Journal of Thyroid Research最新文献_第4页

Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction 在甲状腺功能障碍诊断中解释促甲状腺激素的挑战

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2019-09-22 DOI: 10.1155/2019/4106816

S. Razvi, S. Bhana, Sanaa Mrabeti

The pituitary hormone, thyrotropin (TSH), is regarded as the primary biomarker for evaluating thyroid function and is useful in guiding treatment with levothyroxine for patients with hypothyroidism. The amplified response of TSH to slight changes in thyroid hormone levels provides a large and easily measured signal in the routine care setting. Laboratories provide reference ranges with upper and lower cutoffs for TSH to define normal thyroid function. The upper limit of the range, used to diagnose subclinical (mild) hypothyroidism, is itself a matter for debate, with authoritative guidelines recommending treatment to within the lower half of the range. Concomitant diseases, medications, supplements, age, gender, ethnicity, iodine status, time of day, time of year, autoantibodies, heterophilic antibodies, smoking, and other factors influence the level of TSH, or the performance of current TSH assays. The long-term prognostic implications of small deviations of TSH from the reference range are unclear. Correction of TSH to within the reference range does not always bring thyroid and other biomarkers into range and will not always resolve the patient's symptoms. Overt hypothyroidism requires intervention with levothyroxine. It remains important that physicians managing a patient with symptoms suggestive of thyroid disease consider all of the patient's relevant disease, lifestyle, and other factors before intervening on the basis of a marginally raised TSH level alone. Finally, these limitations of TSH testing mitigate against screening the population for the undoubtedly substantial prevalence of undiagnosed thyroid disease, until appropriately designed randomised trials have quantified the benefits and harms from this approach.

垂体激素促甲状腺素(TSH)被认为是评估甲状腺功能的主要生物标志物，有助于指导甲状腺功能减退患者使用左旋甲状腺素治疗。TSH对甲状腺激素水平轻微变化的放大反应在常规护理设置中提供了一个大而容易测量的信号。实验室提供TSH上下限的参考范围来定义正常的甲状腺功能。用于诊断亚临床(轻度)甲状腺功能减退的范围上限本身就是一个有争议的问题，权威指南建议在范围的下半部分进行治疗。伴随疾病、药物、补品、年龄、性别、种族、碘状态、一天中的时间、一年中的时间、自身抗体、异性恋抗体、吸烟和其他因素影响TSH水平或当前TSH测定的性能。TSH与参考范围的小偏差对长期预后的影响尚不清楚。将TSH校正到参考范围内并不总能使甲状腺和其他生物标志物进入范围，也并不总能解决患者的症状。明显的甲状腺功能减退需要左甲状腺素干预。对于有甲状腺疾病症状的患者，医生在仅根据略微升高的TSH水平进行干预之前，应考虑患者的所有相关疾病、生活方式和其他因素，这一点仍然很重要。最后，在适当设计的随机试验量化该方法的益处和危害之前，TSH检测的这些局限性减轻了对未确诊甲状腺疾病的人群筛查的不利影响。

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引用次数: 47

Study of Vitamin D Level and Vitamin D Receptor Polymorphism in Hypothyroid Egyptian Patients 埃及甲状腺功能减退患者维生素D水平及受体多态性的研究

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2019-08-26 DOI: 10.1155/2019/3583250

Hoda Elrawi, N. Ghanem, Naglaa M Elsayed, H. Ali, L. Rashed, Mai M. Mansour

Purpose The current study aimed at assessing vitamin D level and vitamin D receptor polymorphism in hypothyroid Egyptian patients and its effect on hypothyroidism and thyroid morphology, also to find a causal relation between vitamin D and hypothyroidism. Methods This case-control study was conducted on 35 hypothyroid patients and 35 matched unrelated healthy controls. Total serum 25-hydroxyvitamin D3 and thyroid antibodies were measured using a human ELISA kit. Genotyping was performed by using real-time PCR. HOMA-IR was also calculated (fasting insulin in mIU/L × fasting glucose in mg/dL/405). All subjects were assessed for thyroid morphology by thyroid ultrasonography. Results Vitamin D level was lower in hypothyroid patients than in control subjects. Vitamin D was also inversely related to TSH, HOMA-IR, and levels of anti-TG and anti-TPO. VDR polymorphism (Fok1 and Apa1) had no relation to TSH or vitamin D levels in both patients and control groups. Low vitamin D levels were associated with increased thyroid vascularity and nodularity; furthermore, vitamin D was inversely proportional to thyroid gland volume. Correlation of HOMA-IR with the levels of both anti-TG and anti-TPO in the 70 subjects proved that HOMA-IR was positively correlated to both antibodies. Conclusion This study confirmed the association of vitamin D deficiency with hypothyroidism, thyroid autoimmunity, increased volume, nodularity, and vascularity of thyroid gland in hypothyroid patients as well as increased HOMA-IR. It proved the association between HOMA-IR and thyroid autoimmunity. The study proved no association between VDR polymorphisms (Fok1 and Apa1) with either vitamin D levels or TSH levels.

