT水平呈负相关(P＜0.05)。 结论亚临床甲状腺功能减退症患者血清TSH水平与肾上腺皮质功能指标ACTH、CORT水平存在相关性。     

Mutations of thyrotropin receptor gene

 Thyrotropin is the primary pituitary hor- mone which stimulates the growth and differentiation of thyroid cells. TSH binds a specific receptor present in the plasma membrane of thyroid cells and signals the G protein transducers, which activate different effec- tors, mainly adenyl cyclase and phospholipase C. The TSH receptor belongs to a broad class of receptors known as seven-loop receptors because they contain a long stretch of amino acids which cross the plasma membrane seven times. Mutations in the TSH receptor gene have been found in hyperfunctioning thyroid adenomas. These mutations are: (a) somatic (present only in the tumor), (b) dominant (only one copy of the gene is affected), and (c) lead to the constitutive activation of the cAMP signaling cascade. Most mutations which have been identified occur in the intracellular loop III and in the transmembrane domain VI. Germline mutations in the same regions of the receptor have been found in congenital nonautoimmune hyperthyroidism. In addition, germ line mutations have been described in the extracellular domain of the receptor leading to increased TSH levels. The clinical implications of these findings are discussed. Received: 15 January 1996 / Accepted: 8 March 1996     

Human lymphocyte antigens (HLA) and Graves' disease in Turkey

To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.This study was presented in part at the Annual Meeting of the National Endocrinology and Diabetes Association, Bursa, Turkey, May 25–28, 1992.     

Graves病患者TRAb与抗TSHAb抗体关系的初步研究

根据自身免疫性甲状腺疾病发病机制的独特型－抗独特型免疫免疫学说，用兔抗人ＴＳＨＡｂ检测ＴＳＨ抗独特型抗体（ＴＳＨＡｂ２）。以正常人为对照，以其结合率＾－ｘ＋２ｓ为正常值上限，大于此值为阳性。６０例ＴＲＡｂ阳性病人，６５％病人ＴＳＨＡｂ２阳性，而４０例ＴＲＡｂ阳性病人中，只有５％病人ＴＳＨＡｂ２阳性。两组差异显著（Ｐ〈０．０５）。ＴＲＡｂ和ＴＳＨＡｂ２呈正相关（ｒ＝０．６４５，Ｐ〈０．０１）。同时用     

Dexamethasone suppression and multiple hormonal responses (TSH,prolactin and growth hormone) to TRH in some psychiatric disorders

Summary Baseline and TRH-induced changes of thyroid stimulating hormone (TSH), prolactin (PRL), and growth hormone (GH) were measured in 15 healthy control subjects and 63 psychiatric inpatients with DSM-III diagnoses of major depression (n = 19), schizophrenic disorder (n = 20), alcohol dependence (n = 10), and adjustment disorder (n = 14); baseline and postdexamethasone cortisol (CS) were also determined 3–6 days after the TRH-challenge. All patients and controls were women of similar mean age, weight, height, and they were free from interfering illness or drugs.Baseline TSH and PRL were lower in depression, TRH-induced TSH and PRL responses were lower in the whole patient group, but most markedly in depression and alcohol dependence. Postdexamethasone CS was significantly higher in depression, schizophrenia and alcohol dependence. Basal GH did not differentiate the subgroups; TRH-induced pathological GH responses were sometimes found in the patient groups. The differences were most marked quantitatively in major depression: a multivariate analysis of variance showed that TSH, postdexamethasone CS and PRL were the most important variables in separating patients from controls. A discriminant function derived from these variables classified all controls and 18 of 19 depressed patients correctly; however, 25 of the 44 other patients were also classified with depression.It was confirmed that psychiatric patients show significantly more endocrine disturbances than controls, and this was seen not only in major depression but also in at least three other conditions. Further work is needed to identify other neuroendocrine patterns more specific to depressive disorder.     

