Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU

BACKGROUND: Prognostic value of cortisol and thyroid function tests(TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patients admitted to toxicology intensive care unit(ICU).METHODS: In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs(total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am–10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also included.RESULTS: In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS Ⅱ, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy(P=0.04; OR=1.06; 95%CI=1.05–1.08; cut-off=42 μg/d L; sensitivity=70%; specificity=82%). Between aluminium phosphide(ALP)-and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning(all Ps<0.001 in both uni and multivariate analyses). Median(interquartile range; IQR) GCS was 7(6, 10) and 15(8, 15) in non-ALP and ALP-poisoned patients(P<0.003). SAPS Ⅱ and APACHE Ⅱ could not prognosticate death at all.CONCLUSION: Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.

Effects of High Fluoride and Low Iodine on Thyroid Function in Offspring Rats

Thirty-two Wistar rats were divided randomly into four groups of eight with six females and two males in each group. The rats were exposed to high fluoride drinking water （45 mg F-L^-1 from 100 mg NaF L-1）, low dietary iodine （0.0855 mg kg-1）, or both together in order to assess the effects of these three regimens on the thyroid function of the offspring rats. After the animal model was established, the offspring rats were bred and 10-, 20-, 30-, 60-, and 90-d-old rats were used for the experiment. The treatments for the offspring rats were the same as those of their parents. In comparison with control rats, the relative thyroid glands were changed by three regimens, but the mean values of thyroid weight in the experimental groups saw no marked difference. Serum TT3 levels were increased in all stages in the low iodine （LI） group. In the high fluoride （HiF） group, increase in TT3 levels was observed except in 20-d-old rats. Decrease in TT3 at 20- and 90-d and increase in TT3 at 30- and 60-d were found in HiF＋LI group. Serum TT4 levels first saw an increase, and then dropped in the LI and HiF＋LI group. However, an increase in TT4 was found in the HiF group. The levels of TSH in serum rocketed at d 20, and then dropped in the next stages in experimental groups. The results suggested that thyroid disorder could be induced by high flroride in drinking water, low iodine diet, or both of them. Exposure time to fluoride or low iodine diet was one of the important factors that fluoride can induce the development of thyroid dyfunction.

Impact of Nonlethal Levels of Metacid-50 and Carbaryl on Thyroid Function and Cholinergic System of Channa punctatus

With regard to brain acetylcholinesterase and acetylcholine and serum triiodothyronine(T_3) and thyroxine(T_4)profiles,a biphasic response pattern was elicited in Channa punctatus chroni- cally exposed to nonlethal doses of locally used pesticides,namely,Metacid-50 and Carbaryl. Data revealed that these xenobiotics caused significant inhibition of brain acetylcholinesterase activity and a decrease in thyroxine level accompanied by a concurrent increase in acetylcholine accumulation and T_3 level.It is surmised that Metacid-50 and Carbaryl influence both neural and hormonal functions.1989 Academic Press.Inc.

DYNAMIC OBSERVATION OF THYROID FUNCTION IN PATIENTS WITH APLASTIC ANEMIA

Accelerating cell growth is one of the functions of thyroid hormone. In the absence or lack of this hormone, hematopoietic disorder may occur. Dynamic observation of thyroid function in aplastic anemia (AA) state has not been reported yet.

Efficacy of Xiaojin Capsules Combined with Selenium Yeast Capsules on 120 Cases of Hashimoto's Thyroiditis with Abnormal Thyroid Function