目的研究埃及甲状腺功能减退患者维生素D水平和维生素D受体多态性及其对甲状腺功能减退和甲状腺形态的影响，探讨维生素D与甲状腺功能减退之间的因果关系。方法对35例甲状腺功能减退患者和35例不相关的健康对照进行病例-对照研究。采用人ELISA试剂盒检测血清总25-羟基维生素D3和甲状腺抗体。采用实时荧光定量PCR进行基因分型。同时计算HOMA-IR(空腹胰岛素(mIU/L) ×空腹血糖(mg/dL/405)。通过甲状腺超声检查评估所有受试者的甲状腺形态。结果甲状腺功能减退患者维生素D水平低于正常对照组。维生素D也与TSH、HOMA-IR、抗tg和抗tpo水平呈负相关。在患者和对照组中，VDR多态性(Fok1和Apa1)与TSH或维生素D水平无关。低维生素D水平与甲状腺血管和结节性增加有关;此外，维生素D与甲状腺体积成反比。HOMA-IR与70例受试者抗tg和抗tpo水平的相关性证明HOMA-IR与两种抗体均呈正相关。结论:本研究证实维生素D缺乏与甲状腺功能减退、甲状腺自身免疫、甲状腺体积、结节性和血管性增加以及HOMA-IR升高有关。证实了HOMA-IR与甲状腺自身免疫之间的关系。研究证明VDR多态性(Fok1和Apa1)与维生素D水平或TSH水平没有关联。

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引用次数: 14

Antithyroid Peroxidase Antibodies in Multinodular Hashimoto's Thyroiditis Indicate a Variant Etiology 多结节性桥本甲状腺炎的抗甲状腺过氧化物酶抗体提示病因变异

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2019-07-21 DOI: 10.1155/2019/4892329

Pabithadevi B. Mehanathan, R. Erusan, K. Shantaraman, S. Kannan

Introduction Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder, which predominantly presents as a diffuse goiter, with few studies which report HT presenting as multinodular goiter, with variable frequencies ranging from 59% to 78.6% especially from south Indian populations. This variant clinical presentation may have diagnostic challenges which require further analysis. Anti-TPO antibodies are more common (90-95%) in Hashimoto's thyroiditis than anti-TG antibodies in Hashimoto's thyroiditis. This study analyzes the clinical features and the correlation of anti-TPO levels with diffuse and multinodular forms of HT. Material and Methods This study was conducted in the Department of General Surgery in a tertiary care hospital in south Tamil Nadu. Patients presenting with clinical features of a thyroid disorder were interviewed and given a detailed clinical, radiological examination and guided FNAC. Those patients diagnosed by FNAC as HT were registered and a sample of 3cc of blood was drawn for T3, T4, TSH, and anti-TPO analysis. All the data were tabulated. Results and Discussion Of the 212 patients who presented with goiters, 96 were diagnosed by FNAC as having a cytological picture suggestive of Hashimoto's thyroiditis. Of these 96 patients with HT, 46 (47.9%) were multinodular (HT-MNG), 14 (14.58%) were solitary nodules (HT-SNT), and the remaining 36 (37.5%) were diffuse goiters (HT-D). Of the 46 patients who are HT-MNG, 36.9% had elevated anti-TPO-Ab (more than 35.0U/l) and 63.1% had normal/lower values (less than 35.0U/l). But of 36 patients with HT-D, 77.7% had elevated anti-TPO-Ab levels (>35U/l). Chi square statistics was 15.8346 and the p value is 0.0005 (<.05). Eight cases of HT-D and 3 cases of HT-MNG had hyperthyroidism and 3 cases of HT-D had hypothyroidism and all other cases were in euthyroid state. Conclusion Patients presenting as multinodular Hashimoto's thyroiditis have low prevalence of elevated anti-TPO-Ab than diffuse HT which suggests that multinodular form of Hashimoto's thyroiditis is a unique clinical entity with etiopathogenesis that is at variance with the diffuse form.

