Vitamin D,selenium,and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis

BACKGROUND Diabetes and thyroiditis are closely related.They occur in combination and cause significant damage to the body.There is no clear treatment for type-2 diabetes mellitus(T2DM)with Hashimoto's thyroiditis(HT).While single symptomatic drug treatment of the two diseases is less effective,combined drug treatment may improve efficacy.AIM To investigate the effect of a combination of vitamin D,selenium,and hypoglycemic agents in T2DM with HT.METHODS This retrospective study included 150 patients with T2DM and HT treated at The Central Hospital of Shaoyang from March 2020 to February 2023.Fifty patients were assigned to the control group,test group A,and test group B according to different treatment methods.The control group received low-iodine diet guidance and hypoglycemic drug treatment.Test group A received the control treatment plus vitamin D treatment.Test group B received the group A treatment plus selenium.Blood levels of markers of thyroid function[free T3(FT3),thyroid stimulating hormone(TSH),free T4(FT4)],autoantibodies[thyroid peroxidase antibody(TPOAB)and thyroid globulin antibody(TGAB)],blood lipid index[low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triacylglycerol(TG)],blood glucose index[fasting blood glucose(FBG),and hemoglobin A1c(HbA1c)]were measured pre-treatment and 3 and 6 months after treatment.The relationships between serum 25-hydroxyvitamin D3[25(OH)D3]level and each of these indices were analyzed.RESULTS The levels of 25(OH)D3,FT3,FT4,and LDL-C increased in the order of the control group,test group A,and test group B(all P<0.05).The TPOAB,TGAB,TC,TG,FBG,HbA1c,and TSH levels increased in the order of test groups B,A,and the control group(all P<0.05).All the above indices were compared after 3 and 6 months of treatment.Pre-treatment,there was no divergence in serum 25(OH)D3 level,thyroid function-related indexes,autoantibodies level,blood glucose,and blood lipid index between the control group,test groups A and B(all P>0.05).The 25(OH)D3 levels in test groups A and B were negatively correlated with FT4 and TGAB(all P<0.05).CONCLUSION The combination drug treatment for T2DM with HT significantly improved thyroid function,autoantibody,and blood glucose and lipid levels.

Presence of thyroid-associated ophthalmopathy in Hashimoto's thyroiditis

·AIM: To determine the prevalence of ophthalmopathy in Hashimoto’s patients and to make a comparison in subgroups of patients·METHODS: The study involved 110 Hashimoto’s thyroiditis patients and 50 control subjects attending to the endocrinology department of the hospital. Subgroup classification of patients was made as euthyroid,subclinic and clinic in Hashimato’s thyroiditis. All patients were evaluated by a single experienced ophthalmologist for the prevalence and characteristics of eye signs.·RESULTS:Theoverallprevalencesofeyechanges were22.7%(25 patients) in patients and 4%(2 persons) in control subjects respectively(P =0.002). In patients the most common symptom was retrobulbar eye pain with or without any eye movement. Thirteen patients had significant upper eyelid retraction(11.8%). Six patients had eye muscle dysfunction as reduced eye movements in up gaze. In control patients one person had proptosis and another had lid retraction. The clinical activity score and classification of the ophthalmopathy did not show any significant differences among subgroups.·CONCLUSION:Theeyesignsweremostlymild(22.7%)and the most common eye sign was the presence of upper eyelid retraction(11.8%). Additionally six patients had eye muscle dysfunction as reduced eye movements in up gaze. Therefore we recommend to make a routine ophthalmic examination in Hashimoto’s thyroiditis patients in order not to omit the associated ophthalmopathy.