[Objectives]To explore the efficacy of Xiaojin Capsules combined with Selenium Yeast Capsules in the treatment of Hashimoto's thyroiditis(HT)with abnormal thyroid function.[Methods]A total of 180 HT patients who were treated in the First Affiliated Hospital of Henan University and Henan Provincial People's Hospital from December 2020 to December 2021 were selected as the research subjects and randomly divided into the observation group(n=120)and the control group(n=60)in at a tratio of 2∶1 ratio according to their visiting time.The observation group was treated with Xiaojin Capsules(oral,5 capsules each time,twice a day for 12 weeks)and Selenium Yeast Capsules(oral,1 capsule each time,twice a day for 12 weeks).The control group was treated with only Selenium Yeast Capsules(oral,1 capsule each time,twice a day for 12 weeks).[Results]The difference in the levels of thyroid peroxidase antibody(TPO-Ab),thyroglobulin antibody(TGAb),serum free triiodothyronine(FT_(3)),serum free thyroxine(FT_(4)),and thyroid stimulating hormone(TSH)between the observation group and control group was statistically significant(P<0.05).The diameters of thyroid between the observation group and the control group before,during and after treatment were significantly different(P<0.05).The total effective rate of the observation group was 82.5%(99/120),which was significantly higher than 56.67%(34/60)in the control group,and the difference was statistically significant(P<0.05).The cure rate(22.50%)in the observation group was significantly higher than the control group(3.33%),and the difference was statistically significant(P<0.01).The ineffective rate of the observation group was 17.50%,which was significantly lower than that of the control group(40.00%),and the difference was statistically significant(P<0.01).The markedly effective rate of the observation group was 40.83%,which was significantly higher than that of the control group(31.67%),and the difference was statistically significant(P<0.05).The effective rate in the observation group was 191%,and the effective rate in the control group was 21.67%,and the difference was not statistically significant(P>0.05).[Conclusions]Xiaojin Capsules combined with Selenium Yeast Capsules in the treatment of HT can eliminate or alleviate the clinical symptoms and signs,significantly reduce the levels of TPO-Ab and TGAb in serum,restore thyroid function,improve thyroid shape and structure in the treatment of HT,and the clinical effect is satisfactory.

Study on the relationship of iodine nutritional status with thyroid function and autoantibodies in pregnant women in Baotou

Objective:To investigate the relationship of iodine nutritional status with thyroid function in pregnant women in Baotou,and provide a scientific basis for the guide of reasonable iodine supplementation.Methods:By use of As-Ce catalysis spectrophotometry,the urinary iodine concentration was determined in 90 women during different periods of pregnancy admitted to Baogang Hospital of Inner Mongolia from January 2017 to December 2017.The determination of thyroid function and the autoantibody level was carried out by electro-chemiluminescence immunoassay(ECLIA).Results:In the early trimester of pregnancy,pregnant women with iodine deficiency,iodine sufficiency and iodine excess accounted for 36.67%,40.00%and 23.33%respectively;in the middle trimester of pregnancy,they accounted for 66.67%,26.67%and 6.66%respectively;they made up 40.00%,40.00%and 20.00%respectively in the late trimester of pregnancy.The rate of iodine deficiency in women in the middle trimester of pregnancy was significantly higher than that in women in the early and the late trimesters of pregnancy respectively,and the difference was statistically significant(p<0.05).The rate of iodine deficiency in pregnant women was positively correlated to the positivity of thyroid peroxidase antibody.Moreover,it had no relationship with the positivity of thyroglobulin antibody.No matter in the pregnant women with iodine deficiency or with iodine excess,the abnormality rate of thyroid function and autoantibodies was significantly higher than that in the pregnant women with iodine sufficiency.The difference was statistically significant(p<0.05).Conclusions:The iodine deficiency in the women in the middle trimester of pregnancy is more severe than that in the women in the early and the late trimesters of pregnancy.Iodine deficiency during pregnancy is positively correlated with the positivity of thyroid peroxidase antibody.Pregnant women with iodine deficiency and iodine excess show a higher abnormality rate of thyroid function and autoantibodies.It is recommended to advocate health education on iodine nutrition to pregnant women,and conduct the dynamic monitoring of urinary iodine concentration and the screening of thyroid function and autoantibodies during pregnancy.

