目的观察亚临床甲状腺功能减退症(亚临床甲减,SCH)患者用左甲状腺素(L-T_4)干预治疗对血脂、血压、心率、心功能的影响。方法根据1周内2次促甲状腺激素(TSH)>4.8 m U/L且游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT_4)正常为标准,于...目的观察亚临床甲状腺功能减退症(亚临床甲减,SCH)患者用左甲状腺素(L-T_4)干预治疗对血脂、血压、心率、心功能的影响。方法根据1周内2次促甲状腺激素(TSH)>4.8 m U/L且游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT_4)正常为标准,于2015年7月至2016年4月分别从我院体检中心筛查出SCH患者11例,内分泌科门诊收集SCH患者86例,共计97例随机分成4组,随访1年,TSH≥10.0 m U/L且未干预者为A组(11例),TSH≥10.0 m U/L且用L-T_4干预者为B组(23例),4.8 m U/L<TSH<10.0 m U/L且用L-T_4未干预者为C组(37例),4.8 m U/L<TSH<10.0 m U/L干预者为D组(26例)。全部SCH患者每3个月随诊1次,进行体格检查,测定TSH、FT3、FT_4、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(Tg Ab)及血脂浓度,同时进行心功能检测,并根据甲功结果调整L-T_4的剂量。结果共有82例(84.5%)SCH患者完成了随访。(1)血脂:LT_4干预后,B组的总胆固醇(TC)低于A组[(4.13±0.19)mmol/L vs.(4.92±0.27)mmol/L,P<0.05),而随访前后C组和D组比较差异无统计学意义(P>0.05);低密度脂蛋白胆固醇(LDL)、三酰甘油(TG)和高密度脂蛋白胆固醇(HDL)各组间以及随访前后变化差异均无统计学意义(P>0.05)。(2)血压、心率和心功能:随访后B组和C组舒张压均下降(P<0.05),干预前后四组间收缩压、心率比较差异均无统计学意义(P>0.05)。未干预者射血分数由64.02%±5.25%降到62.28%±5.31%,干预者由62.27%±4.58%上升至63.18%±3.98%,但随访前后、干预与未干预者间差异均无统计学意义(P>0.05)。结论 L-T_4干预对TG、HDL、LDL、血压、心率以及心功能无明显影响;对于TSH≥10.0 m U/L的SCH患者应用L-T_4可降低TC的水平。展开更多
Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Dep...Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.展开更多
文摘目的观察亚临床甲状腺功能减退症(亚临床甲减,SCH)患者用左甲状腺素(L-T_4)干预治疗对血脂、血压、心率、心功能的影响。方法根据1周内2次促甲状腺激素(TSH)>4.8 m U/L且游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT_4)正常为标准,于2015年7月至2016年4月分别从我院体检中心筛查出SCH患者11例,内分泌科门诊收集SCH患者86例,共计97例随机分成4组,随访1年,TSH≥10.0 m U/L且未干预者为A组(11例),TSH≥10.0 m U/L且用L-T_4干预者为B组(23例),4.8 m U/L<TSH<10.0 m U/L且用L-T_4未干预者为C组(37例),4.8 m U/L<TSH<10.0 m U/L干预者为D组(26例)。全部SCH患者每3个月随诊1次,进行体格检查,测定TSH、FT3、FT_4、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(Tg Ab)及血脂浓度,同时进行心功能检测,并根据甲功结果调整L-T_4的剂量。结果共有82例(84.5%)SCH患者完成了随访。(1)血脂:LT_4干预后,B组的总胆固醇(TC)低于A组[(4.13±0.19)mmol/L vs.(4.92±0.27)mmol/L,P<0.05),而随访前后C组和D组比较差异无统计学意义(P>0.05);低密度脂蛋白胆固醇(LDL)、三酰甘油(TG)和高密度脂蛋白胆固醇(HDL)各组间以及随访前后变化差异均无统计学意义(P>0.05)。(2)血压、心率和心功能:随访后B组和C组舒张压均下降(P<0.05),干预前后四组间收缩压、心率比较差异均无统计学意义(P>0.05)。未干预者射血分数由64.02%±5.25%降到62.28%±5.31%,干预者由62.27%±4.58%上升至63.18%±3.98%,但随访前后、干预与未干预者间差异均无统计学意义(P>0.05)。结论 L-T_4干预对TG、HDL、LDL、血压、心率以及心功能无明显影响;对于TSH≥10.0 m U/L的SCH患者应用L-T_4可降低TC的水平。
文摘Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.
