食盐加碘后甲状腺摄 ~（131）I率的变化及其与尿碘的关系

目的：了解食盐加碘后健康人及甲亢患者甲状腺摄131I率的变化及其与24小时尿碘含量的相关性,探讨甲状腺摄131I率与碘营养状况的关系。方法：对比食盐加碘前后健康体检者及甲亢患者甲状腺摄131I率的变化,分析健康体检者甲状腺摄131I率、晨尿碘浓度及经肌酐校正的尿碘含量与24小时尿碘含量的相关关系。结果：健康人及甲亢患者食盐加碘后3、6及24小时甲状腺摄131I率均显著降低;健康体检者甲状腺摄131I率与24小时尿碘含量呈负相关（r=-0.7651,P〈0.001）,晨尿碘浓度与24小时尿碘含量呈正相关（r=0.8231,P〈0.001）,经肌酐校正的尿碘含量与24小时尿碘含量呈正相关（r=0.9054,P〈0.001）。结论：食盐加碘对甲状腺摄131I率有显著影响,应重新确立甲状腺摄131I率的正常范围及甲亢的诊断标准;经肌酐校正的尿碘含量较晨尿碘浓度能更准确地反映碘营养状况;甲状腺摄131I率可作为评估个体碘营养状况的指标,可以稳定地反映近期的碘营养状况。     

不同剂量131I对分化型甲状腺癌患者摄碘率、甲状腺激素水平及生活质量的影响

摘要 目的：探讨不同剂量¹³¹I对分化型甲状腺癌（DTC）患者摄碘率、甲状腺激素水平及生活质量的影响。方法：选取2018年6月～2020年6月我院收治的DTC患者100例,均接受¹³¹I清甲治疗,根据放射剂量的不同分为小剂量组（100mci）和大剂量组（150mci）,例数均为50例。比较两组患者摄碘率、甲状腺激素水平、肝肾功能、生活质量和不良反应发生率。结果：小剂量组2 h、6 h、24 h的摄碘率高于大剂量组（P<0.05）。小剂量组的清甲率高于大剂量组（P<0.05）。两组治疗1个月后促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、甲状腺球蛋白（TG）水平下降（P<0.05）;小剂量组治疗1个月后TSH、FT3、TG水平低于大剂量组（P<0.05）。两组治疗前、治疗1个月后的组间、组内门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、血清尿素（Urea）、肌酐（Cr）、尿酸（UA）水平对比,差异均无统计学意义（P>0.05）。小剂量组的生活质量优良率高于大剂量组（P<0.05）。小剂量组的不良反应发生率低于大剂量组（P<0.05）。结论：不同剂量¹³¹I清甲治疗对DTC患者肝肾功能无明显影响,但选用100mci剂量可提高DTC患者摄碘率,减轻对甲状腺功能的损害,同时还可提高患者的生活质量,减少不良反应发生率。     

放射性核素碘治疗对甲亢性心脏病患者血浆ET、TNF-α及IL-1水平的影响

目的:观察放射性核素碘(131I)治疗对甲亢性心脏病(甲亢心)患者治疗前后血内皮素(ET)、肿瘤坏死因子-α(TNF-α)及白细胞介素-1(IL-1)水平的影响,探讨ET、TNF-α及IL-1与甲亢心的关系。方法:采用酶联免疫吸附法(ELISA)测定测定63例单纯甲状腺功能亢进症(单纯甲亢组)患者以及86例甲亢心患者(甲亢心组)131I治疗前后血ET、TNF-α及IL-1的含量,并观察甲状腺激素水平的变化。结果:131I治疗甲亢心组患者前后血ET、TNF-α及IL-1均显著高于单纯甲亢组;甲亢心组患者131I治疗后血ET、TNF-α、IL-1、FT3及FT4显著下降,而TSH水平增高(P<0.05)。结论:131I可调节甲亢心患者血ET、TNF-α、IL-1的分泌,上述因子水平变化与甲亢心患者的甲状腺功能和心功能的改善密切相关。     