Thyroid Function in Pregnant Women from a West-African Population

Thyroid dysfunction is frequent in pregnant women and is often associated with an increased risk of adverse maternal and fetal outcome. In the present work, thyroid function of pregnant women from Benin republic was studied. Two hundred forty (240) pregnant women, without thyroid disease history, have been included in the study. A blood sample was drawn for measurement of TSH, free T3 and free T4 serum levels. From the first to the third trimester, plasma levels of free T3 and free T4 decreased when plasma levels of TSH increased. Using recommendations of the 2011 American Thyroid Association (ATA) guidelines, thyroid dysfunction was observed in 24.17% of subjects. Hypothyroidism was present in 22.50% of subjects with 19.17% of subclinical hypothyroidism, 0.83% of overt hypothyroidism and 2.50% of hypothyroxinemia and hyperthyroidism was observed in 1.67% of subjects. An increase from 15.52% to 28.07% was observed in the frequency of hypothyroidism from the first to the third trimester of pregnancy. When an upper cut-off value of 4 mU/L was used for TSH, as recommended in the 2017 ATA guidelines, prevalence of thyroid disorders was 14.58% with 12.91% of hypothyroidism but no hypothyroidism was observed in women in the first trimester of pregnancy. A rise in hypothyroidism frequency was observed when pregnant women age increased. Hypothyroidism was very common in pregnant women in Benin. To allow accurate assessment of thyroid status in pregnant women in Benin, pregnancy specific range for plasma level of TSH and thyroid hormones should be established.

Association between thyroid function and gallstone disease

AIM: To investigate those associations using data of the population-based Study of Health in Pomerania.METHODS: A study population of 3 749 residents aged 20-79 years without previously diagnosed thyroid disease was available for analyses. Serum TSH was used to assess thyroid function. Cholelithiasis was defined by either a prior history of cholecystectomy or the presence of gallstones on ultrasound. Logistic regression was performed to analyze independent associations between thyroid function and cholelithiasis.RESULTS: There were 385 persons (10.3%) with low (＜0.3 mIU/L), 3 321 persons (88.6%) with normal and 43 persons (1.2%) with high serum TSH levels (＞3 mIU/L).The proportion of cholelithiasis among males and females was 14.4% and 25.3%, respectively. Among males, there was an independent relation between high serum TSH and cholelithiasis (OR 3.77; 95%-CI 1.06-13.41; ,P＜0.05). zAlso among males, there was a tendency towards an elevated risk of cholelithiasis in persons with low serum TSH (OR 1.40; 95%-CI 0.96-2.02; P = 0.07). In the female population, no such relation was identified.CONCLUSION: There is an association between thyroid and gallstone disease with a gender-specific relation between hypothyroidism and cholelithiasis.

Age- and Gender-Specific Changes in Thyroid Size and Thyroid Function Test Values of Euthyroid Subjects

Background: The thyroid status is evaluated by two clinical diagnostic tests which are thyroid ultrasonography and thyroid function tests. The objective of this research is to critically analyze the age and gender based variations of thyroid volume and thyroid hormone levels in the hospital based euthyroid subjects. Methodology: A total of 221 euthyroid subjects aged 1 - 86 years were selected to observe the normal thyroid size by ultrasonography at Department of Radiology and the thyroid function test values (FT3, FT4 and TSH) of 2413 euthyroid subjects aged (Results: The best fitted equations with significant correlation coefficients and p Conclusion: The thyroid size first increases and then decreases whereas the thyroxin level first decreases and then increases with aging. Left lobe volume is almost same for both genders and right lobe volume is higher in males. The thyroid size in menarche and menopause periods of females is larger than that of males. Such age- and gender-specific changes recommend the new refer-ence ranges for the normal thyroid functions.