桥本甲状腺炎(Hashimoto’s thyroiditis, HT)是一种常见的自身免疫性甲状腺疾病，主要表现为弥漫性甲状腺肿，很少有研究报道HT表现为多结节性甲状腺肿，发病率从59%到78.6%不等，尤其是在印度南部人群中。这种不同的临床表现可能有诊断挑战，需要进一步分析。抗tpo抗体在桥本甲状腺炎中比抗tg抗体更常见(90-95%)。本研究分析临床特征及抗tpo水平与弥漫性和多结节性HT的相关性。材料和方法本研究在泰米尔纳德邦南部一家三级护理医院的普通外科进行。对有甲状腺疾病临床特征的患者进行访谈，并给予详细的临床、影像学检查和指导下的FNAC。对经FNAC诊断为HT的患者进行登记，抽取3cc血样进行T3、T4、TSH和抗tpo分析。所有的数据都已制成表格。结果和讨论在212例甲状腺肿大的患者中，96例经FNAC诊断为有提示桥本甲状腺炎的细胞学图像。96例HT患者中，多结节性(HT- mng) 46例(47.9%)，单发结节性(HT- snt) 14例(14.58%)，弥漫性甲状腺肿大(HT- d) 36例(37.5%)。在46例HT-MNG患者中，36.9%的患者抗tpo - ab升高(> 35.0U/l)， 63.1%的患者正常/较低(< 35.0U/l)。但在36例HT-D患者中，77.7%的患者抗tpo - ab水平升高(约35U/l)。卡方统计量为15.8346,p值为0.0005(< 0.05)。HT-D组8例、HT-MNG组3例发生甲亢，HT-D组3例发生甲减，其余均处于甲状腺功能正常状态。结论多结节性桥本甲状腺炎患者抗tpo - ab升高的发生率低于弥漫性HT，提示多结节性桥本甲状腺炎是一种独特的临床实体，其发病机制与弥漫性桥本甲状腺炎不同。

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引用次数: 6

Medullary Thyroid Carcinoma: An Update on Imaging 甲状腺髓样癌:影像学进展

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2019-07-07 DOI: 10.1155/2019/1893047

S. Kushchayev, Y. Kushchayeva, S. Tella, Tetiana Glushko, K. Pacak, O. Teytelboym

Medullary thyroid carcinoma (MTC), arising from the parafollicular C cells of the thyroid, accounts for 1–2% of thyroid cancers. MTC is frequently aggressive and metastasizes to cervical and mediastinal lymph nodes, lungs, liver, and bones. Although a number of new imaging modalities for directing the management of oncologic patients evolved over the last two decades, the clinical application of these novel techniques is limited in MTC. In this article, we review the biology and molecular aspects of MTC as an important background for the use of current imaging modalities and approaches for this tumor. We discuss the modern and currently available imaging techniques—advanced magnetic resonance imaging (MRI)-based techniques such as whole-body MRI, dynamic contrast-enhanced (DCE) technique, diffusion-weighted imaging (DWI), positron emission tomography/computed tomography (PET/CT) with 18F-FDOPA and 18F-FDG, and integrated positron emission tomography/magnetic resonance (PET/MR) hybrid imaging—for primary as well as metastatic MTC tumor, including its metastatic spread to lymph nodes and the most common sites of distant metastases: lungs, liver, and bones.

甲状腺髓样癌(MTC)，起源于甲状腺滤泡旁C细胞，占甲状腺癌的1-2%。MTC通常具有侵袭性，可转移至颈部和纵隔淋巴结、肺、肝和骨骼。尽管在过去的二十年中发展了许多新的用于指导肿瘤患者管理的成像方式，但这些新技术在MTC中的临床应用受到限制。在本文中，我们回顾了MTC的生物学和分子方面，作为使用当前成像方式和方法治疗该肿瘤的重要背景。我们讨论了现代和当前可用的成像技术-基于磁共振成像(MRI)的先进技术，如全身MRI，动态对比增强(DCE)技术，弥散加权成像(DWI)，正电子发射断层扫描/ 18F-FDOPA和18F-FDG的计算机断层扫描(PET/CT)，以及集成正电子发射断层扫描/磁共振(PET/MR)混合成像-用于原发性和转移性MTC肿瘤。包括其转移扩散到淋巴结和最常见的远处转移部位:肺、肝和骨。

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引用次数: 41

Treatment Outcomes in Anaplastic Thyroid Cancer. 甲状腺无节细胞癌的治疗结果

IF 1.7 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2019-05-23 eCollection Date: 2019-01-01 DOI: 10.1155/2019/8218949

Kelsey L Corrigan, Hannah Williamson, Danielle Elliott Range, Donna Niedzwiecki, David M Brizel, Yvonne M Mowery

Background: Anaplastic thyroid cancer (ATC) is rare, accounting for 1-2% of thyroid malignancies. Median survival is only 3-10 months, and the optimal therapeutic approach has not been established. This study aimed to evaluate outcomes in ATC based on treatment modality.

