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。     

胃癌和甲状腺疾病相关性研究进展

胃癌是我国常见的恶性肿瘤之一。多种因素与胃癌的发生相关,如环境、饮食、幽门螺杆菌感染、慢性萎缩性胃炎和肠上皮化生等。随着对胃癌研究的深入,国外学者发现胃癌的发病率在碘摄入不足或者摄入过多的地区有逐渐增高的趋势,而碘是甲状腺疾病发病的重要因素。最新的研究发现,胃癌和甲状腺疾病的关系可能受到地域因素的影响,但目前缺乏对此关系的大样本临床研究。本文试对这些研究的最新进展作一综述。     

妊娠期甲状腺疾病诊断及治疗的研究进展

妊娠期妇女体内激素水平会发生变化,使妊娠妇女甲状腺激素水平的测定和判断存在一定的困难,应选择适用于妊娠妇女的甲状腺激素水平特异值,进而正确评估甲状腺功能状态及对母体和胎儿的影响。孕前及妊娠期测定促甲状腺素和游离甲状腺激素有很大的必要性,因为甲状腺疾病以及单纯性甲状腺抗体阳性会导致多种妊娠不良结局,尤其是甲状腺功能减退对胎儿智力发育和认知功能具有非常大的影响。孕期甲状腺激素的监测对评估甲状腺功能状态及疾病预后具有非常大的作用,可以提示临床医师是否给予药物干预及如何调整药量。对于孕期甲状腺激素补充治疗后应达到的目标值以及甲状腺抗体阴性的亚临床甲状腺功能降低的妊娠患者是否给予干预,目前仍有异议。     

左甲状腺素联合碘131对甲状腺功能亢进症患者甲状腺体积、TR-Ab和TPOAb水平的影响

目的:研究左甲状腺素联合碘131对甲状腺功能亢进症患者甲状腺体积、促甲状腺激素受体抗体(Thyrotropin receptor antibody,TR-Ab)和甲状腺过氧化物酶抗体(Thyroid peroxidase antibody,TPOAb)水平的影响。方法:选择2013年1月-2019年1月我院收治的68例甲状腺功能亢进症患者,随机分为两组。对照组使用小剂量(111～148 MBq)的碘131,观察组在碘131的基础上,联合服用左甲状腺素,每次12.5μg,每日1次,均治疗3个月后观察疗效及甲状腺体积、TR-Ab和TPOAb水平变化。结果:观察组治疗3个月后的有效率明显高于对照组(P0.05);治疗前,两组的甲状腺体积、TR-Ab和TPOAb水平无明显差异(P0.05),治疗后,两组的上述指标均明显降低(P0.05),且观察组明显低于对照组(P0.05);治疗前,两组的血清游离三碘甲状腺原氨酸(Free triiodothyronine,FT3)、促甲状腺素(Thyroxine,TSH)和游离四碘甲状腺素(Free tetraiodothyroxine,FT4)水平无明显差异(P0.05),治疗后,两组的血清FT3和FT4水平明显降低(P0.05),血清TSH水平明显升高(P0.05),观察组更加明显(P0.05);治疗前,两组的血清甲状腺球蛋白(Thyroglobulin,Tg)和半胱氨酸蛋白酶抑制剂C(Cysteine protease inhibitor C,Cys C)水平无明显差异(P0.05),治疗后,两组的血清Tg和Cys C水平明显降低(P0.05),观察组明显低于对照组(P0.05)。结论:左甲状腺素联合碘131对甲状腺功能亢进症有确切的疗效,能有效阻碍甲状腺自身抗体产生,改善甲状腺功能,降低血清Tg和Cys C水平。     

下丘脑－垂体－甲状腺轴的形态学变化与碘缺乏病

碘缺乏病是世界上广泛分布和侵犯人数最多的甲状腺功能低下的地方病。利用光镜、电镜、组织化学、免疫组织化学及免疫荧光等方法研究低碘时下丘脑、垂体、甲状腺、脑及耳蜗的形态学变化,为碘缺乏病的发病机理与诊治提供形态学资料。     