Thyroid function profile, and its association to consumption of cassava and <i>Moringa stenopetala</i>in pregnant women

Background: Pregnancy is associated with the change in thyroid function. Thyroid function is also affected by goitrogenic substances in some plant foods, like cassava. Aim: This study aims to assess thyroid function status and its association to consumption of foods containing goitrogenic substances. Methods: A cross sectional study was done on a total of 65 pregnant women attending Sawla Health Center, South Ethiopia. Serum samples were collected and analyzed for TSH, total T4 and total T3 by using ELISA kit. Data on consumption of foods containing were obtained from food frequency questionnaire. Results: The median TSH of the first, second and third trimesters, respectively are 2.57, 1.86 and 2.42 mIU/L, which are within the reference interval (0.30-6.20 mIU/L) of the test kit. The median total T4 values (9.8, 10.0 and 10.3 μg/dl in the first, second and third trimesters, respectively) were also within the reference interval (4.8-11.6 μg/dl) of the test kits. The median total T3 in the first (2.60 ng/ml) and third (2.35 ng/ml) trimesters were elevated, but it was within the reference interval (0.69-2.02 ng/ml) in the second trimester (1.92 ng/ml). Though statistically non-significant median TSH was increased in women grouped as cassava consumers and M. stenopetala consumers while median total T4 values were decreased in these groups. Conclusion: The study subjects have normal thyroid function as the median values of TSH and total T4 were within the reference interval of the test kit. Frequent consumption of cassava and Moringa stenopetala may affect thyroid function.

Effects of <i>Nigella sativa</i>L. Seed Extract on Fatigue, Blood Biochemical Parameters and Thyroid Function in Male Mice

Nigella sativa L. (Black seed), is a traditional herbal medicine that has been used for many purposes. The present study was designed to investigate the effects of hydro-alcoholic extract of nigella sativa L. (NS) on performance of Forced Swimming Test (FST), blood biochemical parameters related to fatigue and thyroid functions. Therefore, Blood Urea Nitrogen (BUN), Creatine Kinase (CK), Lactic Dehydrogenase (LDH), and Total Protein (TP), triiodothyronine T3, thyroxin T4 and TSH tests were investigated. Thirty five male adult mice were randomly divided into five groups: three NS-fed groups, one fluoxetine treated group and one control group. Three NS experimental groups received hydro-alcoholic extract of NS at doses of 50, 100 and 200 mg/kg orally for two weeks. Immobility time decreased in all NS groups compared with control group. Administration of NS significantly increased the concentration of T3 and T4 of the treatment groups. On the contrary, the amount of BUN, CK, LDH, TP and TSH decreased. In conclusion, black seed extract at the experimented doses showed anti-depressant, anti-fatigue and hyperthyroid effects.

Comparison of the Reference Intervals Used for the Evaluation of Maternal Thyroid Function During Pregnancy Using Sequential and Nonsequential Methods

Background： Maternal thyroid dysfunction is common during pregnancy, and physiological changes during pregnancy can lead to the overdiagnosis of hyperthyroidism and misdiagnosis of hypothyroidism with nongestation-specific reference intervals. Our aim was to compare sequential with nonsequential methods for the evaluation of thyroid function in pregnant women. Methods： We tested pregnant women who underwent their trimester prenatal screening at our hospital from February 2011 to September 2012 for serum thyroid stimulating hormone （TSH） and free thyroxine （FT4） using the Abbott and Roche kits. There were 447 and 200 patients enrolled in the nonsequential and sequential groups, respectively. The central 95% range between the 2.5th and the 97.5th percentiles was used as the reference interval for the thyroid function parameter. Results： The nonsequential group exhibited a significantly larger degree of dispersion in the TSH reference interval during the 2nd and 3rd trimesters as measured using both the Abbott and Roche kits （all P 〈 0.05）. The TSH reference intervals were significantly larger in the nonsequential group than in the sequential group during the 3rd trimester as measured with both the Abbott （4.95 vs. 3.77 mU/L, P 〈 0.001） and Roche kits （6.62 vs. 5.01 mU/L, P〈 0.004）. The nonsequential group had a significantly larger FT4 reference interval as measured with the Abbott kit during all trimesters （ 12.64 vs. 5.82 pmol/L; 7,96 vs. 4.77 pmol/L; 8.10 vs. 4.77 pmol/L, respectively, all P 〈 0.05）, whereas a significantly larger FT4 reference interval was only observed during the 2nd trimester with the Roche kit （7.76 vs. 5.52 pmol/L, P = 0.002）. Conclusions： It was more reasonable to establish reference intervals for the evaluation of maternal thyroid function using the sequential method during each trimester of pregnancy. Moreover, the exclusion of pregnancy-related complications should be considered in the inclusion criteria for thyroid function tests.