Methods: Retrospective review was performed for patients treated at a single institution between 1990 and 2015. Demographic and clinical covariates were extracted from the medical record. Overall survival (OS) was modeled using Kaplan Meier curves for different treatment modalities. Univariate and multivariate analyses were conducted to assess the relationships between treatment and disease characteristics and OS.

Results: 28 patients with ATC were identified (n = 16 female, n = 12 male; n = 22 Caucasian, n = 6 African-American; median age 70.9). Majority presented as Stage IVB (71.4%). Most patients received multimodality therapy. 19 patients underwent local surgical resection. 21 patients received locoregional external beam radiotherapy (EBRT) with a median cumulative dose of 3,000 cGy and median number of fractions of 16. 14 patients received systemic therapy (n = 11 concurrent with EBRT), most commonly doxorubicin (n = 9). 16 patients were never disease free, 11 patients had disease recurrence, and 1 patient had no evidence of disease progression. Median OS was 4 months with 1-year survival of 17.9%. Regression analysis showed that EBRT (HR: 0.174; 95% CI: 0.050-0.613; p=0.007) and surgical resection (HR: 0.198; 95% CI: 0.065-0.598; p=0.004) were associated with improved OS. Administration of chemotherapy was not associated with OS.

Conclusions: Anaplastic thyroid cancer patients receiving EBRT to the thyroid area/neck and/or surgical resection had better OS than patients without these therapies, though selection bias likely contributed to improved outcomes since patients who can undergo these therapies tend to have better performance status. Prognosis remains poor overall, and new therapeutic approaches are needed to improve outcomes.

背景：甲状腺无细胞癌（ATC）非常罕见，占甲状腺恶性肿瘤的1-2%。中位生存期仅为3-10个月，最佳治疗方法尚未确定。本研究旨在根据治疗方式评估ATC的治疗效果：方法：对1990年至2015年间在一家机构接受治疗的患者进行回顾性研究。从病历中提取了人口统计学和临床协变量。采用卡普兰-梅尔曲线对不同治疗方式的总生存期（OS）进行建模。进行了单变量和多变量分析，以评估治疗和疾病特征与OS之间的关系。结果：共发现28例ATC患者（女性16例，男性12例；白种人22例，非裔美国人6例；中位年龄70.9岁）。大多数患者为 IVB 期（71.4%）。大多数患者接受了多模式治疗。19名患者接受了局部手术切除。21 名患者接受了局部体外放射治疗（EBRT），中位累积剂量为 3,000 cGy，中位分次为 16 次。14名患者接受了全身治疗（11人与EBRT同时进行），其中最常见的是多柔比星（9人）。16名患者从未无病，11名患者疾病复发，1名患者无疾病进展迹象。中位生存期为4个月，1年生存率为17.9%。回归分析显示，EBRT（HR：0.174；95% CI：0.050-0.613；P=0.007）和手术切除（HR：0.198；95% CI：0.065-0.598；P=0.004）与OS的改善有关。化疗与OS无关：结论：接受甲状腺区域/颈部EBRT治疗和/或手术切除的甲状腺无节细胞癌患者的OS优于未接受这些治疗的患者，但选择偏倚可能是导致预后改善的原因之一，因为能接受这些治疗的患者往往有更好的表现状态。总体预后仍然不佳，需要新的治疗方法来改善预后。