Diagnostic value of traditional Chinese medical dialectical classification in hashimoto's thyroiditis complicated with suspicious nodules

Objective:To explore the diagnostic value of traditional Chinese medical(TCM)dialectical classification in Hashimoto's thyroiditis complicated with suspicious nodules.Methods:The clinical data of patients with Hashimoto's thyroiditis complicated with thyroid nodules in the Department of Breast and thyroid surgery of Weifang Hospital of traditional Chinese Medicine from January 2018 to December 2019 were collected.The patients were examined by 2 or more experienced TCM doctors,and the four diagnostic data were obtained,and then the relevant syndrome types of the patients were judged according to the data.According to the color Doppler ultrasonographic features of thyroid nodules,the patients who met the indication of fine needle aspiration biopsy of thyroid nodules were selected and underwent fine needle aspiration biopsy of thyroid nodules before operation.To analyze the clinical diagnostic value of that the ultrasonic mode used in this study and thyroid cytopathology Bethesda report system combine dialectical classification of traditional Chinese medicine in Hashimoto's thyroiditis complicated with suspected thyroid nodules.Result:A total of 89 patients with Hashimoto's thyroiditis complicated with thyroid nodules were collected.according to the ultrasonic mode,the difference between different modes was statistically significant(P<0.05).The mode of color ultrasound is also related to the dialectical classification of traditional Chinese medicine.The patients with high malignant risk score are mainly qi depression and phlegm stagnation,phlegm and blood stasis,while those with low score are exuberant liver fire and heart liver yin deficiency.According to the study of different The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC)classification,the dialectical classification of patients with higher TBSRTC classification was more inclined to qi depression and phlegm stagnation,phlegm and blood stasis,and there was significant difference between different classification(P<0.05).Conclusion:Qi depression and phlegm obstruction,phlegm and blood stasis have high ultrasound malignant risk score and high TBSRTC classification grade in patients with Hashimoto's thyroiditis complicated with suspected thyroid nodules,which has important clinical diagnostic value.

Reference Interval of Thyroidal Function of Women in the Early,Middle and Late Pregnancy in Jingzhou City,Hubei Province

[Objectives]To study the reference value of thyroid function in healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)in Jingzhou City.[Methods]362 healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)were selected as the study group,and 360 non-pregnant women were selected as the control group.Serum thyroid hormone levels in the two groups were detected,and the reference value was expressed as the median(M)and 95%confidence interval(CI).On this basis,the chart of changing trend of thyroid hormone in the early,middle and late pregnancy were plotted.[Results]Compared with the control group,FT3,TT4,TT3,FT4and TSH in the early,middle and late pregnancy were significantly different in the study group(P<0.05).In the study group,there were significant differences in the early,middle and late pregnancy(P<0.05).[Conclusions]This trend chart has certain reference value in the screening,diagnosis and treatment of thyroid diseases in healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)in Jingzhou City of Hubei Province.

Doctor Song Fuyin's Experience in Treating Hashimoto's Thyroiditis Based on Qi,Blood Essence and Spirit Syndrome Differentiation Stage Classification

The paper systematically summarizes the experience of Director Song Fuyin in treating Hashimoto's thyroiditis which is a typical emotional disease that causes obvious changes in organ morphology and endocrine and body fluid metabolism.It belongs to the category of psychosomatic diseases,and is the embodiment of a series of pathogenesis processes of qi disease,blood disease,essence disease and deformation in TCM theory.The whole course of the disease is dominated by the dialectical relationship of mutual influence,mutual control,mutual root and mutual use among the deity disease,qi disease,blood disease,essence and spiritual disease.Therefore,the treatment emphasizes the dialectical relationship based on qi,blood,essence and spirit.At the beginning,the treatment focuses on regulating qi and clearing heat and eliminating phlegm;at the middle stage,the treatment focuses on replenishing essence and promoting yang and eliminating wind and calming the deity;at the late stage,the treatment focuses on replenishing qi and eliminating phlegm and promoting collages.Flexible use of calming the spirits,regulating qi,dispersing essence,eliminating phlegm,promoting blood and other methods of stage classification treatment,can be targeted,improve the cure rate of the disease.This article aims to clarify the experience of Director Song Fuyin in treating Hashimoto's thyroiditis based on syndrome differentiation of qi,blood essence and spirit.