Changing pattern of thyroid and adrenal function in postmenopausal women after hormone replacement therapy

Objective:To investigate the changing pattern of thyroid and adrenal function in postmenopa-usal women;and the relationship between hormone replacement therapy(HRT)and thyroid andadrenal function.Methods:The levels of tT_3,tT_4,fT_3,fT4,TSH and cortisol were measured in 60 postmeno-pausal women(30 cases in HRT group;30 cases in control group)before and 12 months afterHRT.Results:The serum levels of tT_3,tT_4,fT_3,fT_4,TSH and cortisol had no significant differ-ence before and 12 months after HRT in postmenopausal women.The values of them were all innormal ranges.Conclusion:Changing pattern of thyroid and adrenal function was not as significant as that ofgonads in postmenopausal women and the impact of HRT on it was not so significantly evident.

Effects of mild insufficient iodine intake on thyroid function and autoantibodies in pregnant women

Objective To investigate the effects of mild insufficient iodine intake on thyroid function and autoantibodies in pregnant women,and to provide a basis for scientific supplementation of iodine to pregnant women.Methods From December 2015 to March 2016,Suixi County

TSH RECEPTOR GENETIC ALTERATIONS IN THE AUTONOMOUSLY FUNCTIONING THYROID ADENOMAS

Objective To determine the relationship between TSH receptor gene mutations and autonomously functioning thyroid adenomas (AFTAs). Methods The thyroid samples from 14 cases of diagnosed AFTAs were analyzed, with normal thyroid specimens adjacent to the tumors as controls. The 155 base pairs DNA fragments which encompassed the third cytoplasmic loop and the sixth transmembrane segments in the TSH receptor gene exon 10 were amplified by Polymerase chain reaction (PCR) and analyzed by the single-strand conformation polymorphism (SSCP). Direct sequencing of the PCR products was performed with Prism Dye Terminator Cycle Sequencing Core Kit. Results 6 of 14 AFTA specimens displayed abnormal migration in SSCP analysis. In sequence analysis of 3 abnormally migrated samples, one base substitution at nucleotide 1957 (A to C) and two same insertion mutations of one adenosine nucleotide between nucleotide 1972 and 1973 were identified. No mutations were found in controls. Conclusion This study confirmed the presence of TSH receptor gene mutations in AFTAs; both one-point substitution mutation and one-base insertion mutation were found to be responsible for the pathogenesis of AFTAs.