碘131联合胰岛素泵对2型糖尿病伴发甲亢患者炎性因子和甲状腺功能的影响

摘要 目的：观察碘131联合胰岛素泵治疗2型糖尿病伴发甲亢患者的临床疗效。方法：选取2017年3月至2019年1月本院收治的2型糖尿病伴发甲亢患者110例,按随机数表法分为观察组（n=55）与对照组（n=55）,观察组患者给予碘131联合胰岛素泵治疗,对照组患者给予甲巯咪唑联合胰岛素注射治疗。分别在治疗前后检测两组患者的血糖、血清炎性因子及甲状腺功能指标,比较两组患者临床有效率及不良反应发生率。结果：观察组临床有效率为92.73%,高于对照组的74.55%（P<0.05）。治疗后,两组患者空腹血糖、餐后2 h血糖、糖化血红蛋白均下降（P<0.05）,血清肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）、白细胞介素（IL）-6、总三碘甲状腺原氨酸（TT3）、游离三碘甲状腺原氨酸（FT3）、总四碘甲状腺原氨酸（TT4）、游离四碘甲状腺原氨酸（FT4）水平均下降,且观察组低于对照组（P<0.05）;观察组总不良反应率为18.18%,低于对照组的58.18%（P<0.05）。结论：碘131联合胰岛素泵治疗2型糖尿病伴发甲亢安全有效,能够更好地改善患者的甲状腺功能,降低炎性因子水平。     

罗盖全联合钙尔奇D治疗甲亢低骨量患者的疗效

为了探讨罗盖全联合钙尔奇D在治疗甲亢低骨量患者中的应用价值,本研究将100例甲亢低骨量患者随机分为两组,A组50例,碘131 (131I)治疗后服用钙尔奇D和罗盖全; B组50例,碘131 (131I)治疗后骨质自然恢复,C组20例为正常对照组。碘131(131I)治疗前及治疗后3个月、6个月和12个月时,测量各组骨密度的变化情况,评估治疗疗效。研究结果表明,A组的骨密度随着治疗时间延长而逐渐增加,腰椎(L2-4)治疗12个月后与C组相比无显著性差异(p0.05);B组腰椎(L2-4)在3个月后有所下降,12个月后明显增加(p=0.001);6个月后两组腰椎骨密度差异有统计学意义(p=0.023),12个月后差异更加明显(p=0.001)。本研究结果初步得出结论:碘131 (131I)联合钙尔奇D和罗盖全治疗的甲亢低骨量患者恢复时间和疗效优于单纯碘131 (131I)治疗,可有效防止骨量进一步减少,减少骨质疏松症的发生。     

妊娠期妇女甲状腺功能的筛查情况及相关影响因素分析

摘要 目的：了解妊娠期妇女甲状腺功能的筛查情况及相关影响因素。方法：以2016年1月~2017年1月在我院接受产前检查的400例孕妇为研究对象,其中早期妊娠78例、中期妊娠146例、晚期妊娠176例,同期健康体检合格妇女120例为对照组。比较妊娠妇女和对照组促甲状腺激素（TSH）、游离T3（FT3）及游离T4（FT4）水平,并分析妊娠合并甲状腺功能异常者妊娠不良结局发生情况,并分析妊娠合并甲状腺功能异常的影响因素。结果：400例孕妇中,亚临床甲减62例、临床甲减5例、亚临床甲亢16例、临床甲亢2例,甲状腺疾病合计85例。孕早期TSH低于孕中期及孕晚期,FT3浓度高于孕中期及孕晚期,FT4浓度高于孕中期及孕晚期,孕中期及孕晚期TSH水平高于对照组,孕中期及孕晚期FT3、FT4浓度低于对照组,差异有统计学意义（P<0.05）。不同年龄、流产次数、碘摄入量、吸烟组妊娠合并甲状腺功能异常率差异比较有统计学意义（P<0.05）。Logistic回归分析,年龄≥30岁、流产次数≥2次、碘摄入量≥150 μg/d为妊娠合并甲状腺功能异常发生的独立危险因素。妊娠合并甲状腺功能异常组妊娠不良结局合计率高于妊娠合并甲状腺功能正常组（P<0.05）。结论：加强对妊娠期妇女甲状腺功能的筛查和高危因素的管理能够预防不良妊娠结局,达到优生优育。     