Histopathological Patterns and Early Postoperative Complications among Patients with Surgically Treated Thyroid Diseases at Bugando Medical Centre, Mwanza, Tanzania

Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. Histopathological patterns of surgically treated thyroid diseases play an important role in early diagnosis and management of these diseases. There is, however, limited published data regarding histopathological reports on thyroid disease in our local setting. This study aimed to determine the histopathological patterns and highlight early postoperative complications among patients with surgically treated thyroid diseases at Bugando Medical Centre (BMC). Methods: This was a longitudinal study involving all patients with surgically treated thyroid diseases seen at BMC over a period of 6 months from October 2019 to March 2020. Results: A total of 84 patients were studied. Females outnumbered males by a female to male ratio of 11:1. The median age of patients was 44 [IQR, 35 - 54] years old, the youngest was 14 years old and the oldest was 76 years old. Colloid goiter was the most common non-neoplastic lesion accounting for 34 (44.7%) patients. Among the neoplastic lesions, follicular adenoma was the most commonly encountered benign pathologies (n = 16;21.1%), while papillary carcinoma was the most commonly encountered malignancy (n = 4;50%). Following thyroidectomy, 12 (14.3%) patients developed early complications, of which hemorrhage sometimes requiring blood transfusion was the leading intra/postoperative complications accounting for 4 (33.3%) patients. Other complications include temporary recurrent laryngeal nerve palsy 2 (16.7%), surgical site infection 2 (16.7%) and tracheomalacia, bronchospasm, thyroid abscess and respiratory obstruction in 1 (8.3%) patient each, respectively. In this study, malignant thyroid lesion (p Conclusion: This study demonstrated that colloid goiter was the most common non-neoplastic lesion, and on the neoplastic category, follicular adenoma was the most common benign lesion, while papillary carcinoma was the most frequent malignant lesion.

Early warning study of color doppler ultrasound in children with thyroid nodules and thyroid cancer

Objective: To study the diagnostic value of color doppler ultrasound in children with thyroid nodules and thyroid cancer. Methods: A total of sixty children with thyroid nodules treated in our hospital from March 2017 to March 2018 were selected for study. All patients underwent color Doppler ultrasound diagnosis. According to the diagnostic data, benign thyroid nodules and thyroid cancer were analyzed. The nodule nature was grouped into benign nodules group and malignant nodules group. The aspect ratio and boundary of the two groups were compared in blurring, calcification, blood flow signal classification, etc. Results: A total of 95 nodules were diagnosed by color doppler ultrasonography in 60 cases of thyroid nodules. 49 cases were benign nodules. There were 80 nodules, accounting for 82.11%, 11 cases of thyroid cancer, and 15 nodules. Accounted for 15.79%. Biopsy puncture pathology confirmed 77 benign nodules and 18 malignant nodules. The pathological results were gold standard. The specificity of color Doppler ultrasound was 90%, the sensitivity was 66.67%, and the accuracy of ultrasound diagnosis was 86.32%.The two nodules were statistically significant in terms of boundary, aspect ratio, calcification, echo, and resistance index (P<0.05), but the end-diastolic blood flow velocity (EDV) and peak systolic blood flow velocity ( There was no statistical difference between the PSV levels (P>0.05).Conclusion: Color Doppler ultrasound has the advantages of simple operation, high accuracy, non-invasive and painless, and reproducible detection. The high-frequency probe can clearly display changes such as minute lesions, blood flow signals, echoes, calcifications, etc., and can diagnose thyroid cancer in time. It provides a favorable basis for clinical treatment and has important clinical warning value, especially for children with thyroid examination.