Investigating the Association of Smoking with Thyroid Volume and Function

This study was conducted to explore possible correlation between smoking habit and thyroid volume and function in Jeddah. A total of 226 volunteers i.e. 128 male and 98 female were screened at Radiology Department King Abdul-Aziz University Hospital. They were categorized as smokers and non- smokers;the number of smokers was 99 cases i.e. 48 Cigarette smokers and 51 Shisha smokers, and the non-smokers were 127 cases. The information was gathered via a questionnaire distributed at the radiology department. Ultrasonography of thyroid and thyroid function test were performed for 166 participants;and data were analyzed Using SPSS version 22 and Microsoft excel. The study was carried out based on random selection and findings revealed that most of the cases were in the age group between 20 to 30 years old, high body mass index (BMI) was 33.1 kg/m2 in persons above 60 years old and the highest percentage smokers in the age group from 20 to 30 years (40.02%). Ultrasonography of thyroid showed 96 (58%) normal cases, 46 (28%) abnormal “solid” cases and 24 (14%) abnormal “cyst” cases. A lower proportion of cigarette and shisha smokers (15.4% and 5.6% respectively) had an enlarged thyroid gland compared to no cigarettes or shisha smokers (47.9% and 47.3% respectively). The difference between these frequencies was statistically significant (Chi-square = 9.446 and 11.424, p = 0.002 and p = 0.001 for cigarette and shisha smoking respectively). Consequently, it can be concluded from this research that there are no direct significant values correlating smoking habit to thyroid volume or function. However, it is always recommended not smoke due to other well-known threats.

玫瑰痤疮277例甲状腺功能分析

目的分析玫瑰痤疮患者甲状腺功能(以下简称甲功)的临床特征,探讨玫瑰痤疮患者的甲功特点。方法收集2019年7月至2022年7月在新疆维吾尔自治区人民医院门诊及住院的玫瑰痤疮患者277例(病例组)及同期在该院体检中心体检的健康人群280例(对照组)作为研究对象。2组性别、年龄比较差异无统计学意义(P>0.05),具有可比性。收集2组所有研究对象的一般资料和甲功相关指标水平等数据,并对相关因素进行统计分析。结果①2组患者甲功中血清游离三碘甲状腺原氨酸(FT3)、三碘甲状腺原氨酸(T3)、促甲状腺激素(TSH)水平比较差异均有统计学意义(P<0.05),而游离甲状腺素(FT4)、甲状腺素(T4)、抗甲状腺过氧化物酶(TPO)和抗甲状腺球蛋白(TGAb)抗体水平比较差异均无统计学意义(P>0.05);②对不同病情严重程度的玫瑰痤疮患者的甲功指标进行比较,结果提示轻、中、重度玫瑰痤疮患者各项甲功指标比较差异无统计学意义(P>0.05);③2组患者甲状腺超声甲状腺大小比较差异无统计学意义(P>0.05),轻、中、重度玫瑰痤疮患者甲状腺大小比较差异也无统计学意义(P>0.05)。结论玫瑰痤疮患者的血清甲功指标水平均在正常范围,FT3、T3、TSH水平与健康人群比较差异有统计学意义(P<0.05)。

^(131)I+TSH抑制治疗对分化型甲状腺癌术后患者甲状腺功能、免疫功能及复发转移的影响

目的研究分化型甲状腺癌(DTC)术后采用^(131)I+促甲状腺激素(TSH)抑制治疗的临床疗效及对患者甲状腺功能、免疫功能及复发转移的影响。方法回顾性选取2018年1月至2019年12月于该院就诊并接受治疗的97例DTC患者为研究对象,根据术后治疗方案不同分为对照组57例(采用TSH抑制治疗)和观察组40例(在对照组基础上联合^(131)I治疗)。观察两组清除残余甲状腺组织(清甲)的效果,以及甲状腺功能指标[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)及甲状腺球蛋白(Tg)]、甲状腺抗体指标[促甲状腺素受体抗体(TRAb)、甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb)]水平和免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞细胞亚群比例)变化。随访统计两组术后1、3年复发和转移情况。结果观察组完全清除率为72.5%,明显高于对照组的52.6%,差异有统计学意义(P<0.05)。治疗后,两组FT3、FT4水平明显升高(P<0.05),TSH和Tg水平明显降低(P<0.05);治疗后,观察组FT3、FT4、TSH水平与对照组比较,差异无统计学意义(P>0.05),Tg水平显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组TRAb、TgAb、TPOAb水平及CD8^(+)比例较治疗前明显降低,CD3^(+)、CD4^(+)比例较治疗前明显升高,且观察组水平优于对照组,差异有统计学意义(P<0.05)。观察组术后1、3年复发率分别为0、7.5%,转移率分别为2.5%、10.0%;对照组术后1、3年复发率分别为14.4%、22.8%,转移率分别为15.8%、28.1%,两组比较,差异均有统计学意义(P<0.05)。结论^(131)I+TSH抑制治疗能够提高清甲效果,降低TSH、Tg水平,维持甲状腺功能及改善患者免疫功能,抑制肿瘤复发、转移,提高患者预后。

