目的 探讨髋或膝关节置换术（THR/TKR）并存甲状腺功能减退症（甲减）患者围手术期的处理策略。方法 2009年1月－2011年12月收治30例行THR/TKR并存甲减患者，其中男8例，女22例，平均年龄62.4岁。处理要点包括术前纠正甲状腺激素水平；术中缩短手术时间，减少出血量，选择性应用糖皮质激素；术后补充甲状腺激素，预防感染及深静脉血栓形成，改善胃肠功能。评价指标包括围手术期血压、心率变化，胃肠功能状况，切口愈合时间，甲状腺功能水平，黏液性水肿昏迷等并发症发生率；术前及术后Harris及特种外科医院评分系统（HSS）评分等。 结果 术后心率变化大，非致命性心律失常者20例；血压控制平稳；术后甲状腺功能变化不明显，无黏液性水肿昏迷、心包积液及呼吸窘迫等严重并发症发生。随访1个月，术前HSS评分平均28分，术后86分；术前Harris评分平均32分，术后87分。 结论 术前控制血清促甲状腺素在0.5～3.0 mU/L以内，总甲状腺素、游离甲状腺素至正常水平，是有效预防甲减患者THR/TKR围手术期并发症的关键；综合应用左甲状腺素片、糖皮质激素和抗凝治疗是安全渡过围手术期的重要保证。
目的 提高临床医生对甲状腺功能减退症（甲减）并发急性呼吸衰竭的认识，减少误诊，提高救治率。方法 对2002年11月－2011年6月收治的6例甲减并发急性呼吸衰竭患者予以有创机械通气及早期使用左旋甲状腺素治疗，使病症得以控制和治愈。 结果 患者使用有创机械通气治疗平均7 d，住院治疗14～43 d，平均（28.6 ±14.4）d， 5例治愈，1例死亡。 结论 甲减并发呼吸衰竭早期使用机械通气及甲状腺激素替代治疗可提高抢救成功率。
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.
The present study aimed to investigate the impact of hypothyroidism on left ventricular systolic function using real-time three-dimensional speckle tracking imaging (RT3D-STI). Thirty hypothyroidism patients and forty healthy volunteers were recruited and received RT3D-STI measurement of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS). A comparison of differences between the hypothyroidism patients and those in the healthy group was carried out and we obtained the results as followings. The values of GLS were (-18.93°3.89) vs. (-21.44°1.99), with P<0.01, GRS were (51.13°11.95) vs. (56.10°5.76), with P<0.0; and GAS were (-31.63°5.38) vs. (-34.40°2.32), with P<0.01, i.e. they were lower in hypothyroidism group than those in the health group. While GCS were (-17.75°1.92) vs. (-17.03°3.45), with P>0.05, which were not significantly different between the two groups. In linear regression, GLS showed significant correlation with both TSH (b=-0.69, P<0.01) and FT3(b=0.71, P<0.01). Meanwhile, the GRS (b=2.98, P<0.05) and GAS (b=3.11, P<0.05) linearly correlated with FT3 level. In conclusion, the present study shows that the global longitudinal and radial moves of left ventricular are weaker in patients with hypothyroidism than healthy controls. And the impairment of left ventricular function would aggravate as FSH rises or FT3 declines.
ObjectiveTo investigate the prevalence of subclinical hypothyroidism (SCH) in health check-up population of West China Hospital of Sichuan University from 2011 to 2012 and to discuss the relationship between SCH and metabolic syndrome (MS). MethodsThose who received thyroid function tests and health examination in the West China Hospital of Sichuan University from 2011 to 2012 were enrolled in the study. The data of medical history, blood pressure, height, weight, thyroid function, TG, HDL-C, FPG were collected. All data were analyzed by SPSS 18.0 software. ResultsA total of 11 976 persons (7 488 male and 4 488 female) received thyroid function tests. There were 1 820 persons (884 males and 936 females, 15.20%) who suffered from SCH. The SCH prevalence was significantly higher in females (20.86%) than that in males (11.81%) (P < 0.01). The people over 60 years old had the highest SCH prevalence. There were 1 145 persons (1 005 males and 140 females) suffered from MS among all 11 976 persons. The MS prevalence was significantly higher in males (13.42%) than that in females (3.12%) (P < 0.01). The SCH prevalence of the MS group was higher, which in the health group was lower (P < 0.01). The TSH level in the MS group was higher, while it was lower in the health group. ConclusionThe prevalence of SCH is higher in health check-up population; and SCH apparently increases the risk of morbidity of MS.
Objective To investigate the relationship between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 792 patients of T2DM were enrolled in the study. There were 448 males and 344 females, with an average age of (54.13±13.06) years. The average duration of diabetes was (8.03±6.70) years. The patients were grouped according to the degree of DR and thyroid function. Among them, 483 patients (61.0%) were no DR, 240 patients (30.3%) were mild DR, 69 patients (8.7%) were severe DR. 725 patients (91.5%) were normal thyroid function, 67 patients (8.5%) were SCH. The prevalence of SCH among no DR group, mild DR group and severe DR group was compared. And the prevalence of DR between normal thyroid function group and SCH group was compared. Logistic regression analysis was used to estimate the association between SCH and DR. Results No significant differences among the three groups (no DR group, mild DR group, severe DR group) were found in the prevalence of SCH (χ2=1.823,P=0.402). There were no significant differences in the incidences of DR between normal thyroid function group and SCH group (χ2=1.618,P=0.239). Logistic regression analysis demonstrated that SCH was not significant associated with DR [mild DR: odds ratio (OR)=1.361, 95% confidence interval (CI)=0.773−2.399,P=0.286; severe DR:OR=1.326, 95%CI=0.520−3.384,P=0.555; DR:OR=1.353, 95%CI=0.798−2.294,P=0.261). Conclusion SCH is not significant associated with DR in patients with T2DM.