{"title":"Treatment Outcomes in Anaplastic Thyroid Cancer.","authors":"Kelsey L Corrigan, Hannah Williamson, Danielle Elliott Range, Donna Niedzwiecki, David M Brizel, Yvonne M Mowery","doi":"10.1155/2019/8218949","DOIUrl":"10.1155/2019/8218949","url":null,"abstract":"Background: Anaplastic thyroid cancer (ATC) is rare, accounting for 1-2% of thyroid malignancies. Median survival is only 3-10 months, and the optimal therapeutic approach has not been established. This study aimed to evaluate outcomes in ATC based on treatment modality.Methods: Retrospective review was performed for patients treated at a single institution between 1990 and 2015. Demographic and clinical covariates were extracted from the medical record. Overall survival (OS) was modeled using Kaplan Meier curves for different treatment modalities. Univariate and multivariate analyses were conducted to assess the relationships between treatment and disease characteristics and OS.Results: 28 patients with ATC were identified (n = 16 female, n = 12 male; n = 22 Caucasian, n = 6 African-American; median age 70.9). Majority presented as Stage IVB (71.4%). Most patients received multimodality therapy. 19 patients underwent local surgical resection. 21 patients received locoregional external beam radiotherapy (EBRT) with a median cumulative dose of 3,000 cGy and median number of fractions of 16. 14 patients received systemic therapy (n = 11 concurrent with EBRT), most commonly doxorubicin (n = 9). 16 patients were never disease free, 11 patients had disease recurrence, and 1 patient had no evidence of disease progression. Median OS was 4 months with 1-year survival of 17.9%. Regression analysis showed that EBRT (HR: 0.174; 95% CI: 0.050-0.613; p=0.007) and surgical resection (HR: 0.198; 95% CI: 0.065-0.598; p=0.004) were associated with improved OS. Administration of chemotherapy was not associated with OS.Conclusions: Anaplastic thyroid cancer patients receiving EBRT to the thyroid area/neck and/or surgical resection had better OS than patients without these therapies, though selection bias likely contributed to improved outcomes since patients who can undergo these therapies tend to have better performance status. Prognosis remains poor overall, and new therapeutic approaches are needed to improve outcomes.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2019 ","pages":"8218949"},"PeriodicalIF":1.7,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9121031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thyroid Function in Patients with Type 2 Diabetes Mellitus and Diabetic Nephropathy: A Single Center Study. 2型糖尿病和糖尿病肾病患者的甲状腺功能:一项单中心研究

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2018-12-02 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9507028

Wei Zhao, Xinyu Li, Xuhan Liu, Lu Lu, Zhengnan Gao

Background: Diabetes mellitus is a common metabolic disease and the prevalence is increasing rapidly. Thyroid disorders including subclinical hypothyroidism (SCH) and low triiodothyronine (T3) syndrome are frequently observed in diabetic patients. We conducted a study to explore thyroid function in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN).

Methods: We included 103 healthy volunteers, 100 T2DM patients without DN, and 139 with DN. Physical examinations including body mass index and blood pressure and laboratory measurements including renal function, thyroid function, and glycosylated hemoglobin were conducted.

Results: Patients with DN had higher thyroid stimulating hormone (TSH) levels and lower free T3 (FT3) levels than those without DN (p < 0.01). The prevalence of SCH and low FT3 syndrome in patients with DN was 10.8% and 20.9%, respectively, higher than that of controls and patients without DN (p < 0.05). Through Pearson correlation or Spearman rank correlation analysis, in patients with DN, there were positive correlations in TSH with serum creatinine (r = 0.363, p = 0.013) and urinary albumin-to-creatinine ratio (r = 0.337, p = 0.004), and in FT3 with estimated glomerular filtration rate (eGFR) with statistical significance (r = 0.560, p < 0.001).

Conclusions: High level of TSH and low level of FT3 were observed in T2DM patients with DN. Routine monitoring of thyroid function in patients with DN is necessary, and management of thyroid dysfunction may be a potential therapeutic strategy of DN.

背景:糖尿病是一种常见的代谢性疾病，发病率呈快速上升趋势。甲状腺疾病包括亚临床甲状腺功能减退症(SCH)和低三碘甲状腺原氨酸(T3)综合征在糖尿病患者中经常观察到。我们进行了一项研究，探讨2型糖尿病(T2DM)和糖尿病肾病(DN)患者的甲状腺功能。方法:我们纳入103名健康志愿者，100名无DN的T2DM患者和139名DN患者。体格检查包括体重指数和血压，实验室测量包括肾功能、甲状腺功能和糖化血红蛋白。结果:DN患者促甲状腺激素(TSH)水平高于非DN患者，游离T3 (FT3)水平低于非DN患者(p < 0.01)。DN患者SCH和低FT3综合征患病率分别为10.8%和20.9%，高于对照组和非DN患者(p < 0.05)。通过Pearson相关或Spearman秩相关分析，DN患者TSH与血清肌酐(r = 0.363, p = 0.013)、尿白蛋白/肌酐比(r = 0.337, p = 0.004)呈正相关，FT3与肾小球滤过率(eGFR)估测呈正相关，差异均有统计学意义(r = 0.560, p < 0.001)。结论:T2DM合并DN患者TSH水平高，FT3水平低。常规监测DN患者的甲状腺功能是必要的，甲状腺功能障碍的管理可能是DN的潜在治疗策略。

