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.

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.

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.

A STUDY ON THE CLINICAL EFFECT AND IMMUNOLOGICAL MECHANISM IN THE TREATMENT OF HASHIMOTO'S THYROIDITIS BY MOXIBUSTION

71 cases of Hashimoto’s thyroiditis were treated by moxibustion and their immune functionand thyroid function were observed.It was found that moxibustion was able to reduce thethyroid amibodies in the peripheral blood of the patients with hypothyroidism and to recovertheir thyroid function.It was also found that moxibustion could lower the thyroid antibodysecretory levels and ADCC(antibody-dependent cell mediated cytotoxicity)activities ofthe lymphocytes,in addition,the action of moxibustion in reducing the secretion of thyroidantibodies was related to its action of regulating the proportions of T lymphocyte subsets.The results indicate that the treatment of Hashimoto’s thyroiditis by moxihustion is probably accomplished through its effect in regulating the relationship among the T lymphocytesubsets.

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.

Prevalence of hypothyroidism and effect of thyroid hormone replacement therapy in patients with non-alcoholic fatty liver disease:A population-based study

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is currently considered as the most common cause of chronic liver disease worldwide.Risk factors for NAFLD have been well-described,including obesity,type 2 diabetes mellites(T2DM),dyslipidemia(DLP)and metabolic syndrome.Hypothyroidism has been identified as an independent risk factor for the development of NAFLD,although the literature is inconsistent AIM To evaluate the prevalence of hypothyroidism in patients with NAFLD,assess if it is an independent risk factor and explore the effect of thyroxine replacement therapy.METHODS Our cohort’s data was obtained using a validated,large,multicenter database(Explorys Inc,Cleveland,OH,United States)aggregated from pooled outpatient and inpatient records of 26 different healthcare systems,consisting of a total of 360 hospitals in the United States,and utilizing Systematized Nomenclature of Medicine-Clinical Terms for coding.We evaluated a cohort of patients with hypothyroidism and NAFLD.Multivariate analysis was performed to adjust for confounding risk factors including hypertension(HTN),T2DM,DLP,obesity and metabolic syndrome.SPSS version 25,IBM Corp was used for statistical analysis,and for all analyses,a 2-sided P value of<0.05 was considered statistically significant.Exclusion criteria were limited to age<18 years.RESULTS Among the 37648180 included individuals in this database who are above the age of 18 years,there were a total of 2320 patients with NAFLD(6.16 per 100000)in the last five years(2015-2020),amongst which 520 patients(22.4%)had hypothyroidism.Baseline characteristics of patients in this database are described in Table 1.Patients with NAFLD were also more likely to have obesity,T2DM,DLP,HTN,and metabolic syndrome(Table 2).While males and females were equally affected,patients in the age group 18-65 years as well as Caucasians seem to be at a higher risk.There was an increased risk of NAFLD among patients with hypothyroidism(OR=1.587).Furthermore,thyroid hormone replacement was not associated with a decreased risk for developing NAFLD(OR=1.106,C=0.952-1.285,P=0.303).CONCLUSION Hypothyroidism seems to be an independent risk factor for the development of NAFLD.Thyroid hormone replacement did not provide a statistically significant risk reduction.Further studies are needed to evaluate the effect of thyroid hormone replacement and assess if being euthyroid while on thyroid replacement therapy affects development and/or progression of NAFLD.

Is nitric oxide level affected in postmenopausal women with hypothyroidism?

AIMTo analyze serum levels of nitric oxide （NO）, an indicator of cardiovascular health, in post-menopausal females with and without hypothyroidism. METHODSNO was analyzed colorimetrically in 30 newly diag-nosed hypothyroid postmenopausal females and 30 postmenopausal females with normal thyroid profle. Results were compared and subjected to appropriate statistical analysis. RESULTSThe levels of serum NO were found to be significantlydecreased in postmenopausal females with hypothyroidismas compared to the levels in those with normal thyroidprofile （P value 〈 0.05）. A negative correlation of NOwas observed with thyroid stimulating hormone whereasa positive correlation of NO was observed with free T3 （FT3）, free T4 （FT4）, T3 and T4 though it was statistically signifcant only for FT4 among postmenopausal females with hypothyroidism.CONCLUSIONPostmenopausal hypothyroid females may be at a risk of compromised cardiovascular health as indicated by low NO levels. Regular monitoring and risk assessment is essential for timely intervention.