碘131与他巴唑治疗甲状腺功能亢进症的临床疗效比较

目的:观察和比较碘131与他巴唑治疗甲状腺功能亢进症的临床疗效及安全性。方法:选取2012年1月至2016年1月于我院确诊并治疗的甲状腺功能亢进患者282例,根据随机数字表法分为碘131治疗组和药物治疗组,碘131治疗组采用131I进行治疗,药物治疗组采用他巴唑口服治疗。比较两组患者的临床疗效,治疗前后血清TSH(thyroid stimulating hormone,促甲状腺激素)、FT(free triiodothyronine,游离三碘甲状腺原氨酸)、FT4(free thyroxine concentration assay,血清游离甲状腺素)水平及TRAb(TRAB thyrotropin receptor antibodies,促甲状腺激素受体抗体)阳性率的变化及治疗期间不良反应的发生情况(心功能、肝功能、肾功能、甲状腺功能下降、白细胞减少),并对患者进行6个月的随访,记录和比较患者甲亢复发情况。结果:治疗后,碘131治疗组的总有效率为92.9%,显著高于药物治疗组(64.5%,P0.05);两组患者血清TSH水平较治疗前显著升高,而血清FT3、FT4水平及TRAb阳性率均较治疗前显著降低(P0.05),且碘131治疗组血清TSH水平明显高于碘131治疗组,而血清FT3、FT4水平及TRAb阳性率明显低于碘131治疗组(P0.05);碘131治疗组复发率及总不良反应发生率均明显低于药物治疗组(P0.05)。结论:碘131对甲状腺功能亢进症的疗效优于他巴唑口服治疗,可明显增加血清TSH水平,降低血清FT3、FT4水平及TRAb阳性率,且患者复发率及不良反应发生率均较低。     

弥漫性甲状腺功能亢进症的遗传率研究Study on heritability with Diffuse Hyperthyroidism

本文对粤东地区204例（男49例,女155例）弥漫性甲状腺功能亢进症（以下均简称亢进）的一级亲属和在籍贯、年龄、性别以及数量方面均与甲亢（先证者）组相对应的204例正常健康人的一级亲属的患病情况进行了分析研究。结果发现,粤东地区`甲亢患者的一级亲属患病率为3.232,正常健康人一级亲属患病为0.145% ,两者对比,相差22.3倍,经χ2检验,差异极显著(P<0.001)。按多基因病遗传率公式计算,粤东地区甲亢遗传率为68.6±3.8%。此结果与先前多数学者的报告相符。     

碘-131联合胰岛素泵治疗2型糖尿病伴发甲亢的近远期疗效及对骨代谢指标的影响

目的:探讨碘-131(~(131)I)联合胰岛素泵治疗2型糖尿病(T2DM)伴发甲亢的近远期疗效及对骨代谢指标的影响。方法:选取2016年5月至2018年5月我院收治的T2DM伴发甲亢患者125例为研究对象,按照随机数字表法分为A组(n=42)、B组(n=42)和C组(n=41)。其中A组给予~(131)I联合胰岛素泵治疗,B组给予~(131)I联合二甲双胍治疗,C组给予胰岛素泵联合甲硫咪唑治疗。比较三组患者治疗后近远期的临床疗效、治疗前后血糖指标、甲状腺功能指标、骨代谢指标以及不良反应发生情况。结果:治疗后,A组临床近期、远期疗效总有效率高于B组和C组,复发率低于B组、C组(P0.05)。治疗后三组患者促甲状腺素(TSH)水平高于治疗前,且A组高于B组,游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)水平低于治疗前,且A组低于B组、C组(P0.05)。治疗后三组患者空腹血糖(FPG)、餐后2小时血糖(2h PG)和糖化血红蛋白(Hb A1c)水平低于治疗前,且A组低于B组、C组(P0.05)。治疗后三组患者骨钙素(BGP)、降钙素(CT)、I型前胶原N端肽(PINP)、β-胶原降解产物(β-CTX)、磷酸酶(ALP)水平低于治疗前,且A组低于B组、C组(P0.05)。治疗期间三组患者不良反应发生率比较无统计学差异(P0.05)。结论:采用~(131)I联合胰岛素泵治疗T2DM伴发甲亢患者安全有效,可改善患者甲状腺功能及骨代谢指标,降低血糖水平。     

三种蛋白尿测定方法的相关性研究

目的:通过观察慢性肾脏病患者晨尿尿蛋白/尿肌酐(Up/Ucr)和晨尿尿蛋白/尿渗透压(Up/Uosm)与24h尿蛋白定量(Pr24h)的相关性,探讨二者代替24h尿蛋白定量的可行性.方法:106例慢性肾脏病患者留取晨尿及24h尿,测定晨尿尿蛋白/尿肌酐和晨尿尿蛋白/尿渗透压比值及24h尿蛋白定量,根据肾小球滤过率(GFR)分5组,确定各组中两者与24h尿蛋白定量的相关性,根据ROC曲线确定二者分别对于24h尿蛋白定量≥1.0g、≥2.0g、≥3.0g的临界值.结果:Up/Ucr在GFR≥15ml/min时与Pr24h相关,GFR<15ml/min时无关.Up/Uosm在所有分组中均与Pr24h相关.二者分别对于Pr24h≥1.0g、≥2.0g、≥3.0g的临界值为0.98、1.96、2.98及0.96、1.99、2.95.结论:Up/Ucr和Up/Uosm均可替代24h尿蛋白定量预测蛋白尿.     