Hypothyroidism and levothyroxine therapy following bariatric surgery: a systematic review,meta-analysis,network meta-analysis,and meta-regression

BackgroundMany health benefits of bariatric surgery are known and well-studied, but there is scarce data on the benefits of bariatric surgery on the thyroid function.ObjectiveWe aimed to make a meta-analysis regarding the impact of bariatric surgery on thyroid-stimulating hormone (TSH) levels, levothyroxine dose, and the status of subclinical hypothyroidism.SettingSystematic review and meta-analysis.MethodsPubMed, EMBASE, and Cochrane Library were searched up to December 2020 for relevant clinical studies. Random-effects model was used to pool results. Network meta-analysis was performed, incorporating direct and indirect comparisons among different types of bariatric surgery. Meta-regression analysis was performed to evaluate the impact of moderator variables on TSH levels and required levothyroxine dose after surgery. We followed the PRISMA guidelines for data selection and extraction. PROSPERO registry number: CRD42018105739.ResultsA total of 28 studies involving 1284 patients were included. There was a statistically significant decrease in TSH levels after bariatric surgery (mean difference = ?1.66 mU/L, 95%CI [?2.29, ?1.03], P < .0001). In meta-regression analysis, we found that the following moderator variables: length of follow-up, mean age, baseline TSH, and preoperative thyroid function, could explain 1%, 43%, 68%, and 88% of the between-study variance, respectively. Furthermore, subclinical hypothyroidism was completely resolved in 87% of patients following bariatric surgery. In addition, there was a statistically significant decrease of levothyroxine dose in frank hypothyroid patients following bariatric surgery (mean difference = ?13.20 mcg/d, 95%CI [?19.69, ?6.71]). In network meta-analysis, we found that discontinuing or decreasing levothyroxine dose was significant following Roux-en-Y gastric bypass, 1 anastomosis gastric bypass, and sleeve gastrectomy, (OR = 31.02, 95%CI [10.34, 93.08]), (OR = 41.73, 95%CI [2.04, 854.69]), (OR = 104.03, 95%CI [35.79, 302.38]), respectively.ConclusionsBased on our meta-analysis, bariatric surgery is associated with the resolution of subclinical hypothyroidism, a decrease in TSH levels, and a decrease in levothyroxine dose.     

血清TGA、TMA、T3、T4、TSH鉴别甲亢型桥本甲状腺炎和Graves病

目的：鉴别甲亢型桥本甲状腺炎（ Ｈ Ｔ）和 Ｇｒａｖｅｓ 病（ Ｇ Ｄ）,提高 Ｈ Ｔ 的诊断率,减少 Ｈ Ｔ 手术和不必要的抗甲状腺治疗。方法：以经甲状腺细针穿刺活检或术后病理证实为 Ｈ Ｔ 和 Ｇ Ｄ 的临床表现为甲状腺功能亢进的病人为研究对象,以活检前或术前清晨空腹血清 Ｔ Ｇ Ａ, Ｔ Ｍ Ａ, Ｔ３, Ｔ４ 和 Ｔ Ｓ Ｈ 为检测指标。结果：甲亢型 Ｈ Ｔ 和 Ｇ Ｄ 病人的 Ｔ Ｇ Ａ, Ｔ３ 有明显差异（ Ｐ＜ ００１）; Ｔ３／ Ｔ４, Ｔ Ｍ Ａ, Ｔ Ｓ Ｈ 有显著差异（ Ｐ＜ ０００１）; Ｔ４ 无差异（ Ｐ＞ ００５）。结论：血清 Ｔ３, Ｔ３／ Ｔ４ , Ｔ Ｓ Ｈ, Ｔ Ｇ Ａ 和 Ｔ Ｍ Ａ 可以作为鉴别甲亢型 Ｈ Ｔ 和 Ｇ Ｄ 的重要检测指标。     

Nocturnal plasma thyrotropin variations are related to slow-wave sleep

SUMMARY  The thyrotropin (TSH) nycthemeral pattern is known to be strongly influenced by sleep, but previous studies have failed to demonstrate any link between sleep structure and TSH variations. Using 10-min blood sampling, nocturnal TSH profiles were analysed in 24 young healthy subjects during normal sleep. Six of the subjects then underwent a partial sleep deprivation experiment, sleep was permitted from 03.00 hours to 07.00 hours. Descending slopes of TSH values were observed for the first 20 minutes of SWS episodes, whereas no significant trend was found for other sleep stages. During the period of sleep deprivation, nocturnal TSH levels increased and then declined immediately after sleep onset; however, the association between SWS and descending TSH slopes persisted. This temporal concordance suggests that some particular mechanisms associated with SWS may modulate TSH release, or conversely that increasing TSH levels prevent the occurrence of SWS.