目的 探讨青少年原发性甲状腺功能亢进（甲亢）手术治疗的可行性。方法 本组76例甲亢患者手术麻醉以颈丛神经阻滞加强化为主； 手术方式为甲状腺大部分切除术，切除腺体组织约80%～90%，残留腺体总量约6～8 g。结果 无手术死亡及甲亢危象病例，术后10例（13.2%）发生并发症11例次，经保守治疗后症状消失。术后得到随访（1～15年）的51例患者中有6例于术后5～8年出现甲亢复发，无术后甲状腺功能低下病例。结论 手术治疗青少年甲亢具有快速安全、疗效持久、费用较低、患者愿意接受的特点，临床上是可行的。
目的 探讨儿童甲状腺功能亢进症的治疗措施及临床效果。 方法 对入选的200例儿童甲状腺功能亢进症患儿给予甲巯咪唑0.5~1.0 mg/(kg•d)、盐酸普萘洛尔0.3 mg/(kg•d)治疗，2~4个月待患儿甲状腺功能基本恢复正常后，将患儿随机分为对照组(n=100)及研究组(n=100)。对照组只给予甲巯咪唑治疗，研究组则继续给予甲巯咪唑并联合左甲状腺素钠治疗。比较治疗前和治疗后6个月、1年及2年患儿甲状腺体积，FT4、FT3和TSH水平，观察治疗后2年不良反应发生情况。 结果 与对照组比较，治疗6个月后研究组甲状腺体积明显降低(Plt;0.05)，药物性甲状腺功能减退症发生率低(Plt;0.05)，不良反应少。 结论 两种治疗措施均能有效改善儿童甲状腺功能亢进症的高代谢症候群，使FT3、FT4及TSH水平恢复正常，甲状腺体积明显降低，但甲巯咪唑联合左甲状腺素钠治疗能更安全有效地控制甲状腺肿大及药物继发性甲状腺功能减退症，并能减少症状复发。
目的 探讨甲状腺功能亢进症(甲亢)围手术期T3、T4水平的变化及其临床意义。方法 检测30例甲亢患者服碘及心得安作术前准备前(a)、术日晨(b)、术中(c)、术后第1天(d)及术后第5天(e)各时相点T3、T4水平。结果 全组患者均未发生甲状腺危象，T3、T4水平a＞b＞c＞d＞e，其中a、b、c高于正常值，d、e值在正常范围。结论 经术前准备，甲亢患者符合临床手术条件时，血T3、T4仍然高于正常水平； 手术未造成甲状腺激素大量释放； 术后12及36小时时段甲状腺危象高发期T3、T4水平不高。
ObjectiveTo systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020. Two reviewers independently screened literature, extracted data, and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 11 studies involving 620 874 subjects and 19 781 cases were included. Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.20, 95%CI 0.92 to 1.57, P=0.18) and subclinical hyperthyroidism could increase the risk of atrial fibrillation (adjusted RR=1.65, 95%CI 1.12 to 2.43, P=0.01). Subgroup analysis showed that for the community population, subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.03, 95%CI 0.84 to 1.26, P=0.81); for cardiac surgery, subclinical hypothyroidism could increase the risk of atrial fibrillation (adjusted RR=2.80, 95%CI 1.51 to 5.19, P=0.001); subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L (adjusted RR=2.06, 95%CI 1.07 to 3.99, P=0.03) and TSH=0.1～0.44 mlU/L (adjusted RR=1.29, 95%CI 1.01 to 1.64, P=0.04). ConclusionsSubclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation. Due to limited quantity and quality of included studies, more high quality studies are needed to verify above conclusions.
目的探讨甲状腺功能亢进（简称甲亢）手术后出现骨饥饿综合征的发病机理。方法回顾性分析四川大学华西医院2009年收治的2例甲亢手术后严重低钙患者的临床资料。结果本组2例病例在甲亢手术后均出现了严重低钙血症，1例低镁血症; 2例病例手术前、后骨代谢碱性磷酸酶均有不同程度升高。结论甲亢手术后骨饥饿综合征是多因素造成的临床症状，所以对手术后低钙症状应给予正确分析和判断，并尽可能在问题出现前给予预测和处理。对于甲亢患者和绝经期女性在围手术期给予钙的补充，手术中注意保存甲状旁腺血供是减少骨饥饿综合征的最佳手段，甲亢手术后及时补钙是必要的。
Objective To analyze the clinical relationship between primary hyperthyroidism and thyroid carcinoma, and diagnosis and treatment for the combination of the two. Methods The clinical data of 15 patients with primary hyperthyroidism complicated with thyroid carcinoma from January 1998 to December 2008 were retrospectively analyzed. Results Fifteen cases were smoothly discharged. The morbidity was 2.56% (15/585) of primary hyperthyroidism complicated with thyroid carcinoma. There were no operative complications. Five cases showed thyroid nodules and all cases were performed thyroidectomy. Neither hyperthyroidism nor thyroid carcinoma recurred during 9 months to 10 years (average 5.5 years) follow-up.Conclusions The diagnosis of primary hyperthyroidism complicated with thyroid carcinoma is still difficult to be made preoperatively and chiefly depend on postoperative pathology. Rational surgical treatment can result in good effectiveness and better prognosis.
Objective To investigate the diagnosis and treatment of pulmonary arterial hypertension ( PAH) due to rare causes. Methods The clinical presentation, laboratory testing, diagnosis and treatment of 4 patients with PAH associated with rare causes in Beijing Anzhen Hospital from January 2001 to March 2008 were analysed retrospectively. Results Primary biliary cirrhosis, hyperthyroidism, antiphospholipid syndrome and pulmonary artery sarcoma may cause PAH, which were improved after corresponding diagnosis and management. Conclusion PAH can result from rare causes. The enhancement of its recognition will help earlier diagnosis and treatment and improve the prognosis.