碘131 与抗甲状腺药物治疗甲亢的临床疗效比较

目的:探讨碘131(I131)和抗甲状腺药物治疗甲亢的临床疗效对比,为临床提供参考依据。方法:选择2012年1月至2014年10月我院甲状腺功能亢进患者218例,按照随机数字表法分为观察组和对照组,每组各109例患者,观察组采用碘131治疗,对照组采用抗甲状腺药物治疗。比较治疗12个月后两组患者的临床疗效、复发率和并发症,采用酶联免疫吸附法检测治疗前后血清甲状腺激素水平。结果:治疗12个月后,观察组的有效率为92.66%明显高于对照组的69.72%,观察组的复发率为2.75%明显低于对照组的13.76%,差异均有统计学意义(P0.01)。观察组的心脏病、肝功能受损及血象降低等不良反应的发生率为7.34%明显低于对照组32.11%,差异有统计学意义(P0.01)。治疗后两组患者的血清甲状腺素(T4)、游离三碘甲状原氨酸(FT3)、三碘甲状原氨酸(T3)、促甲状腺激素(TSH)、游离甲状腺素(FT4)水平较治疗前降低,且观察组的降低幅度优于对照组,差异均有统计学意义(P0.05)。结论:碘131治疗甲亢可提高临床疗效,降低复发率,不良反应轻,可降低血清甲状腺激素水平,,值得推广应用。     

The use of radioactive iodine in the treatment of Graves disease

Fifty patients with uncomplicated Graves' disease were treated with radioactive iodine (I(131)). Twenty-six patients who were followed for one year or longer are the basis of this report. Twenty-five are now euthyroid; only one is not completely well. The total dose of radioiodine administered varied from 0.5 to 10 millicuries. The average length of time necessary for return to a euthyroid state was from three to four months. Hypometabolism developed in three patients, and in one the signs and symptoms of myxedema developed. No other complications ensued. One patient who apparently relapsed had complete return to normal after further iodine administration. The determination of the uptake of radioactive iodine by the thyroid gland is a useful diagnostic procedure in differentiating conditions simulating hyperthyroidism.Following treatment with radioactive iodine, the thyroid gland becomes smaller, the uptake of iodine by the gland is reduced, and the level of organic iodine in the plasma becomes normal. In acute thyroiditis, in spite of a high basal metabolic rate, high content of organic iodine in the plasma and other evidences of "hyperthyroidism," the uptake of I(131) has been very low.     

Radioiodine treatment of multinodular non-toxic goitre.

OBJECTIVE--To investigate the long term effect of radioactive iodine on thyroid function and size in patients with non-toxic multinodular goitre. DESIGN--Consecutive patients with multinodular non-toxic goitre selected for radioactive iodine treatment and followed for a minimum of 12 months (median 48 months) after an intended dose of 3.7 MBq/g thyroid tissue corrected to a 100% uptake of iodine-131 in 24 hours. PATIENTS--69 patients with a growing multinodular non-toxic goitre causing local compression symptoms or cosmetic inconveniences. The treatment was chosen because of a high operative risk, previous thyroidectomy, or refusal to be operated on. MAIN OUTCOME MEASUREMENTS--Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 1, 2, 3, 6, and 12 months after treatment and then once a year. RESULTS--56 patients were treated with a single dose of 131I, 12 with two doses, and one with four doses. In 45 patients treated with one dose and remaining euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (23-48) ml at 24 months in the 39 patients in whom this was measured during follow up. The median reduction was 40 (22-48) ml (60% reduction, p < 0.0001), half of which occurred within three months. Patients treated with two doses as well as those developing hypothyroidism and hyperthyroidism had a significant reduction in thyroid volume. Eleven patients developed hypothyroidism (cumulative five year risk 22%, 95% confidence interval 4.8% to 38.4%). Side effects were few: three cases of hyperthyroidism and two cases of radiation thyroiditis. Only one patient was dissatisfied with the result; she was referred for operation six months after treatment. CONCLUSIONS--A substantial reduction in thyroid volume accompanied by a low incidence of hypothyroidism and few side effects makes the use of radioactive iodine an attractive alternative to surgery in selected cases of non-toxic multinodular goitre.     