Correlation of Cognitive Performance and Thyroid Hormone Levels in Adolescents with Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) can negatively affect cognitive functioning. This study aimed at correlating serum T3, T4, TSH with adolescent’s performance on a learning disability scale. Methods: A cross-sectional study was conducted on 100 schoolchildren, (10 - 15 years). Thyroid hormones were estimated and classified into two groups: euthyroid and subclinical hypothyroid. NIMHANS index for Specific Learning Disabilities was used to assess the learning ability and cognitive functions. Results: Subclinical hypothyroid group made more mistakes than euthyroid group. In SCH male group, T3 correlated with language and T4 levels correlated in all areas except in language. In the females, there is no significant correlation between T3 and ability parameters except in partial correlation coeffeicient among euthyroid children in arithmetic, visual-motor skills and memory. T4 results did not correlate in language skills. There was a statistical significance between T4 and ability skills in girls except in language. TSH and language skills correlated in females. Conclusion: T3 and T4 levels have correlation with cognitive skills other than TSH. It is necessary to measure both T3 and T4 in addition to TSH in adolescents.

Short-term overt hypothyroidism affect on lipids after thyroxine-withdrawal in patients with differentiated thyroid carcinoma

Objective: The aim of the study was to investigate the effects of short-term overt hypothyroidism on lipids after thyroxine-withdrawal in patients with iatrogenically induced hypothyroidism before radioiodine treatment for differentiated thyroid carcinoma (DTC). Methods: Thirty patients with a history of differentiated thyroid carcinoma on thyroid-stimulating hormone (TSH)-suppressive thyroxine replacement therapy were studied. Blood sample were taken before and 4 weeks after withdrawal of thyroxine substitution. Venous blood was drawn after an overnight fast and analyzed for serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB). Fifty healthy people matched for age and gender were controls. Their blood samples were taken only once. Results: After thyroxine-withdrawal, the patients presented with increased serum TSH and low serum FT4 and FT3 levels compared with controls. Serum TG, TC, LDL, HDL, ApoB and Lp(a) increased after thyroxine withdrawal, reaching statistical significant differences with previous evaluation. However, when compared to euthyroid controls, only TC, LDL and ApoB were increased when patients were hypothyroidism. No changes were observed in ApoA1 in patients during thyroxine withdrawal, or when comparing the values observed in patients to those of euthyroid controls. Conclusion: TG, TC, LDL, HDL, ApoB and Lp(a) were increased during short-term overt hypothyroidism.

Unilateral Periorbital Oedema with Hypothyroidism and Multinodular Goiter

Thyroid associated ophthalmopathy is an autoimmune disorder which involves orbital and periorbital tissue. The immune-mediated inflammation of the orbital tissues can involve extraocular muscles, orbital connective tissue or orbital fat and periocular soft tissues. Bilateral involvement of thyroid associated orbitopathy is usually asymmetric, but unilateral thyroid associated orbitopathy has been less reported. Periorbital oedema as the only sign with hypothyroidism is uncommon and if present, it is more frequent bilaterally present and no cases are evidenced as unilateral. Pitting oedema in hypothyroidism is rare and can be due to increased capillary permeability, decreased adrenergic tone and increase in serotonin metabolism. Unilateral periorbital and eyelid oedema can associate with various clinical entities, multidisciplinary team is necessary to exclude the concomitant disease, so the patient can immediately be treated with proper therapy. We represent the case of unusually unilateral recurrent periorbital oedema in the period of time for 3 years with stabilized primary hypothyroidism and multinodular goitre.