胺碘酮致甲状腺功能异常的诊治进展

胺碘酮是治疗心律失常的常用药物。但由于其富含碘及自身固有的特性,可导致一系列甲状腺功能的紊乱,甚至引发明显的甲状腺功能减退(甲减)或甲状腺功能亢进(甲亢)。对于胺碘酮所致甲减(AIH)的诊断和治疗目前比较清晰,但对胺碘酮所致甲亢(AIT)的诊断、鉴别其亚型及治疗有一定的难度。     

胺碘酮致甲状腺功能异常的诊治进展

胺碘酮是治疗心律失常的常用药物。但由于其富含碘及自身固有的特性,可导致一系列甲状腺功能的紊乱,甚至引发明显的甲状腺功能减退（甲减）或甲状腺功能亢进（甲亢）。对于胺碘酮所致甲减（AIH）的诊断和治疗目前比较清晰,但对胺碘酮所致甲亢（AIT）的诊断、鉴别其亚型及治疗有一定的难度。     

改良Miccoli手术与传统甲状腺手术治疗甲状腺良性疾病对比观察

目的:探讨改良Miccoli手术与传统甲状腺手术治疗甲状腺良性疾病效果。方法:选取我院2014年10月-2015年11月甲状腺良性疾病患者共96例,随机分为观察组和对照组。给予对照组传统开放手术治疗,给予观察组改良Miccoli手术治疗。观察治疗效果。结果:观察组手术时间、术中出血量、切口长度、住院时间、引流时间以及颈部活动恢复时间,均优于对照组,组间比较有差异(P0.05)。结论:相比传统开放手术,改良Miccoli手术治疗甲状腺良性结节具有更好地效果,能够加快患者的康复进程,保障患者的生活质量。     

大连市沙河口区孕妇尿碘水平追综调查结果分析

目的评价全民食盐加碘防治碘缺乏病效果。方法选择补碘重点人群孕妇,要求孕妇年龄〈30岁,进行尿碘检测。结果各年度尿碘中位数均达到或超出孕妇尿碘适宜水平。结论调整全民食盐加碘浓度使重点人群碘营养合理化。     

肠道菌群与甲状腺疾病

肠道菌群被称为人类的第二基因组。近年研究发现许多内分泌及免疫相关疾病如糖尿病、非酒精性脂肪肝、炎症性肠炎、类风湿性关节炎等的发生发展与肠道菌群紊乱存在相关性。甲状腺是机体重要的内分泌腺体,常见的甲状腺疾病包括：甲状腺功能亢进症、甲状腺功能减退症和甲状腺炎等。甲状腺疾病的病因及发病机制尚不清楚,多数学者认为其与自身免疫异常有关。肠道菌群可以通过影响机体免疫状态等多种机制参与甲状腺稳态的维持,本文对肠道菌群与甲状腺疾病之间的关联性研究进展进行简要综述,以期为肠道菌群和甲状腺疾病领域的研究提供理论依据。     

The role of selenium in thyroid hormone metabolism and effects of selenium deficiency on thyroid hormone and iodine metabolism

Selenium deficiency impairs thyroid hormone metabolism by inhibiting the synthesis and activity of the iodothyronine deiodinases, which convert thyroxine (T₄) to the more metabolically active 3,3′-5 triiodothyronine (T₃). Hepatic type I iodothyronine deiodinase, identified in partially purified cell fractions using affinity labeling with [¹²⁵I]N-bromoacetyl reverse triiodothyronine, is also labeled with⁷⁵Se by in vivo treatment of rats with⁷⁵Se-Na₂SeO₃. Thus, the type I iodothyronine 5′-deiodinase is a selenoenzyme. In rats, concurrent selenium and iodine deficiency produces greater increases in thyroid weight and plasma thyrotrophin than iodine deficiency alone. These results indicate that a concurrent selenium deficiency could be a major determinant of the severity of iodine deficiency.     

