目的 探讨碘131（131I）治疗后Graves眼病（GO）预后与血清促甲状腺激素受体抗体（TRAb）水平变化之间的关系。 方法 选择2011年5月－12月初发Graves病患者238例，分为GO组124 例和非GO组114 例，分别检测131I治疗前及131I治疗后2、3、6个月甲状腺功能和TRAb，GO患者131I治疗前和治疗后6 个月进行临床活动度评分（CAS）。 结果 131I治疗前各组TRAb水平差异无统计学意义（P＞0.05），TRAb水平与GO CAS评分之间无相关；131I治疗后6个月所有患者TRAb水平显著增加；非GO组有5例新发GO，新发GO组与其他患者的TRAb水平分别为（58.7 ± 77.9）、（61.9 ± 81.1）U/L，差异无统计学意义（P＞0.05）；GO组又分为GO无变化29例，GO加重17例，GO缓解78例，三组患者TRAb水平分别为（53.5 ± 77.6）、（66.2 ± 89.9）、（66.8 ± 42.2）U/L，差异无统计学意义（P＞0.05）。 结论 131I治疗后患者TRAb水平显著增加，但TRAb水平的变化和GO预后无关，TRAb与GO的关系还需要进一步研究。
To study the relationship between the level of serum thyrotropin receptor antibody (TRAb) and the severity of Crave′s disease. From August, 1996 to June, 1998, 156 outpatients with Crave′s disease were followed up. The level of serum TRAb were measured by radio-receptor-analysis (RRA). Results: ①The level of serum TRAb rose in 90.1% of the untreated group; ②The level of serum TRAb restored to normal after the antithyroid drugs were used and the thyroxine level in serum returned to normal; ③In recurrent patients with the treatment of131I, drugs or operation, the serum TRAb level increased. Conclusion: The level of serum TRAb has great significance in the diagnosis, treatment and follow up of the Crave′s disease.
Thirty patients with heperthyroidism were investigated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyromicrosome antibody (TMA), thyroglobulin antibody (TGA) and hydrocortisone before and after operation. The levels of serum T3, T4, TGA, TMA were markedly decreased after operation, and the level of hydrocortisone farther decreased from the preoperative low level. But only a little decrease in TSH level was found as compared with that before operation. The assay of these hormones and antibodies has very important clinical significance for judgement of the effect of operation and prevention of crisis of hyperthyroidism.
目的 探讨甲状腺疾病患者血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲状腺球蛋白(TG)含量水平变化与临床意义。 方法 采用电化学发光法对2009年1月-6月诊断的725例甲状腺疾病患者的FT3、FT4、TSH、TG进行检测，对各类甲状腺疾病的激素含量进行统计分析。 结果 血清中此类激素的水平与甲状腺的功能状态呈平行关系。 结论 在不同甲状腺疾病患者血清FT3、FT4、TSH、TG变化各有特点，有助于临床鉴别诊断。
Objective To investigate the value of thyroid stimulating hormone (TSH) inhibition therapy in postoperative patients with differentiated thyroid carcinoma. Methods One hundred and six patients with differentiated thyroid carcinoma after total or near-total thyroidectomy were divided into two groups: TSH inhibition therapy group and thyroid hormone replacement therapy group. The non-recurrence and (or) non-metastasis rate in two groups was analyzed retrospectively by Wilcoxon statistical analysis. Results The non-recurrence and (or) non-metastasis rate of 3-， 5- and 10-year in TSH inhibition therapy group were 98.31%， 92.41% and 75.45% respectively， and were higher than those (93.57%， 84.18% and 52.06% respectively) in thyroid hormone replacement therapy group （P=0.046 5）. Conclusion TSH inhibition therapy after total or near-total thyroidectomy may be an essential treatment for differentiated thyroid carcinoma patients.
ObjectiveTo investigate the relationship between thyroid stimulating hormone (TSH) and the blood lipid level in patients with subclinical hypothyroidism (SCH). MethodsWe carried out a retrospective analysis on the clinical data of 264 patients with their first diagnosis of subclinical hypothyroidism without treatment from 2010 January to 2014 January. A total of 288 healthy controls were chosen from communities. The patients were groups based on TSH≥10.0 mU/L and 3.6 mU/L≤ TSH< 10.0 mU/L. We investigated the relationship between TSH and the level of blood lipids by analyzing liver and renal function, blood lipids, thyroid function, and thyroid peroxidase antibody (TPO-Ab) in the patients. ResultsTriglyceride (TG) and high density lipoprotein cholesterol levels were not significantly different among the three groups (P>0.05). Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels of the group with TSH≥10 mU/L were respectively (5.93±1.12) and (3.82±1.11) mmol/L, which were significantly higher than those in the controls[(4.43±1.12) and (2.66±0.43) mmol/L] (P<0.05). TC, TG and LDL-C levels of the group with 3.6 mU/L≤ TSH< 10.0 mU/L were higher than the controls, but the differences were not significant (P>0.05). After thyroid hormone replacement therapy within 12 weeks, TG, LDL-C, and TC levels of TPO-Ab positive patients with subclinical hypothyroidism (n=112) were respectively (4.62±1.03), (2.97±0.52), and (1.17±0.62) mmol/L, which were significantly lower than those levels before treatment[(5.43±1.18), (3.62±0.58), and (2.03±0.71) mmol/L] (P<0.05). ConclusionThe disorder of lipid metabolism exists in patients with subclinical hypothyroidism. Especially, the level of TSH greater than or equal to 10 mU/L is a high risk factor for dyslipidemia. In TPO-Ab positive patients, therapy of thyroid hormone replacement can effectively improve the blood lipid abnormalities in patients with subclinical hypothyroidism, and it may be an effective measure to improve the disorder of lipid metabolism economically and effectively.