左甲状腺素钠治疗对妊娠合并甲状腺功能减退患者甲状腺功能指标及母婴结局的影响

目的探讨左甲状腺素钠治疗妊娠合并甲状腺功能减退患者的效果。方法378例妊娠合并甲状腺功能减退患者随机分为两组,对照组采用甲状腺片治疗,观察组采用左甲状腺素钠治疗,对比两组的临床疗效。结果治疗后,观察组的FT_(4)、FT_(3)水平均高于对照组,TSH水平、不良母婴结局发生率均低于对照组(P<0.05)。两组的不良反应发生率对比,差异无统计学意义(P>0.05)。结论左甲状腺素钠治疗妊娠合并甲状腺功能减退患者可有效改善其甲状腺功能与母婴结局。

甲状腺功能检测联合TG-Ab、TPO-Ab水平检查对亚临床甲减患者的诊断效果

目的分析甲状腺功能检测联合抗甲状腺球蛋白抗体(TG-Ab)、甲状腺过氧化物酶抗体(TPO-Ab)水平检查对亚临床甲减患者的诊断效果。方法选取2021年10月至2023年10月我院收治的100例疑似亚临床甲减患者为观察组,再选取同期到院进行常规体检的100名健康志愿者为对照组。所有研究对象入院后均进行甲状腺功能与TG-Ab、TPO-Ab水平检测,对比分析两种检查单独与联合应用时的诊断效能。结果两组的游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)水平比较,差异无统计学意义(P>0.05);观察组的促甲状腺激素(TSH)、TG-Ab、TPO-Ab水平高于对照组,差异具有统计学意义(P<0.05)。TSH、FT3、FT4和TG-Ab、TPO-Ab联合检测对亚临床甲减的诊断准确度、灵敏度高于单独检测(P<0.05)。结论甲状腺功能联合TG-Ab、TPO-Ab检测诊断亚临床甲减可取得较高的诊断效能。

新生儿足跟血TSH初筛阳性的危险因素研究

目的探讨新生儿足跟血促甲状腺激素(TSH)初筛阳性的危险因素。方法选取2020年5月至2022年5月于该院分娩的562例新生儿为研究对象。其中TSH阳性患儿纳入TSH阳性组,TSH阴性患儿纳入健康组。比较两组一般资料(包括性别、胎龄、分娩时间、出生体质量)及母体临床特征[有无妊娠期贫血、血红蛋白水平、有无妊娠期糖尿病、空腹血糖(FBG)水平、有无甲状腺功能减退、有无甲状腺功能亢进和TSH水平、游离三碘甲状腺原氨酸(FT_(3))水平、游离甲状腺素(FT_(4))水平]。采取非条件Logistic逐步回归分析新生儿足跟血TSH初筛阳性的危险因素。绘制受试者工作特征(ROC)曲线分析母体TSH、FT_(3)、FT_(4)对新生儿足跟血TSH初筛阳性的诊断效能。结果TSH初筛结果显示,足跟血TSH初筛阳性共17例(TSH阳性组),另选100例足跟血TSH初筛阴性新生儿为健康组。两组性别、胎龄、分娩时间、母体妊娠期贫血比例、母体血红蛋白水平、母体妊娠期糖尿病比例、母体FBG水平、母体甲状腺功能亢进症比例比较,差异均无统计学意义(P>0.05)。TSH阳性组低体质量新生儿比例、母体甲状腺功能减退比例、母体TSH水平显著高于健康组,母体FT_(3)、母体FT_(4)水平显著低于健康组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,出生低体质量、母体甲状腺功能减退、母体TSH水平升高、母体FT_(3)水平降低、母体FT_(4)水平降低是新生儿足跟血TSH初筛阳性的危险因素(P<0.05)。ROC曲线结果显示,母体TSH、FT_(3)、FT_(4)诊断新生儿足跟血TSH初筛阳性的曲线下面积分别为0.713、0.718、0.661。结论出生低体质量、母体甲状腺功能减退、母体TSH水平升高、母体FT_(3)水平降低、母体FT_(4)水平降低是新生儿足跟血TSH初筛阳性的危险因素,在筛查时需给予更多关注。