孕早期孕妇促甲状腺激素、甲状腺过氧化物酶抗体及微小RNA-873-5p水平与妊娠期糖尿病相关性研究

目的:分析研究孕早期促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)及微小RNA-873-5p(miR-873-5p)水平与妊娠期糖尿病(GDM)的相关性。方法:选取定期产检的GDM孕妇命名为GDM组(n=109),另选同期在本院产检的糖耐量正常孕妇为对照组(n=60)。收集两组孕妇的一般资料及孕早期实验室检测指标(TSH、TPOAb、miR-873-5p),采用单因素、多因素分析TSH、TPOAb、miR-873-5p水平与GDM的关系;并绘制ROC曲线分析血清TSH、TPOAb、miR-873-5p水平对GDM的预测价值。结果:GDM组的血清TSH、TPOAb、miR-873-5p水平均高于对照组,差异具有统计学意义(均P<0.05);多因素Logistic回归分析显示,年龄>30岁(OR=1.982)、孕前BMI≥24 kg/m^(2)(OR=2.020)、TSH升高(OR=2.113)、TPOAb升高(OR=2.307)及miR-873-5p水平升高(OR=2.059)是发生GDM的独立危险因素(均P<0.05);ROC曲线分析显示,血清TSH、TPOAb、miR-873-5p及联合检测的曲线下面积(AUC)分别为0.830、0.829、0.762、0.936,联合检测优于单一检测(P<0.05)。结论:TSH、TPOAb及miR-873-5p在GDM孕妇体内呈高表达,可能成为GDM发生的辅助预测指标。

妊娠早、中期妇女尿碘/尿肌酐比值与亚临床甲状腺功能减退症合并自身抗体阳性的相关性

目的:探讨妊娠早、中期妇女尿碘/尿肌酐比值(UIC/UCr)与亚临床甲状腺功能减退症(SCH)合并自身抗体阳性的相关性。方法:回顾性选取2018年1月—2021年6月贵阳市第一人民医院进行孕检的妊娠早、中期SCH孕妇作为研究对象,依据甲状腺自身抗体检测结果,将其分为:妊娠早、中期甲状腺抗体阳性组;妊娠早、中期甲状腺抗体阴性组;另选取同时期进行检查的妊娠早、中期健康孕妇作为对照组,每组各100例,共计300例,观察甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、UIC/UCr、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)等指标。结果:妊娠早期三组孕妇一般临床资料比较,差异无统计学意义(P>0.05),妊娠中期三组孕妇收缩压(SBP)、舒张压(DBP)比较,差异有统计学意义(F=7.024、11.357,P<0.05);UIC/UCr分析显示,与其他组别比较,妊娠早、中期阳性组孕妇均值和百分位分布数值最低;甲状腺激素及抗体水平比较,除FT3和FT4外,妊娠早、中期阳性组孕妇UIC/UCr、TPOAb、TgAb和TSH水平与健康组和阴性组比较,差异有统计学意义(F=71.710、279.102、130.017、275.949、22.991、220.702、288.882、184.459,P<0.001);相关性分析结果显示,UIC/UCr与TSH、TgAb、TPOAb水平呈负相关;多元线性回归分析结果发现,UIC/UCr、TSH是TPOAb、TgAb的主要影响因素。结论:妊娠早、中期SCH合并自身抗体阳性孕妇,UIC/UCr显著偏低且与TPOAb、TgAb关系密切,建议在临床中加强UIC/UCr指标观察。

非自杀性自伤的内分泌免疫研究进展

非自杀性自伤(NSSI)多发生在青少年和成年早期,与情绪相关疾病发生率增高及发展至难治性等相关,是自杀的重要危险因素。NSSI人群其内分泌和免疫发生一些变化,探讨NSSI发生的内分泌免疫机制,可能有助于NSSI早期预防与干预。本文从下丘脑-垂体-肾上腺轴(HPA轴)、下丘脑-垂体-甲状腺轴(HPT轴)、下丘脑-垂体-性腺轴(HPG轴)及免疫炎症与NSSI发生的相关研究进展作一综述。

