ObjectiveTo investigate the association between serum thyroid hormone levels and prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) without thyroid disease, and explore the prognostic value of serum thyroid hormone levels for patients with AECOPD.MethodsThe clinical data of 239 hospitalized cases of AECOPD [149 males, 90 females, aged 42-92 (77.7±8.9) years] from January 2013 to November 2017 were retrospectively analyzed. Serum thyroid hormone levels including total tetraiodothyronin (TT4), total triiodothyronin (TT3), thyroid stimulating hormone (TSH), free tetraiodothyronin (FT4) and free triiodothyronin (FT3) were measured by chemiluminescence immunoassay. All patients were divided into a survival group and a death group according to the prognosis. Serum thyroid hormone levels were compared between two groups. Correlations of serum thyroid hormone levels with the occurrence of death in AECOPD patients were analyzed. The prognostic value of serum thyroid hormone levels for AECOPD patients was explored by receiveroperating characteristic (ROC) curve analysis. And the best cut-off value of serum thyroid hormone level in predicting the risk of death was calculated.ResultsSerum TT4, TT3, FT4 and FT3 levels in the survival group were significantly higher than those in the death group [TT4: (89.35±21.45) nmol/L vs. (76.84±21.33) nmol/L; TT3: (1.05±0.34) nmol/L vs. (0.72±0.19) nmol/L; FT4: (16.17±2.91) pmol/L vs. (14.45±2.85) pmol/L; FT3: (3.06±0.81) pmol/L vs. (2.24±0.72) pmol/L; all P<0.05]. The differences of serum TSH level between two groups were not statistically significant [0.98 (0.54-1.83)vs. 0.57 (0.31-1.84), P>0.05]. Spearman correlation analysis showed that serum TT4, TT3, FT4 and FT3 levels were significant correlated with the occurrence of death (r values were 0.226, 0.417, 0.220, 0.387, respectively, P<0.05). And there was no significant correlation between serum TSH level and the occurrence of death (P>0.05). ROC curve analysis was done between serum thyroid hormone levels (TT4, TT3, TSH, FT4 and FT3) and the occurrence of death in the AECOPD patients. The areas under ROC curve were 0.659, 0.793, 0.588, 0.655 and 0.772, respectively. Serum TT3 was the best indicator for predicting the occurrence of death. When serum TT3 level was 0.85nmol/L, the Youden index was the highest (0.486), with a sensitivity of 70.2%, and a specificity of 78.3%. It was the best cut-offl value of serum TT3 to predict the risk of death in AECOPD patients.ConculsionsSerum thyroid hormone levels are significant associated with the prognostic for AECOPD patients. There is certain value of serum thyroid hormone levels in prognostic evaluation of AECOPD patients.
Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
To study the relationship between the level of serum thyrotropin receptor antibody (TRAb) and the severity of Crave′s disease. From August, 1996 to June, 1998, 156 outpatients with Crave′s disease were followed up. The level of serum TRAb were measured by radio-receptor-analysis (RRA). Results: ①The level of serum TRAb rose in 90.1% of the untreated group; ②The level of serum TRAb restored to normal after the antithyroid drugs were used and the thyroxine level in serum returned to normal; ③In recurrent patients with the treatment of131I, drugs or operation, the serum TRAb level increased. Conclusion: The level of serum TRAb has great significance in the diagnosis, treatment and follow up of the Crave′s disease.
ObjectiveTo systematically review the efficacy and safety of recombinant human TSH (rhTSH) in radioiodine therapy for benign thyroid goiter. MethodsWe electronically searched MEDLINE, EBSCO, The Cochrane Library (Issue 6, 2015) and CNKI databases from January 1990 to March 2015, to identify randomized controlled trials (RCTs) about rhTSH in radioiodine therapy of benign thyroid goiter. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 6 RCTs were included. The results of meta-analysis showed that: compared with the control group, the thyroid volume was significantly reduced at 1 year after radiation in the rhTSH group (MD=0.14, 95%CI 0.05 to 0.23, P=0.002). There were no significant differences in FT4, FT3 and the percentage of patients who had thyroid antibody between two groups before and after radiation. In addition, rhTSH did not significantly increase the incidence of hyperthyroidism and neck pain. ConclusionrhTSH is effective and safe in radioiodine therapy of benign thyroid goiter. Due to the limitation of quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the progress of diagnosis and treatment for differentiated thyroid carcinoma （DTC） in pregnancy. Methods The literatures on studying the diagnosis and treatment of DTC in pregnancy were reviewed and analyzed retrospectively. Results Radionuclide scanning and radioiodine （131I） administration during pregnancy were contraindicated. Surgery during the second trimester was considered safe. Monitoring of pregnancy must be strict during each trimester if surgery was delayed until after delivery. Conclusions Pregnancy makes the diagnosis and treatment of DTC become more complicated，the diagnosis and treatment of DTC during pregnancy present a challenging situation for the endocrinologists，surgeon，and obstetrician.