{"title":"Thyroid Function in Patients with Type 2 Diabetes Mellitus and Diabetic Nephropathy: A Single Center Study.","authors":"Wei Zhao, Xinyu Li, Xuhan Liu, Lu Lu, Zhengnan Gao","doi":"10.1155/2018/9507028","DOIUrl":"https://doi.org/10.1155/2018/9507028","url":null,"abstract":"Background: Diabetes mellitus is a common metabolic disease and the prevalence is increasing rapidly. Thyroid disorders including subclinical hypothyroidism (SCH) and low triiodothyronine (T3) syndrome are frequently observed in diabetic patients. We conducted a study to explore thyroid function in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN).Methods: We included 103 healthy volunteers, 100 T2DM patients without DN, and 139 with DN. Physical examinations including body mass index and blood pressure and laboratory measurements including renal function, thyroid function, and glycosylated hemoglobin were conducted.Results: Patients with DN had higher thyroid stimulating hormone (TSH) levels and lower free T3 (FT3) levels than those without DN (p < 0.01). The prevalence of SCH and low FT3 syndrome in patients with DN was 10.8% and 20.9%, respectively, higher than that of controls and patients without DN (p < 0.05). Through Pearson correlation or Spearman rank correlation analysis, in patients with DN, there were positive correlations in TSH with serum creatinine (r = 0.363, p = 0.013) and urinary albumin-to-creatinine ratio (r = 0.337, p = 0.004), and in FT3 with estimated glomerular filtration rate (eGFR) with statistical significance (r = 0.560, p < 0.001).Conclusions: High level of TSH and low level of FT3 were observed in T2DM patients with DN. Routine monitoring of thyroid function in patients with DN is necessary, and management of thyroid dysfunction may be a potential therapeutic strategy of DN.","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":"2018 ","pages":"9507028"},"PeriodicalIF":2.1,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9507028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36843506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 24

Symptomatic Primary Hyperparathyroidism as a Risk Factor for Differentiated Thyroid Cancer. 有症状的原发性甲状旁腺功能亢进是分化型甲状腺癌症的危险因素。

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2018-11-18 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9461079

Guadalupe Vargas-Ortega, Lourdes Balcázar-Hernández, Baldomero González-Virla, Claudia Ramírez-Rentería, Oriana Nieto-Guzmán, Ana Pamela Garrido-Mendoza, Marco Antonio Flores-Maya, Moisés Mercado, Mendoza-Zubieta Victoria

Background: The primary hyperparathyroidism (PHPT) is a common disease for the endocrinologist. The concomitant thyroid disease and differentiated thyroid cancer (DTC) appear to be more frequent in patients with PHPT than in the general population. The aim of this study was to characterize patients with symptomatic PHPT with and without DTC and analyze frequency and risk factors.

Methods: We consecutively studied patients with symptomatic PHPT diagnosed and treated at our center between 2013 and 2015. Patients with subclinical and syndromic forms of PHPT were excluded. Clinical and biochemical characteristics of patients with and without DTC were compared and risk factors were determined. All patients were studied with thyroid ultrasound and thyroid gammagraphy with TC-MIBI. Two expert surgeons performed all the surgical procedures.

Results: In 59 patients included, we found 12 cases of PTC (20.3%). The final histopathological report of the PTC was 7 cases of follicular variant, 2 cases of oncocytic variant, 2 cases of classic variant, and 1 case of columnar cells variant of PTC. Patients with thyroid cancer were older than patients without thyroid cancer (62 ± 9.5 versus 52 ± 15.8, p = 0.03). Higher preoperative levels of iPTH were associated with PTC (p=0.03) [OR 5.16 (95% CI: 1.08-24.7)].

Conclusion: PTC is frequent in patients with symptomatic PHPT. Thyroid nodules in patients with symptomatic PHPT must be studied before parathyroidectomy. In symptomatic PHPT, higher level concentration of parathormone (PTH) was associated with higher risk of DTC.