疾病状态早产儿血清FT_(3)、FT_(4)、TSH水平变化及其与疾病转归的关系

目的 探讨疾病状态早产儿血清游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺激素(FT_(4))、促甲状腺激素(TSH)水平变化及其与疾病转归的关系。方法 选择2019年1月至2020年2月郑州市第一人民医院新生儿病房的258例疾病状态早产儿作为研究对象,纳入疾病组;另择同期收治的85例未合并疾病的早产儿纳入对照组。采用危重病例评分(NCIS)评估疾病组严重程度,于出生后T_(1)(7~10 d)、T_(2)(14~17 d)时间点测定血清FT_(3),FT_(4)、TSH水平,统计短暂性低甲状腺素血症(TH)及低T_(3)综合征比率,随访观察预后情况。结果 疾病组T_(1)、T_(2)时间点FT_(3)、FT_(4)水平低于对照组,TSH高于对照组(P<0.05);疾病组新生儿TH、低T_(3)综合征比率高于对照组(P<0.05)。危重组新生儿出生后T_(1)、T_(2)时间点FT_(3)、FT_(4)水平低于非危重组(P<0.05)。危重组新生儿TH、低T_(3)综合征比率高于非危重组(P<0.05)。所有患病早产儿均进行预后随访及统计,预后不佳组新生儿出生后T_(1)、T_(2)时间点FT_(3)、FT_(4)低于预后良好组,新生儿TH、低T_(3)综合征比率高于预后良好组(P<0.05)。单因素及多因素分析示,胎龄、出生体重、出生1 min Apgar评分、出生5 min Apgar评分、严重程度、低T_(3)综合征及TH发生是预后不佳的独立危险因素(P<0.05)。结论 疾病状态早产儿甲状腺素水平变化与疾病严重程度相关,TH及低T_(3)综合征可能与早产儿不良预后相关。

参芪扶正汤治疗桥本氏甲状腺炎合并甲状腺功能减退临床疗效及相关机制研究

[目的]探讨参芪扶正汤治疗桥本氏甲状腺炎(HT)合并甲状腺功能减退的临床疗效,初步分析其治疗机制。[方法]选择秦皇岛市中医医院2020年1月—2023年1月收治的HT患者110例,按照随机数字表法分为观察组和对照组,每组55例,两组均口服左甲状腺素钠片,在此基础上,对照组口服亚硒酸钠片,观察组口服中药参芪扶正汤,疗程12周。比较两组治疗前后中医证候评分、甲状腺体积和峡部厚度、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb),长链非编码RNA人母系表达基因3(lncRNA MEG3)、微小RNA-17(miR-17)、辅助性T淋巴细胞亚群17(Th17)、调节性T细胞(Treg)含量、Th17/Treg值,并比较两组治疗总有效率。[结果]治疗后观察组中医证候评分低于对照组(P<0.05),甲状腺体积和峡部厚度均低于对照组(P<0.05);血清FT3、FT4水平高于对照组(P<0.05),TSH、TGAb、TPOAb水平低于对照组(P<0.05);观察组Th17、Th17/Treg、miR-17低于对照组(P<0.05),Treg、lncRNA MEG3高于对照组(P<0.05);治疗总有效率高于对照组(P<0.05)。[结论]参芪扶正汤可以改善中医证候和甲状腺功能,调节甲状腺自身抗体,减小甲状腺体积,治疗HT合并甲状腺功能减退效果显著,其机制可能与调节血清lncRNA MEG3、miR-17有关。

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。

脂代谢异常人群亚临床甲状腺功能减退患病率及相关因素研究

目的探讨脂代谢异常人群亚临床甲状腺功能减退(SCH)患病率及相关因素。方法选择梧州市红十字会医院2018年1月至2022年12月收入的3650例脂代谢异常人群,分析SCH患病率,对SHC患者和非SCH患者的临床资料进行对比,将有差异项目带入Logistic回归方程计算,分析其对脂代谢异常人群患SCH的影响。结果脂代谢异常人群中SCH患者962例,患病率26.36%;对SCH患者及非SCH患者一般资料进行单因素Logistic回归分析发现性别、身体质量指数(BMI)、甘油三酯(TG)、舒张压(DP)、抗甲状腺球蛋白抗体(TgAb)、收缩压(SP)、年龄、空腹血浆葡萄糖(FBG)、低密度脂蛋白(LDL-C)、负荷后2 h血糖(2hPG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、谷草转氨酶(AST)、血钙、血磷、血尿酸(UA)、抗甲状腺过氧化物酶抗体(TPOAb)在两组中差异有统计学意义(P<0.05);不同种类脂代谢异常以高TG血症居多,差异有统计学意义(P<0.05),而脂代谢异常人群SCH患病率混合高脂血症最高,差异有统计学意义(P<0.05);将以上对比有差异的影响因素进行多因素Logistic回归分析发现性别、年龄、SP、TC、FBG、2hPG均为影响脂代谢异常人群患SCH的独立因素。结论脂代谢异常与SCH疾病发生之间有紧密联系,患病情况在女性、高龄患者中更突出,血脂可能在一定程度上影响甲状腺激素的分泌,最终引发SCH,因此临床需重视相关因素并进行防治。