The role of selenium in thyroid hormone metabolism and effects of selenium deficiency on thyroid hormone and iodine metabolism

Selenium deficiency impairs thyroid hormone metabolism by inhibiting the synthesis and activity of the iodothyronine deiodinases, which convert thyroxine (T₄) to the more metabolically active 3,3′–5 triiodothyronine (T₃). Hepatic type I iodothyronine deiodinase, identified in partially purified cell fractions using affinity labeling with [¹²⁵I]N-bromoacetyl reverse triiodothyronine, is also labeled with⁷⁵Se by in vivo treatment of rats with⁷⁵Se−Na₂SeO₃. Thus, the type I iodothyronine 5′-deiodinase is a selenoenzyme. In rats, concurrent selenium and iodine deficiency produces greater increases in thyroid weight and plasma thyrotrophin than iodine deficiency alone. These results indicate that a concurrent selenium deficiency could be a major determinant of the severity of iodine deficiency.     

Different tissue responses for iodine and iodide in rat thyroid and mammary glands

This research describes the effects of short-term elemental iodine (I₂) and iodide (I⁻) replacement on thyroid glands and mammary glands of iodine-deficient (ID) Sprague-Dawley female rats. Iodine deficiency causes atypical tissue and physiologic changes in both glands. Tissue histopathology and the endocrine metabolic parameters, such as serum TT₄, tissue and body weights, and vaginal smears, are compared. A moderate reduction in thyroid size from the ID control (IDC) was noted with both I⁻ and I₂, whereas serum total thyroxine approached the normal control with both I⁻ and I₂, but was lower in IDC. Thyroid gland IDC hyperplasia was reduced modestly with I₂, but eliminated with I⁻. Lobular hyperplasia of the mammary glands decreased with I₂ and increased with I⁻ when compared with the IDC; extraductal secretions remained the same as IDC with I₂, but increased with I⁻; and periductal fibrosis was markedly reduced with I₂, but remained severe with I⁻. Thus, orally administered I₂ or I⁻ in trace doses with similar iodine availability caused different histopathological and endocrine patterns in thyroid and mammary glands of ID rats. The significance of this is that replacement therapy with various forms of iodine are tissue-specific.     

Effect of selenium on thyroid hormone metabolism in filial cerebrum of mice with excessive iodine exposure

The effects of supplementing selenium on thyroid hormone metabolism were studied on mice with excessive iodine exposure. The serum concentrations of thyroxine (T₄) and triiodothyronine (T₃) and the activities of iodothyronine 5′ and 5-deiodinase (D2, D3) were measured in the brain of filial mice to study the influence of selenium on thyroid hormone metabolism. Measurements were carried out on postnatal day 0, 14, and 28. It was found that selenium supplementation alleviated the adverse effects of excessive iodine on progeny. The serum TT₄ level as well as TT₄ and TT₃ concentrations and D3 activity in cerebrum of progeny decreased, whereas D2 activity increased in the cerebrum of progeny on postnatal day 0 and 14. Selenium supplementation exerted some favorable effects on thyroid hormone metabolism in cerebrum of progeny of dam with excessive iodine intake.     

Resistance to thyroid hormone mediated by defective thyroid hormone receptor alpha

Background

Thyroid hormone acts via receptor subtypes (TRα1, TRβ1, TRβ2) with differing tissue distributions, encoded by distinct genes (THRA, THRB). THRB mutations cause a disorder with central (hypothalamic–pituitary) resistance to thyroid hormone action with markedly elevated thyroid hormone and normal TSH levels.

Scope of review

This review describes the clinical features, genetic and molecular pathogenesis of a homologous human disorder mediated by defective THRA. Clinical features include growth retardation, skeletal dysplasia and constipation associated with low-normal T4 and high-normal T3 levels and a low T4/T3 ratio, together with subnormal reverse T3 levels. Heterozygous TRa1 mutations in affected individuals generate defective mutant receptors which inhibit wild-type receptor action in a dominant negative manner.