甲状腺激素水平检测在妊娠早期的临床价值

目的 探讨甲状腺激素水平检测在妊娠早期的临床价值,为临床早期干预及改善妊娠结局提供参考依据。方法 选取本院进行健康产检的40例妊娠早期孕妇为试验组,同期健康体检的40例非妊娠育龄期女性为对照组,两组均接受甲状腺激素水平检测,并对其检测结果进行比较。结果 试验组促甲状腺素水平低于对照组,三碘甲状腺原氨酸、甲状腺素、游离三碘甲腺原氨酸水平高于对照组(P<0.05)。与甲状腺功能正常组相比,甲状腺功能亢进组三碘甲状腺原氨酸、甲状腺素、游离三碘甲腺原氨酸、游离甲状腺素水平升高,促甲状腺素水平降低;甲状腺功能减退组三碘甲状腺原氨酸、甲状腺素、游离三碘甲腺原氨酸、游离甲状腺素水平降低,促甲状腺素水平升高(P<0.05)。甲状腺功能减退组不良妊娠结局发生率高于甲状腺功能正常组、甲状腺功能亢进组(P<0.05)。结论 对妊娠早期孕妇实施甲状腺激素水平检测,能够实现对孕妇甲状腺功能的监测,辅助临床对甲状腺异常疾病进行判断,对预防孕妇不良妊娠结局具有重要积极影响。

妊娠早期血清25-(OH)D、铁蛋白水平与甲状腺功能的相关性

目的测定妊娠早期血清25-羟基维生素D[25-(OH)D]、铁蛋白(SF)水平与甲状腺功能的相关性。方法选取进行常规产前检查的161例妊娠早期妇女为研究对象,按照25-(OH)D水平分为缺乏组、不足组和充足组;按照SF水平分为铁缺乏组和铁正常组。比较各组甲状腺功能指标血清促甲状腺激素(TSH)、游离甲状腺素(FT 4)、甲状腺过氧化物酶抗体(TPO-Ab)水平,并分析25-(OH)D、SF水平与甲状腺功能指标的相关性。结果25-(OH)D充足组较不足组和缺乏组血清TPO-Ab水平降低,不足组较缺乏组降低(P<0.05)。铁正常组血清TSH水平低于铁缺乏组,FT 4水平高于铁缺乏组(P<0.05)。Pearson相关性分析显示,血清25-(OH)D水平与TPO-Ab呈负相关(r=-0.524,P=0.024);SF水平与TSH水平呈负相关(r=-0.613,P=0.025),与FT 4水平呈正相关(r=0.762,P=0.012)。结论妊娠早期血清TPO-Ab水平与维生素D缺乏相关,TSH、FT 4与铁元素缺乏相关,甲状腺功能指标检测有助于评估孕妇维生素D及铁储存量,对临床有重要意义。

孕早期甲状腺功能异常与妊娠期糖尿病的关系研究

目的 探讨孕早期甲状腺功能异常与妊娠期糖尿病(GDM)的关系。方法 100例孕早期孕妇,根据是否发生GDM分成GDM组(n=24)与非GDM组(n=76),对所有孕妇进行甲状腺功能检测,并收集所有孕妇一般资料调查问卷,包括年龄、体质量指数(BMI)、孕次、产次、甲状腺功能指标[甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、FT_(3)/FT_(4)]。比较两组孕妇一般资料,分析GDM发生的影响因素以及甲状腺功能对GDM的预测价值。结果 与非GDM组的(21.84±2.15)kg/m^(2)、43.42%、(3.24±0.62)IU/ml、(2.18±0.59)mU/L、(4.57±0.69)pmol/L、(0.28±0.05)比较,GDM组的BMI(22.94±2.37)kg/m^(2)、TgAb阳性率66.67%、TPOAb(4.39±0.75)IU/ml、TSH(3.36±0.71)mU/L、FT_(3)(5.19±0.76)pmol/L、FT_(3)/FT_(4)(0.33±0.07)水平更高(P<0.05)。以单因素分析差异有统计学意义的因素作为自变量,以GDM作为因变量,分别进行0与1赋值。建立多因素Logistic回归模型,发现TPOAb(OR=3.725)、TSH(OR=2.965)、FT_(3)/FT_(4)(OR=4.137)是GDM发生的独立影响因素(P<0.05)。绘制受试者工作特征曲线(ROC曲线)显示,TPOAb、TSH、FT_(3)/FT_(4)的曲线下面积分别为0.698、0.709、0.759。结论 GDM的发生受到孕早期甲状腺功能异常的影响,TPOAb、TSH、FT_(3)/FT_(4)是其独立影响因素,对GDM有较高的预测价值。

