甲状腺功能减退症转变为甲状腺功能亢进症伴再生障碍性贫血1例分析

1临床资料1.1现病史患者,女,年龄26岁,发现颈部肿块8年以上,心悸、多汗、多食及消瘦3个月,加重1周为主诉于2015年7月1日入院。8年前患者因发现颈部肿块就诊于当地医院,被诊断为桥本甲状腺炎伴甲状腺功能减退症,一直服用优甲乐50μg治疗,此后多次复查甲状腺功能提示T3、FT3、T4、FT4明显低于正常,TSH高于正常,后因颈部肿块消退,未再复查甲状腺功能。

甲状腺功能亢进合并颅内静脉窦血栓的研究进展

颅内静脉血栓形成(cerebral venous thrombosis,CVT)是指由各种病因引起的颅内静脉或静脉窦血栓形成,使血液回流受阻或脑脊液循环障碍,致使颅内高压和局灶脑损害为特征的脑血管病中的一类。如今国内外关于甲状腺功能亢进合并CVT的病例报道及研究日益增多。甲状腺功能亢进与CVT的联系越来越紧密。因此,现就对甲状腺功能亢进合并CVT的发病机制、诊断、治疗及相关研究进展等归纳总结,加深临床医生对甲状腺功能亢进合并CVT的认识。

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultra-sonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of asso-ciated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

ROLE OF ^(99)Tc^m-SESTAMIBI DUAL-PHASE PARATHYROID SCINTIGRAPHY IN PREOPERATIVE LOCALIZATION IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

Objective To evaluate the application of 99Tcm-sestamibi dual-phase parathyroid scintigraphy in the preoperative localization in patients with primary hyperparathyroidism and to compare the diagnostic efficacy of various imaging modalities. Methods Ninety-two consecutive patients, diagnosed as hyperparathyroidism and presented with hypercalcaemia as the predominant symptom, were included. All the patients underwent dual-phase parathyroid scintigraphy using 99Tcm-sestamibi and parathyroid ultrasound scan. Among them, 48 patients underwent parathyroid computed tomography (CT). All patients were referred for parathyroidectomy. Results 99Tcm-sestamibi dual-phase parathyroid scintigraphy revealed the diagnostic sensitivity of 76.5%, 80%, 75% and 33.3% for the subgroup of single adenomas, multiple adenomas, ectopic parathyroid and parathyroid hyperplasia respectively. The specificity was 100% for all leisons. 99Tcm-sestamibi dual-phase parathyroid scintigraphy was proved to be superior to the other imaging modalities (ultrasound and CT) in terms of the preoperative diagnostic accuracy. The lesion weight was found to be an underlying factor leading to the false negative result. Conclusion 99Tcm-sestamibi dual-phase parathyroid scintigraphy was found to have higher diagnostic accuracy in comparison with other imaging modalities and is recommended preoperatively in order to reduce the sugery time and unnecessary neck exploration.

Vitamin D receptor and PCNA expression in severe parathyroid hyperplasia of uremic patients

Objective To clarify the role of vitamin D receptor (VDR) expression in parathyroid proliferation and resistance of parathyroid glands to 1,25(OH) 2D 3 with secondary hyperparathyroidism (SHPT) Methods This study used archive parathyroid with 7 uremic patients The expression of proliferation cell nuclear antigen (PCNA) and VDR was evaluated in nineteen surgically excised parathyroid tissues, including 11 diffuse hyperplasia (DH type) and 8 nodular hyperplasia (NH type) of parathyroid glands, by immunohistochemistry (avidin biotin complex method) Results The weight of parathyroid in SHPT was remarkably increased by 16 1 times The numbers of parathyroid cells were increased by 1 86 times The rate of PCNA was remarkably increased in parathyroid hyperplasia with SHPT compared with that in control group [(6 35±3 36)‰ vs (1 73±1 31)‰, P <0 001] The number of PCNA in DH type was lower than that in NH type ( P <0 001) The density of VDR in the parathyroid with SHPT was significantly decreased [(40 28±13 13)% vs (83 79±3 77)%, P <0 001], VDR immunoreactivity expression in NH type was lower than that in DH type [(27 14±4 12)% vs (49 84±7 33)%, P <0 001] A significantly negative correlation was found between VDR density and the weight of the parathyroid ( r =-0 46, P <0 05), the same as VDR and PCNA ( r = -0 75, P <0 001) Conclusion VDR density was significantly decreased in parathyroid tissue of uremic patients showing nodular hyperplasia compared with that in diffuse hyperplasia and there was significantly negative correlation between VDR density and the weight of the parathyroid, and this may contribute to the progression of SHPT Furthermore, VDR deficiency may cause the resistance of parathyroid cells to 1, 25(OH) 2D 3, in part

Protirelin(thyrotropin-releasing hormone)in thyroid gland:possible involvement in regulation of thyroid status

AIM:To establish the presence of the hypothalamic hormone protirelin(thyrotropin-releasing hormone,TRH)in human thyroid and to investigate whether the concentration of this peptide in the thyroid gland is sensitive to thyroid status.METHODS:A procedure has been developed for the determination of TRH in the thyroid gland,distinct from TRH-like peptides which also react with TRH-antibody.RESULTS:Human thyroid was shown to contain both authentic TRH and TRH-like peptides,a similar pattern was seen in a range of animal thyroids.The concentrations of TRH in non-active goiter thyroids were substantial(41.6-248 pmol·g-1);in contrast the thyroids from hyperthyroid patients contained very little TRH(0.01-2.52 pmol·g-1).CONCLUSION:The physiologic role of TRH in the thyroid is not known but the large difference between the concentrations of this hormone in non-active and hyperactive thyroids suggests that thyroidal TRH may be involved in the regulation of thyroid status.