Major conclusions

Mutations in human TRα1 mediate RTH with features of hypothyroidism in particular tissues (e.g. skeleton, gastrointestinal tract), but are not associated with a markedly dysregulated pituitary–thyroid axis.

General significance

Human THRA mutations could be more common but may have eluded discovery due to the absence of overt thyroid dysfunction. Nevertheless, in the appropriate clinical context, a thyroid biochemical signature (low T4/T3 ratio, subnormal reverse T3 levels), may enable future identification of cases.This article is part of a Special Issue entitled Thyroid hormone signalling.     

Effect of iodine supplement on iodine status and 5′-deiodinase activity in the brain of neonatal rats with iodine deficiency

The weanling Wistar rats of iodine deficiency were divided into three groups for supplementation of different levels of iodine (iodine-excessive [IE], iodine-adequate [IA], and iodine-deficient [ID]), with a control group (C). The iodine content in the thyroid was determined by epithermal neutron activation analysis. The activities of 5′-deiodinase and 5-deiodinase in the brains were assayed by determining the conversion ratios of T4 to T3 and rT3, respectively. The thyroid hormones levels in serum were also tested. The results indicated that the ID group had a goiter containing a small amount of iodine, but the IE group had a slightly swollen thyroid with rich iodine; the concentration of iodine per unit mass of thyroid was lower in group IE than in groups IA and C. The highest 5′-deiodinase and lowest 5-deiodinase activities in group ID and the lowest 5′-deiodinase activity in group IE were found. The iodine deficiency or excess resulted in a compensated hypothyroid state. The results suggest that the iodine status and the deiodinases activities would become normal for the rats of iodine deficiency if adequate iodine is supplemented soon after birth. Meanwhile, it is also critical to avoid excessive intake of iodine to reduce the risk for overcorrecting.     

Concentration of selenium in the whole blood and the thyroid tissue of patients with various thyroid diseases

We investigated the possible differences between the concentrations of selenium in the whole blood and thyroid tissue of patients with thyroid disease. The study comprises 41 women with nodular goiter, 19 women and 2 men with thyroid cancer, 18 women with Graves’ disease, and 7 women with thyroiditis. The concentration of selenium was determined by the TRXRF method. The lowest mean selenium level was achieved in the whole blood of women with Graves’ disease and the highest in the whole blood of healthy people. In the thyroid cancer tissue, we found the lowest concentration of selenium and the highest in the thyroid gland of women with nodular goiter and Graves’ disease. The low selenium levles in the thyroid tissue may increase thyroid cancer risk.     

Propranolol has direct antithyroid activity: Inhibition of iodide transport in cultured thyroid follicles

The effect of propranolol on the process of thyroid hormone formation was studied in a physiological culture system. Porcine thyroid follicles were preincubated with propranolol for 24 h. Iodide transport, iodine organification, and de novo thyroid hormone formation were measured by incubating these follicles with the mixture of carrier-free 0·1 μCi Na ¹²⁵I and 50 nM NaI for 2 to 6 h at 37°C. A concentration of propranolol greater than 100 μM inhibited iodide transport in a dose-dependent manner; this inhibition was non-competitive with iodide and independent of thyrotropin (TSH). Reduced iodine organification and thyroid hormone formation was seen with 150 μM propranolol or greater. The inhibitory action of propranolol was not caused by beta-blocking activity, since D -propranolol (devoid of beta-blocking activity) inhibited iodide transport, and other beta-blockers (metoprolol, atenolol, and labetalol) did not inhibit iodide transport. The inhibition of iodide transport was most likely caused by membrane stabilizing activity since quinidine, which possess the same membrane stabilizing activity as propranolol, also inhibited iodide transport. TSH-mediated cAMP generation and Na ⁺K⁺ ATPase activity, membrane functions for iodide transport, were unaffected by propranolol. Our study has shown, for the first time, that propranolol has a direct antithyroid action, namely inhibition of iodide transport in the intact thyroid follicle.