背景：原发性甲状旁腺功能亢进症（PHPT）是内分泌学家的常见疾病。伴发甲状腺疾病和分化型甲状腺癌症（DTC）在PHPT患者中似乎比普通人群更常见。本研究的目的是描述伴有和不伴有DTC的症状性PHPT患者的特征，并分析频率和危险因素。方法：我们连续研究了2013年至2015年间在我们中心诊断和治疗的有症状PHPT患者。排除亚临床和综合征型PHPT患者。比较了DTC患者和非DTC患者的临床和生化特征，并确定了危险因素。所有患者均接受甲状腺超声检查和TC-MIBI甲状腺造影检查。两位专业外科医生完成了所有的手术。结果：在纳入的59例患者中，我们发现了12例PTC（20.3%）。PTC的最终组织病理学报告为7例滤泡变异，2例嗜酸细胞变异，2例行变异和1例柱状细胞变异。患有甲状腺癌症的患者比没有患有甲状腺癌症的患者年龄大（62±9.5对52±15.8，p=0.03）。术前较高的iPTH水平与PTC相关（p=0.03）[OR 5.16（95%CI:1.08-24.7）]。有症状的PHPT患者的甲状腺结节必须在甲状旁腺切除术前进行研究。在有症状的PHPT中，甲状旁腺激素（PTH）浓度越高，患DTC的风险越高。

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引用次数: 0

Regional Node Distribution in Papillary Thyroid Cancer with Microscopic Metastasis. 甲状腺乳头状癌伴显微转移的局部淋巴结分布。

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2018-11-01 eCollection Date: 2018-01-01 DOI: 10.1155/2018/1718284

Luis-Mauricio Hurtado-López, Alejandro Ordoñez-Rueda, Felipe-Rafael Zaldivar-Ramírez, Erich Basurto-Kuba

Background: Optimal neck lymphadenectomy in patients with papillary thyroid cancer (PTC) and microscopic lymph node metastasis needs to be defined in order to aid surgeons in their decision about the best way to proceed in these cases.

Methods: Patients who underwent total thyroidectomy and lymphadenectomy at levels IIa to VI were divided into two groups: Group 1 (G1) with macroscopic metastasis detected before surgery and Group 2 (G2) with microscopic metastasis detected in sentinel node during surgery. Odds ratio (OR) was computed for age, sex, tumor size, multicentricity, capsular invasion, vascular/lymphatic permeation, and nodes with metastasis.

Results: Primary tumor size was (G1 versus G2, respectively) 3.8 cm versus 1.98 cm (P<0.001); only lymphatic permeation was correlated to an increase in metastasis in lymph nodes 65.4% versus 25% (OR=5.6, p<0.001); metastatic frequency by region was IIa 18.5% versus 1.5%, III 24.3% versus 9.9%, IV 17.4% versus 18.1%, and VI 25.9% versus 71,2%. Metastasis to level V was found only in G1.

Conclusion: Selective lymphadenectomy at levels III, IV, and VI is optimal for PTC patients without preoperative evidence of lymph node disease, but who present with lymph node microscopic metastasis in an intraoperative assessment.

背景:对于乳头状甲状腺癌(PTC)和显微淋巴结转移患者，需要确定最佳的颈部淋巴结切除术，以帮助外科医生决定在这些病例中进行的最佳方式。方法:将行甲状腺全切除术和淋巴结切除术的IIa ~ VI级患者分为两组:1组(G1)术前有肉眼转移，2组(G2)术中前哨淋巴结有显微转移。计算年龄、性别、肿瘤大小、多中心性、包膜浸润、血管/淋巴浸润和淋巴结转移的比值比(OR)。结果:原发肿瘤大小分别为(G1和G2) 3.8 cm和1.98 cm。结论:III级、IV级和VI级选择性淋巴结切除术是术前无淋巴结疾病证据，但术中评估出现淋巴结显微转移的PTC患者的最佳选择。

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引用次数: 5

Feasibility of Endoscopic Thyroidectomy via Axilla and Breast Approaches for Larger Goiters: Widening the Horizons. 经腋窝和乳房入路的内镜下甲状腺切除术治疗大甲状腺肿大的可行性:拓宽视野。

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2018-10-02 eCollection Date: 2018-01-01 DOI: 10.1155/2018/4057542

Goonj Johri, Gyan Chand, Nitish Gupta, Chaitra Sonthineni, Anjali Mishra, Gaurav Agarwal, Sabaretnam Mayilvaganan, Ashok Kumar Verma, Saroj Kanta Mishra