左甲状腺素钠片对早期先兆流产合并亚临床甲减患者甲状腺功能及妊娠结局的影响

目的:深入探究左甲状腺素钠片在改善早期先兆流产合并亚临床甲减患者的甲状腺功能指标上的效果,并进一步分析其对妊娠结局的潜在影响。方法:选取在2020年5月—2023年2月聊城市妇幼保健院收治的552例早期先兆流产合并亚临床甲减患者作为研究样本,通过随机数字表法将患者分为对照组(n=276)和观察组(n=276)。对照组予以甲状腺片治疗,观察组予以左甲状腺素钠片治疗。比较两组治疗前及治疗1个月后甲状腺功能[游离甲状腺素(FT_(4))、甲状腺过氧化物酶抗体(TPOAb)及促甲状腺激素(TSH)]、激素水平[β-人绒毛膜促性腺激素(β-hCG)、雌二醇(E_(2))、孕酮(P)]及妊娠结局[流产、早产、产后出血、胎膜早破、胎儿宫内窘迫、低体重儿、胎儿畸形、剖宫产、自然分娩]。结果:治疗前,两组甲状腺功能及激素水平比较,差异均无统计学无意义(P>0.05)。治疗1个月后,两组FT_(4)水平比较,差异无统计学意义(P>0.05);TPOAb及TSH水平均相较对照组有所降低,β-hCG、E_(2)、P水平相较对照组均有所提升,差异均有统计学意义(P<0.05)。观察组流产、早产、产后出血、胎膜早破、胎儿宫内窘迫、低体重儿、胎儿畸形不良妊娠结局相对于对照组均明显偏低;剖宫产相对于对照组明显偏低,自然分娩更高,差异均有统计学意义(P<0.05)。结论:对早期先兆流产合并亚临床甲减患者给予左甲状腺素钠片治疗,能够有效改善其甲状腺功能及激素水平,降低不良妊娠结局的出现,提升自然分娩率。

双指数导向干预联合5A早期康复护理在甲状腺癌手术患者中的应用

目的探讨在甲状腺癌手术患者中应用双指数导向干预联合5A早期康复护理的效果。方法选取该院2018年7月—2023年6月行手术治疗的80例甲状腺癌患者为研究对象,采用随机数字表法将其分为对照组和干预组。对照组(n=40)采用常规护理,干预组(n=40)采用双指数导向干预联合5A早期康复护理。比较两组的嗓音障碍程度、咽喉反流症状程度、自我护理能力。结果干预后,干预组嗓音障碍指数评分为(12.48±3.45)分,低于对照组的(15.52±4.07)分,差异有统计学意义(P<0.05)。干预组咽喉反流症状指数评分为(8.13±2.31)分,低于对照组的(12.36±3.28)分,差异有统计学意义(P<0.05)。干预组自我护理能力量表评分高于对照组,差异有统计学意义(P<0.05)。结论双指数导向干预联合5A早期康复护理应用于甲状腺癌手术患者干预中,能够改善患者嗓音障碍程度、咽喉反流症状程度,提高自我护理能力。

早期积极心理干预对DTC患者负性情绪和癌因性疲乏的影响

目的 探讨在分化型甲状腺癌(DTC)患者的治疗中,采用早期积极心理进行干预,对患者负性情绪和癌因性疲乏的影响。方法 抽取2021年6月—2023年1月平煤神马医疗集团总医院收治的160例DTC癌患者,随机分为对照组(常规护理)和研究组(常规护理+早期积极心理干预),每组各80例,评估患者干预前后的心理状态、癌因性疲乏、生活质量、护理工作满意度。结果 护理干预1~4周后,两组患者汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分均降低,并且研究组患者评分更低(P<0.05);干预后,两组患者的癌因性疲乏评分均升高,但是研究组患者的以上指标升高幅度小于对照组(P<0.05);此外,两组患者的护士观察量表(NOSIE)评分均明显改善,并且研究组变化幅度大于对照组(P<0.05);研究组患者的护理满意度高于对照组(95.00%vs 82.50%,P<0.05)。结论 对DTC患者开展早期积极心理干预,能够帮助患者改善负性情绪,减轻癌因性疲乏,提高患者的生活质量和护理满意度。