ObjectiveTo observe the transthyretin (TTR) gene mutation, protein and mRNA expression in patients with familial vitreous amyloidosis. MethodsSubjects were divided into three groups: (1) illness group: seven patients with familial vitreous amyloidosis. (2) No-illness group: 9 unaffected family members. (3) Control group: 9 healthy individuals in same area. Subjects' peripheral venous blood were collected and DNA were extracted, 4 exons of TTR gene were amplified by reverse transcription polymerase chain reaction(RT-PCR), the gene fragments were sequencing by the fluorescence labelling method. Serum TTR protein expression was detected by Western blot, and TTR mRNA in leukocyte was assayed by RT-PCR. Results4 exons of TTR gene of all samples were amplified, and DNA sequencing data showed that 7 patients and 3 subjects DNA from unaffected family members had mutated in the 3rd exon of 107th base, changing from G to C. Heterozygous mutation occurred in codon of the 83th amino acid in exon 3, namely, Gly83Arg, resulted in the change of GGC to CGC. The protein and mRNA expression of TTR was lower in illness group than no-illness group and control groups(P < 0.05). Compared with control group, TTR mRNA expression in unaffected family members groups was significant decreased(P < 0.05). ConclusionHeterozygous mutation occurred in codon of the 83th amino acid in exon 3, namely Gly83Arg, and suggested that Gly83Arg is connected with the change of TTR mRNA and protein expression.
目的 探讨颅内动脉瘤破裂后，患者血清促肾上腺皮质激素、甲状腺激素水平的变化情况。 方法 监测2010年3月－6月共51例动脉瘤患者术前、术后2～3、4～5 d促肾上腺皮质激素（ACTH）、甲状腺激素水平的变化情况，并对监测结果进行统计学处理。 结果 ACTH、促甲状腺激素、甲状腺素、血清游离甲状腺素在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05），三碘甲状腺原氨酸（T3）、血清游离三碘甲状腺原氨酸（FT3）在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）；不同部位动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05）；Fisher、Hunt分级不同级别的动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）。 结论 动脉瘤破裂患者的血清T3、FT3的变化水平情况，可以作为判断患者病情的轻重与预后的一项重要指标。
ObjectiveTo observe changing trend of thyroid hormones levels for postoperative patients with differentiated thyroid carcinoma,and to discuss the best therapeutic timing of thyrotropin (TSH) suppression. MethodsNinety-six patients with differentiated thyroid carcinoma from January 2011 to December 2013 in this hospital were selected.All of these 96 cases were divided into total thyroidectomy group (n=50) and thyroid lobectomy and isthmectomy group (n=46) according to the surgical approach.Serum thyroid hormones levels (T3,FT3,T4,FT4,and TSH) were detected on day 1,2,4,5,7,14 after operation. Results① In the total thyroidectomy group,the levels of T3 and FT3 elevated transiently on day 5,then decreased gradually,and which were lower than the low limit of normal range on day 14.The levels of T4 and FT4 elevated transiently,then reached the peak on day 2,and which started to decrease gradually and reached the low limit of normal range on day 14.The value of serum TSH decreased transiently,which started to increase rapidly on day 2 and surpassed the high limit of normal range on day 4,then continued to rise until on day 14.② In the lobectomy and isthmectomy group,the values of T3 and FT3 decreased gradually,then started to rise on day 5,and which were lower than preoperative values until on day 14.The values of T4 and FT4 elevated transiently and which reached the peak on day 2,and then gradually decreased,which appeared to be lower than preoperative values on day 14.The value of TSH decreased transiently,and which started to rise on day 4,then elevated gradually and exceeded preoperative level on day 7,which reached the high limit of normal range on day 14. ConclusionsThere are dynamic changes of thyroid hormones in postoperative patients with differentiated thyroid carcinoma.It is feasible to determine the best therapeutic timing of TSH suppression according to the levels of postoperative thyroid hormones.The best timing of thyrotropin suppression therapy is that TSH is above the high limit of normal range after operation.