Scarless (in the neck) endoscopic thyroidectomy (SET) has evolved into a cosmetically preferred alternative to conventional thyroidectomy (ConT). Recently many of our patients are demanding SET; however their goitres are larger than the recommended size of 4-6 cm. Our aim was to compare the outcomes of ET for small (<6 cm) vs large (≥6 cm) goitres and determine its feasibility in such cases. This is a retrospective analysis of prospectively maintained database of patients undergoing ET. Patients were divided into 2 groups: I, small (<6 cm) and II, large goitres (≥6 cm). Their demographic and clinicopathological profiles, operation time, conversion and complication rates, and hospital stay were compared. 99 patients (101 procedures) were included: group I, 60 patients (61 procedures), and group II, 39 patients (40 procedures). Mean tumor size (± SD) was 4.4 ± 0.9 cm and 6.7 ± 1.1 cm in groups I and II, respectively. The groups were comparable with respect to demographic and clinical profile except for mean duration of goiter [30.1 ± 32.6 months (group I) vs 60.5 ± 102.4 months (group I), p = 0.03] and gland weight [21.5 ± 15.3 grams (group I) vs 62.3 ± 51.3 grams (group II), p = 0.001]. Although there was no significant difference between mean operating times, long term perioperative outcomes, and conversion rates, temporary hypocalcaemia and length of stay were longer in group II. One patient had permanent vocal cord palsy (~1%, 1/101); none had permanent hypoparathyroidism. Our results indicate that ET can be offered to a subset of patients with larger goitres desirous of SET with no significant difference in mean operation time, conversions, and long term postoperative complications in experienced hands.

无疤痕(颈部)内窥镜甲状腺切除术(SET)已经发展成为传统甲状腺切除术(ConT)的美容首选选择。最近我们的许多病人都要求SET;然而，他们的甲状腺比推荐的4-6厘米大。我们的目的是比较小型(

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引用次数: 18

Prevalence of Subclinical Hypothyroidism in Acute Coronary Syndrome in Nondiabetics: Detailed Analysis from Consecutive 1100 Patients from Eastern India. 非糖尿病患者急性冠状动脉综合征亚临床甲状腺功能减退的患病率:来自印度东部连续1100例患者的详细分析

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Thyroid Research

Pub Date : 2018-09-04 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9030185

Sudeb Mukherjee, Suhana Datta, S C Mandal

Background: The association between subclinical thyroid dysfunction (defined by no symptoms or clinical features of hypothyroidism but biochemically TSH level in the range of above 5 miu/ml but below 10 miu/ml with normal FT4 level) and Acute Coronary Syndrome (ACS) is not known so far. This study was done to calculate the prevalence of subclinical thyroid dysfunction in patients with ACS.

Methods: A retrospective chart review of 1100 consecutive patients was done who presented to Emergency Department with symptoms suggestive of ACS and admitted. They were later classified in 3 categories that includes Acute ST Elevated Myocardial Infarction (STEMI), Unstable Angina (UA), and Acute Non-ST Elevated Myocardial Infarction (NSTEMI). Thyroid function test (FT4, TSH) and antithyroid peroxidase (TPO) were done and evaluated properly.

Results: Of 1100 consecutive patients 168 (15.27%) patients had the biochemical features of subclinical thyroid dysfunction. These 168 patients include 60 STEMI, 66 NSTEMI, and 42 Unstable Angina patients. There were no statistically significant differences in terms of left ventricular ejection fraction (LVEF) and catheterisation results considering thyroid dysfunction.

Conclusions: Subclinical thyroid dysfunction is quite prevalent in ACS patients. There are no significant associations between STEMI, Unstable Angina, or NSTEMI patients in terms of thyroid dysfunction neither in single vessel versus multivessel disease involvement. The causative role and outcomes of treatment are still uncertain and need further follow-up.

背景:亚临床甲状腺功能障碍(定义为没有甲状腺功能减退的症状或临床特征，但生化TSH水平高于5 miu/ml, FT4水平正常时低于10 miu/ml)与急性冠脉综合征(ACS)之间的关系目前尚不清楚。本研究旨在计算ACS患者亚临床甲状腺功能障碍的患病率。方法:对1100例连续就诊于急诊科并伴有ACS症状的患者进行回顾性分析。随后将患者分为急性ST段抬高型心肌梗死(STEMI)、不稳定型心绞痛(UA)和急性非ST段抬高型心肌梗死(NSTEMI) 3类。检查甲状腺功能(FT4)、TSH及抗甲状腺过氧化物酶(TPO)水平。结果:1100例患者中有168例(15.27%)具有亚临床甲状腺功能障碍的生化特征。这168例患者包括60例STEMI, 66例非STEMI和42例不稳定型心绞痛患者。考虑到甲状腺功能障碍，左室射血分数(LVEF)和导管检查结果无统计学差异。结论:亚临床甲状腺功能障碍在ACS患者中相当普遍。STEMI、不稳定型心绞痛或非STEMI患者在单血管与多血管疾病累及的甲状腺功能障碍方面均无显著相关性。病因作用和治疗结果仍不确定，需要进一步随访。

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引用次数: 10