ObjectiveTo observe changing trend of thyroid hormones levels for postoperative patients with differentiated thyroid carcinoma,and to discuss the best therapeutic timing of thyrotropin (TSH) suppression. MethodsNinety-six patients with differentiated thyroid carcinoma from January 2011 to December 2013 in this hospital were selected.All of these 96 cases were divided into total thyroidectomy group (n=50) and thyroid lobectomy and isthmectomy group (n=46) according to the surgical approach.Serum thyroid hormones levels (T3,FT3,T4,FT4,and TSH) were detected on day 1,2,4,5,7,14 after operation. Results① In the total thyroidectomy group,the levels of T3 and FT3 elevated transiently on day 5,then decreased gradually,and which were lower than the low limit of normal range on day 14.The levels of T4 and FT4 elevated transiently,then reached the peak on day 2,and which started to decrease gradually and reached the low limit of normal range on day 14.The value of serum TSH decreased transiently,which started to increase rapidly on day 2 and surpassed the high limit of normal range on day 4,then continued to rise until on day 14.② In the lobectomy and isthmectomy group,the values of T3 and FT3 decreased gradually,then started to rise on day 5,and which were lower than preoperative values until on day 14.The values of T4 and FT4 elevated transiently and which reached the peak on day 2,and then gradually decreased,which appeared to be lower than preoperative values on day 14.The value of TSH decreased transiently,and which started to rise on day 4,then elevated gradually and exceeded preoperative level on day 7,which reached the high limit of normal range on day 14. ConclusionsThere are dynamic changes of thyroid hormones in postoperative patients with differentiated thyroid carcinoma.It is feasible to determine the best therapeutic timing of TSH suppression according to the levels of postoperative thyroid hormones.The best timing of thyrotropin suppression therapy is that TSH is above the high limit of normal range after operation.
ObjectiveTo systematically review the efficacy and safety of recombinant human TSH (rhTSH) in radioiodine therapy for benign thyroid goiter. MethodsWe electronically searched MEDLINE, EBSCO, The Cochrane Library (Issue 6, 2015) and CNKI databases from January 1990 to March 2015, to identify randomized controlled trials (RCTs) about rhTSH in radioiodine therapy of benign thyroid goiter. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 6 RCTs were included. The results of meta-analysis showed that: compared with the control group, the thyroid volume was significantly reduced at 1 year after radiation in the rhTSH group (MD=0.14, 95%CI 0.05 to 0.23, P=0.002). There were no significant differences in FT4, FT3 and the percentage of patients who had thyroid antibody between two groups before and after radiation. In addition, rhTSH did not significantly increase the incidence of hyperthyroidism and neck pain. ConclusionrhTSH is effective and safe in radioiodine therapy of benign thyroid goiter. Due to the limitation of quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To discuss the relationship between thyroid stimulating hormone (TSH) and clinicopathologic features of the papillary thyroid microcarcinoma (PTMC) patients. Methods The thyroid nodules of 806 cases retrospectively that were for the first time hospitalized to our department in recent 5 years were collected, among them, postoperative pathological examination confirmed the diagnosis of PTMC in 403 cases, 403 cases of benign thyroid lesions, the history data of selected cases that meet the criterion of selection were retrospectively analyzed. TSH and anti thyroid globulin antibody (TGAb) levels between the 2 groups and the prevalence of ratio of PTMC in different TSH levels were compared. Univariate and multivariate analysis were performed to determine the risk factors of PTMC. Results The differences of preoperative TSH levels between the two groups was statistical significance (Z=–6.233,P=0.001), gender composition no statistical significance in two groups (χ2=3.246,P=0.072), and age was statistically significant (Z=–5.855,P=0.001). The constitution of ethnics of two groups was different (χ2=38.961,P=0.001). Logistic regression analysis display that age and TSH level were the independent risk factors of PTMC (age:OR=0.914,P=0.027; TSH:OR=4.662,P=0.008). Conclusions The level of serum TSH in PTMC patients is higher than in patients with benign thyroid nodules. TSH level is probably predictive of malignancy of PTMC.
Objective To study the correlation between preoperative serum thyroid stimulating hormone (TSH) level and the malignant risk of thyroid nodules. Methods This study retrospectively analyzed the medical records of 959 patients with thyroid nodules. Ststistical analysis was conducted by SPSS 17.0 software. Results There were 959 patients with thyroid nodules, of which 746 cases were benign, and 213 cases were diagnosed as thyroid papillary carcinoma (PTC). The preoperative TSH level of PTC patients was higher than that with benign nodules [(2.32±1.65) mU/L vs. (1.76±1.20) mU/L, P<0.001]. Moreover, the higher preoperative TSH level was, the higher risk of diagnosed as PTC would be. There was no correlation between the preoperative TSH level and tumor diameter, number of lesions, and lymph nodes metastasis in PTC (P>0.05). Logistic regression analysis showed that, the preoperative TSH level was an independent risk factor for PTC [OR=1.315, 95% CI was (1.171, 1.477), P<0.001]. The best critical value of TSH in the PTC diagnosis was 1.575 mU/L. At this point, the sensitivity was 62.0%, the specificity was 53.4%, and the area under the receiver operating characteristic (ROC) curve was 0.602 (P<0.001). Conclusion There is a certain correlation between preoperative TSH level and malignant risk of thyroid nodules, and the risk increases with the raise of preoperative TSH level.