孕早期妇女甲状腺功能筛查结果观察分析

目的:分析孕早期妇女甲状腺功能筛查结果。方法:选取2018年1月—2021年1月于清镇市第一人民医院接受甲状腺功能筛查的孕早期妇女800例作为研究对象,均接受甲状腺功能筛查,分析其检查结果,并针对甲状腺功能减退孕妇进行随访干预,每年选入50例甲状腺功能筛查结果为正常的孕早期妇女作为对照组,共计200例。比较甲状腺功能减退孕妇和正常孕妇的甲状腺功能筛查结果,并观察其妊娠结局。结果:在800例孕早期妇女中,150例存在甲状腺功能减退,占比为18.75%(150/800)。甲状腺功能减退组孕妇促甲状腺激素高于对照组,三碘甲状腺原氨酸、甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺激素低于对照组,差异有统计学意义(P<0.05)。接受治疗组甲状腺功能减退孕妇不良妊娠结局发生率低于未接受治疗组,差异有统计学意义(P<0.05)。结论:对孕早期妇女实施甲状腺功能筛查的临床价值突出,能够及时发现甲状腺功能异常情况并进行治疗,有助于降低不良妊娠结局发生率。

妊娠早期合并亚临床甲状腺功能减退妇女自身抗体阳性对不良妊娠结局的影响

目的:观察妊娠早期合并亚临床甲状腺功能减退(SCH)孕妇甲状腺过氧化物酶抗体(TPOAb)阳性对不良妊娠结局的影响。方法:回顾性分析2011年6月至2013年1月在广东省妇幼保健院行妊娠早期促甲状腺激素(TSH)、血清游离甲状腺素(FT_4)、总甲状腺素(TT_4)、TPOAb筛查,并且有妊娠结局的孕妇共13973例。根据检查结果把孕妇分为甲状腺功能正常(N)+TPOAb(-)组、N+TPOAb(+)组、SCH+TPOAb(-)组和SCH+TPOAb(+)组。比较4组孕妇妊娠结局及产科并发症发生情况并进行统计学分析。结果:在13973例孕妇中,N+TPOAb(-)组10179例(72.85%),N+TPOAb(+)组628例(4.49%),SCH+TPOAb(-)组347例(2.48%),SCH+TPOAb(+)组574例(4.11%)。SCH+TPOAb(+)组孕妇流产93例(16.3%)、妊娠期糖尿病133例(23.2%)、早产99例(17.2%),其发生率均高于SCH+TPOAb(-)组,分别为42例(12.1%)、59例(17.0%)、39例(11.2%);高于N+TPOAb(+)组,分别为70例(11.1%)、98例(15.6%)、51例(8.1%)和N+TPOAb(-)组,分别为835例(8.2%)、1033例(10.1%)、794例(7.8%),差异均有统计学意义(P<0.05)。SCH+TPOAb(+)组孕妇胎儿生长受限、胎盘早剥、前置胎盘、足月胎膜早破、出生低体质量儿、巨大儿、新生儿窒息、羊水过多、羊水过少发生率与SCH+TPOAb(-)组、N+TPOAb(+)组和N+TPOAb(-)组比较,差异无统计学意义(P>0.05)。结论:妊娠早期合并SCH且TPOAb(+)可增加流产、早产、妊娠期糖尿病的发生率,建议广泛开展妊娠早期甲状腺功能和TPOAb筛查,早期诊断、早期干预,减低不良妊娠结局风险。