亚临床甲状腺功能减退与糖尿病视网膜病变相关性分析

目的探讨亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)与糖尿病视网膜病变(diabetic retinopathy,DR)的相关性。方法选取2019年1月至2022年3月笔者医院内分泌科收治的2型糖尿病(type 2 diabetes mellitus,T2DM)患者481例,根据患有DR的情况分为无DR组(n=327)、非严重DR组(n=92)和严重DR组(n=62)。比较各组临床资料,Spearman相关分析DR严重程度与其他指标的相关性。Logistic回归分析DR以及严重DR的影响因素。结果非严重DR组促甲状腺激素(Thyroid stimulating hormone,TSH)高于无DR组(P<0.05),游离甲状腺素(free thyroxine,FT_(4))低于无DR组(P<0.05)。严重DR组收缩压、舒张压、血肌酐(serum creatinine,Scr)均高于无DR组(P<0.05),游离三碘甲状腺原氨酸(free triiodothyronine,FT_(3))、FT_(4)均低于无DR组(P<0.05)。Spearman相关分析显示,DR严重程度与收缩压、舒张压、糖尿病病程、低密度脂蛋白胆固醇、Scr、TSH呈正相关(r=0.213、0.142、0.251、0.100、0.159、0.110,P<0.05),与FT_(3)、FT_(4)呈负相关(r=–0.103、–0.133,P<0.05)。Logistic回归分析显示,收缩压、糖尿病病程≥10年、低密度脂蛋白胆固醇、Scr、TSH>4.2mIU/L、FT_(4)是DR的影响因素。收缩压、Scr、TSH>4.2mIU/L是严重DR的影响因素。结论SCH是DR和严重DR的危险因素。

温阳健脾法联合维生素D调节免疫失衡治疗桥本甲减的研究

目的观察温阳健脾法联合维生素D调节免疫失衡,治疗桥本甲状腺炎(HT)合并甲减的疗效。同时通过检测HT甲减期患者治疗前后Th17和Treg细胞表达的百分率,以评估临床疗效。方法选取收治的住院及门诊病人64例作为研究对象,随机分为对照组和实验组各32例,对照组给予维生素D,试验组给予复方甲减平合剂+维生素D,疗程为8周,比较2组患者的中医证候疗效,血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPO-AB)、甲状腺球蛋白抗体(TGAb)、Th17和Treg细胞表达的百分率及甲状腺体积变化。结果治疗前后中医证候积分改善情况试验组明显优于对照组(P<0.05);2组患者在治疗后FT3、FT4、TSH水平及甲状腺体积对比疗效相当(P>0.05)。2组患者治疗前后甲状腺抗体指标比较,试验组的疗效优于对照组(P<0.05)。结论温阳健脾法联合维生素D治疗桥本甲减安全性较高,不良反应少,值得在临床中广泛应用。

甲功五项与TPOAb、TGAb联合诊断甲状腺功能减退的临床价值

目的探究甲功五项联合甲状腺过氧化物酶自身抗体(TPOAb)及抗甲状腺球蛋白抗体(TGAb)诊断甲状腺功能减退(简称甲减)的临床价值。方法将2022年10月至2023年10月在甘肃省天水市第一人民医院进行检查的108例甲减患者纳入研究组,于同期随机挑选108例健康体检人员作为对照组。两组均进行甲功五项、TPOAb、TGAb检测,分析甲功五项与TPOAb、TGAb联合检验诊断甲减的临床效能。结果与对照组比,研究组血清三碘甲状腺原氨酸(T_(3))、四碘甲腺原氨酸(T_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离四碘甲腺原氨酸(FT_(4))水平更低,促甲状腺激素(TSH)、TPOAb、TGAb水平更高,P<0.05;甲功五项与TPOAb、TGAb联合检验诊断甲减的灵敏度、特异度、准确率均高于单一指标检验,P<0.05。结论甲功五项与TPOAb、TGAb联合检验可提高甲减诊断准确率,为后续治疗提供参考。