Objective To investigate the association between preoperative serum TSH concentration and thyroid carcinoma in patients with nodular goiter.Methods Data of 632 patients with nodular goiter from January 2004 to December 2010 were analyzed retrospectively.Results Preoperative serum TSH in nodular goiter with thyroid carcinoma was higher than that without thyroid carcinoma，which was （2.10±1.38）mU/L and （1.51±0.98）mU/L，respectively （P＜0.000 1）.The risk of malignancy increased as serum level of TSH rose in nodular goiter patients （P=0.023 5），the ratios were 9.91% （0.3-0.9mU/L），12.37% （0.9-1.7mU/L）， 20.09% （1.7-4.8mU/L），and 27.27%（＞4.8mU/L）.The TSH level of stageⅢ-Ⅳ patients higher than that stageⅠ-Ⅱ patients （P=0.030 6）.The diameter of tumor ＞4 cm had highest mean TSH level， and which ≤ 2cm had lowest mean TSH level（P=0.018 6）. Conclusion Preoperative serum TSH level perhaps is a risk predictor for nodular goiter with thyroid carcinoma.
Objective To provide the evidence on the selection and related policies of essential medicine for policy-makers through systematic review of the National Essential Medicine List(NEML) around the world. Method We systematically searched the official websites of the health authorities, like the departments of health and pharmaceutical administrations. We selected the published NEML. Two reviewers independently selected literature and extracted data. We analyzed the time of NEML published and updated, NEML committees, selection criteria, medicine category, number of medicines, and medicine information in NEML and standard treatment guidelines (STGs) as well. Results Thirty-six NEMLs from 25 countries were included with 34 in English and 2 in Chinese. From 1982 to 2009, Twenty-five countries developed their NEMLs respectively. They were updated from four months to eight years. The NEML committee members came from central government, ministry of health, pharmaceutical administrations, ministry of public health, ministry of education, essential medicine division, etc. The committees were composed of clinical specialists, health officials, pharmacists (pharmacologists), medicine educators, economist, statisticians, epidemiologist and experts from WHO/UNICEF, etc. Most of the countries took the WHO’s concept of essential medicine and selection criteria as standard. The applications of essential medicine were reviewed by considering the following aspects: safety, effectiveness, economic characteristics, the main disease burden, rational use of drug and supply. The medicines in NEMLs of 25 countries varied from 103 to 2 033, and the median is 447. The Anatomical Therapeutic Chemical (ATC) classification was used to classify the medicines in NEMLs of 12 countries. The drug information was provided, including generic name, dosage, form of medication and administration route as well. The STGs or formularies covered from 73 to 167 common diseases, including the diagnosis, treatments, rational use of drug, contraindications, adverse effects, etc. Conclusions The NEMLs in 25 countries have shown great differences because of the variation of the social and economic developments, disease burdens and the developments of health care systems in different countries. We can learn from the experience of other countries, like Australia and South Africa, in the selection and use of essential medicines, STGs and related policies. We should develop the national essential medicine system for policy making and administration, especially the national essential medicine list for common diseases base on the high quality evidence, the local disease burden as well as specific demands in different areas.