妊娠早期孕妇血清碘和铁水平与甲状腺功能及甲状腺自身抗体的关系

目的:探讨妊娠早期孕妇血清碘和铁水平与甲状腺功能及甲状腺过氧化物酶抗体(TPOAb)之间的关系,为指导妊娠早期个体化补碘补铁提供科学依据。方法:选取来本院初次产检建卡的单胎妊娠孕妇共404名,收集孕妇一般资料并检测血清中血清铁蛋白(SF)、血红蛋白(Hb)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、TPOAb和尿肌酐(UCr)水平及尿碘浓度(UIC)。孕妇根据不同碘营养水平分为碘缺乏组(UIC/UCr<150μg·g^(-1))、碘充足组(150μg·g^(-1)≤UIC/UCr<250μg·g^(-1))和碘超足量/碘过量组(UIC/UCr≥250μg·g^(-1)),根据不同铁营养水平分为铁缺乏组(SF<20μg·L^(-1))、铁充足组(20μg·L^(-1)≤SF≤150μg·L^(-1))和铁过量组(SF>150μg·L^(-1)),分别比较各组孕妇的甲状腺功能和血清TPOAb阳性率以及亚临床甲状腺功能减退(甲减)和亚临床甲状腺功能亢进(甲亢)的患病率。结果:404名孕妇血清中TSH水平中位数(四分位数)1.15 mIU·L^(-1)(0.62 mIU·L^(-1),1.63 mIU·L^(-1)),FT4水平中位数(四分位数)12.96 pmol·L^(-1)(12.06 pmol·L^(-1),13.96 pmol·L^(-1)),UIC/UCr和SF水平中位数(四分位数)分别为158.66μg·g^(-1)(106.93μg·g^(-1),239.41μg·g^(-1))和60.93μg·L^(-1)(33.86μg·L^(-1),89.61μg·L^(-1))。碘缺乏组和碘超足量/碘过量组孕妇血清中TSH水平明显高于碘充足组(P<0.05),碘超足量/碘过量组孕妇TPOAb阳性率高于碘缺乏组和碘充足组(P<0.05),3组孕妇血清中FT4水平比较差异无统计学意义(P>0.05);铁缺乏组孕妇血清中TSH水平和TPOAb阳性率高于铁充足组和铁过量组(P<0.05),铁缺乏组孕妇血清中FT4水平低于铁过量组(P<0.05)。碘缺乏组和碘超足量/碘过量组孕妇亚临床甲减患病率高于碘充足组(P<0.05);铁缺乏组孕妇亚临床甲减患病率高于铁充足组和铁过量组(P<0.05),铁过量组孕妇亚临床甲亢患病率高于铁缺乏组和铁充足组(P<0.05)。相关性分析,孕妇UIC/UCr比值与TSH和FT4水平无相关性(P>0.05);SF水平与TSH水平呈负相关关系(r=-0.148,P<0.05),SF水平与FT4水平呈正相关关系(r=0.150,P<0.05)。结论:妊娠早期孕妇碘和铁营养水平与甲状腺功能及甲状腺自身免疫有关,应及时评估妊娠早期孕妇碘和铁的营养状况,个体化补碘补铁,同时应避免碘和铁过量。

鱼类甲状腺轴对胚胎发育、仔鱼变态及性别分化的调控作用研究进展

鱼类甲状腺轴由下丘脑、垂体、甲状腺组成,下丘脑通过分泌促甲状腺激素释放激素、促肾上腺皮质激素释放激素调节垂体促甲状腺激素的合成和分泌,促甲状腺激素促进甲状腺滤泡合成并释放甲状腺激素(主要为甲状腺素—T4),T4运输至肝脏等外周组织中,经过脱碘转化形成生物活性更强的三碘甲腺原氨酸(T3),T3主要通过同核受体结合发挥生物学功能。甲状腺激素对鱼类胚胎发育、仔鱼变态及性别分化等早期生长发育过程具有重要调控作用:甲状腺激素为鱼类胚胎发育期所必须,外加适量甲状腺激素能够提高胚胎或仔鱼存活率;仔鱼变态过程中,某些外部形态变化及相关组织分化依赖甲状腺激素的调控,牙鲆等仔鱼变态期体内甲状腺激素水平及其受体表达量会显著升高;性腺发育期,甲状腺激素对调控鱼类性别分化方向可能具有一定作用。