Extensive scleral perforation with complete recovery

Sixty patients with abnormally high I(131) uptake were treated with liothyronine (L-triiodothyronine) for seven or eight days and then tested again. Fifty-five patients showed a suppression of iodine uptake sufficient to eliminate the possibility of hyperthyroidism. Also the therapeutic trial of liothyronine indicated whether they were euthyroid, or hypothyroid with iodine deficiency. Six of the patients showed insignificant change in the I(131) uptake after treatment with thyroid hormone-that is, the change from the original uptake was less than 30 per cent. These six patients were later confirmed to be hyperthyroid. In four patients the uptake at the second test was less by between 35 and 52 per cent than at the first. These four patients, like the remainder with even greater suppression in thyroid uptake, remained clinically euthyroid.The repeat I(131) uptake test was thus seen to be considerably more accurate than the single test and well worth the time required to perform it.     

THE USE OF RADIOACTIVE IODINE IN THE TREATMENT OF GRAVES' DISEASE

Fifty patients with uncomplicated Graves'' disease were treated with radioactive iodine (I₁₃₁). Twenty-six patients who were followed for one year or longer are the basis of this report. Twenty-five are now euthyroid; only one is not completely well.The total dose of radioiodine administered varied from 0.5 to 10 millicuries. The average length of time necessary for return to a euthyroid state was from three to four months.Hypometabolism developed in three patients, and in one the signs and symptoms of myxedema developed. No other complications ensued. One patient who apparently relapsed had complete return to normal after further iodine administration.The determination of the uptake of radioactive iodine by the thyroid gland is a useful diagnostic procedure in differentiating conditions simulating hyperthyroidism.Following treatment with radioactive iodine, the thyroid gland becomes smaller, the uptake of iodine by the gland is reduced, and the level of organic iodine in the plasma becomes normal.In acute thyroiditis, in spite of a high basal metabolic rate, high content of organic iodine in the plasma and other evidences of “hyperthyroidism,” the uptake of I₁₃₁ has been very low.     

Effect of lithium on thyroidal 131iodine uptake, its clearance, and circulating levels of triiodothyronine and thyroxine in lead-treated rats

The influence of lead acetate (50 mg per kg body weight) on the 131iodine (131I) biokinetics (uptake and retention) in rat thyroid and serum levels of triiodothyronine (T3) as well as thyroxine (T4) was evaluated as a function of time and in combination with lithium treatment. The 2-h and 24-h uptake of 131I in the thyroid was stimulated significantly by lead treatment. The 24-h uptake showed a maximum stimulation after 4 months of lead treatment. Lithium supplementation, however, showed the opposite effect by reducing the iodine uptake whereby the maximum decrease was noticed after 2 months of treatment. Further, simultaneous lead and lithium treatment resulted in an even more pronounced increase of 2-h 131I uptake with a maximum after 3 months. However, the 24-h uptake after 3 months and 4 months of treatment did not differ significantly from the lead treated reference groups. The thyroidal biological half-life of 131I (Tbiol) was found to have clearly increased following the lead/lithium treatment. Interestingly, the combined lead/lithium treatment applied for 4 months caused a further growth of Tbiol, thus reflecting an increased retention of 131I. A maximum increase of Tbiol was seen after 2 months of combined treatment. A progressive decline of the circulating T3 and T4 levels following lead or lithium treatment was noticed and was more pronounced after combined treatment.     

HYPERTHYROIDISM—Diagnosis by Failure of Triiodothyronine to Suppress Uptake of Iodine131

Sixty patients with abnormally high I¹³¹ uptake were treated with liothyronine (L-triiodothyronine) for seven or eight days and then tested again. Fifty-five patients showed a suppression of iodine uptake sufficient to eliminate the possibility of hyperthyroidism. Also the therapeutic trial of liothyronine indicated whether they were euthyroid, or hypothyroid with iodine deficiency. Six of the patients showed insignificant change in the I¹³¹ uptake after treatment with thyroid hormone—that is, the change from the original uptake was less than 30 per cent. These six patients were later confirmed to be hyperthyroid. In four patients the uptake at the second test was less by between 35 and 52 per cent than at the first. These four patients, like the remainder with even greater suppression in thyroid uptake, remained clinically euthyroid.The repeat I¹³¹ uptake test was thus seen to be considerably more accurate than the single test and well worth the time required to perform it.