扶正化浊汤联合甲状腺片治疗对甲状腺结节大小及疗效的影响

目的探讨扶正化浊汤治疗甲状腺结节(TN)对结节大小的影响。方法TN患者106例,随机均分为观察组和对照组,对照组给予左甲状腺素钠片常规治疗,观察组在对照组基础上同时增加扶正化浊汤治疗;于治疗前、治疗3个月时,对2组患者进行中医主症评分,采用彩色多普勒超声仪记录2组患者结节数目、最大直径、结节体积、血流阻力指数(RI)及搏动指数(PI),同时采集患者外周静脉血4 mL,检测促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲腺原氨酸(FT4)及血管内皮生长因子(VEGF)水平,治疗3个月后评估2组患者的西医疗效,记录2组治疗期间恶心、呕吐、皮疹及口干等不良反应发生情况。结果治疗后3个月,2组中医主症评分均较治疗前下降,且观察组低于对照组(P<0.05);与对照组比较,2组TN患者治疗3个月后结节数目减少、结节最大直径和结节体积均降低,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后3个月,观察组TSH低于对照组,FT 3、FT 4高于对照组(P<0.05);治疗3个月后,观察组VEGF、RI、PI低于对照组(P<0.05);观察组西医疗效和中医证候疗效中的临床痊愈和总有效率均高于对照组,差异有统计学意义(P<0.05);比较观察组与对照组不良反应发生率比较,差异无统计学意义(P>0.05)。结论扶正化浊汤治疗TN疗效显著,可有效减轻患者症状,减小结节数目及大小,调节甲状腺功能,改善血流状况,降低VEGF表达,且安全性高。

彩色多普勒超声联合甲状腺功能检测在桥本甲状腺炎诊断中的应用

目的探讨彩色多普勒超声联合甲状腺功能检测在桥本甲状腺炎(HT)诊断中的应用价值。方法回顾性分析2021年1月至2022年1月于贵州航天医院就诊的126例疑似HT患者的临床资料,患者均进行彩色多普勒超声检查、甲状腺功能指标[甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TgAb)]检测,以临床或病理诊断为金标准,比较彩色多普勒超声、甲状腺功能指标及联合检查HT的诊断效能,采用Kappa检验评估各检查方法与金标准的一致性,评估其诊断效能。结果126例疑似HT的患者经临床或病理检查,最终确诊110例。110例HT患者的TPOAb水平为(303.46±74.43)IU/ml,TgAb水平为(39.06±10.12)%。彩色多普勒超声检查诊断HT的灵敏度为88.18%、特异度为87.50%、准确度为88.10%,与金标准一致性Kappa值为0.585;TPOAb检查诊断HT的灵敏度为74.55%、特异度为81.25%、准确度为75.40%,与金标准一致性Kappa值为0.335;TgAb检查诊断HT的灵敏度为75.45%、特异度为87.50%、准确度为76.98%,与金标准一致性Kappa值为0.378;联合诊断HT的灵敏度为98.18%、特异度为87.50%、准确度为96.83%,与金标准一致性Kappa值为0.857,以上各种方法诊断HT的效能:联合检查诊断灵敏度、准确度及阴性预测值高于其他3种诊断方式(P<0.05)。结论与单一彩色多普勒超声或甲状腺功能检查比较,彩色多普勒超声联合甲状腺功能检测诊断效能更高,有助于临床医师鉴别诊断,改善患者预后。