Gender,race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Thyroid diseases are common, and use of levothyroxine is increasing worldwide. We investigated the influence of gender, race and socioeconomic status on the diagnosis and treatment of thyroid disorders using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years of age) from six Brazilian cities. Diagnosis of thyroid dysfunction was by thyrotropin (TSH), and free thyroxine (FT4) if TSH was altered, and the use of specific medications. Multivariate logistic regression models were constructed using overt hyperthyroidism/hypothyroidism and levothyroxine use as dependent variables and sociodemographic characteristics as independent variables. The frequencies of overt hyper- and hypothyroidism were 0.7 and 7.4%, respectively. Using whites as the reference ethnicity, brown, and black race were protective for overt hypothyroidism (OR=0.76, 95%CI=0.64-0.89, and OR=0.53, 95%CI=0.43-0.67, respectively, and black race was associated with overt hyperthyroidism (OR=1.82, 95%CI=1.06-3.11). Frequency of hypothyroidism treatment was higher in women, browns, highly educated participants and those with high net family incomes. After multivariate adjustment, levothyroxine use was associated with female gender (OR=6.06, 95%CI=3.19-11.49) and high net family income (OR=3.23, 95%CI=1.02-10.23). Frequency of hyperthyroidism treatment was higher in older than in younger individuals. Sociodemographic factors strongly influenced the diagnosis and treatment of thyroid disorders, including the use of levothyroxine.     

MiR-125b在甲状腺癌患者中的表达及其意义

目的探讨miR-125b在甲状腺癌患者中的表达及其意义。方法选取甲状腺乳头状癌组织及其配对的癌旁组织各20例,所有患者均经超声及病理确诊。实时荧光定量PCR检测miR-125b mRNA的表达,Western Blot检测Foxp3、LC 3Ⅰ和LC 3Ⅱ蛋白的表达。将人甲状腺乳头状癌细胞系MDA-T32随机分为3组:对照组(不处理)、阴性对照组(转染无义序列)和miR-125b组(转染miR-125b mimics),实时荧光定量PCR检测miR-125b mRNA的表达,MTT法检测癌细胞对顺铂的敏感性,Western Blot检测Foxp3、LC 3Ⅰ和LC 3Ⅱ蛋白的表达。结果与癌旁组织对比,甲状腺癌组织中MiR-125b mRNA的表达显著降低(P <0.05),Foxp3蛋白表达显著增加(P <0.05)。与对照组相比,miR-125b组细胞中MiR-125b mRNA的表达显著增加(P <0.05),Foxp3蛋白的表达显著降低(P <0.05)。与对照组相比,在顺铂浓度为30μg/ml时,miR-125b组细胞活性显著降低(P <0.05)。在顺铂浓度为0、15、60、120μg/ml时,各组间细胞活性的对比无显著差异(P> 0.05)。与癌旁组织对比,甲状腺癌组织中LC 3Ⅱ蛋白的表达显著增加(P <0.05)。与对照组相比,miR-125b组细胞中LC 3Ⅱ蛋白的表达显著降低(P <0.05)。LC 3Ⅰ蛋白的表达在各组间对比无显著变化(P> 0.05)。结论miR-125b在甲状腺癌中下调,miR-125b介导的Foxp3下调可抑制自噬,并增强甲状腺癌细胞对顺铂的敏感性。     

甲状腺激素对小鼠面神经损伤轴突再生及神经电生理功能的影响

目的： 探讨甲状腺激素对小鼠面神经损伤轴突再生及神经电生理功能的影响。方法： 将64只小鼠随机分为4组,即假手术组、模型组、甲状腺素组、甲状腺素+LY组,每组16只。除假手术组外,其余组均建立面神经损伤模型。术后苏醒开始干预,甲状腺素组于损伤处皮下注射50 μg/kg中性甲状腺素溶液,甲状腺素+LY组在甲状腺素组基础上腹腔注射600 μg/kg PI3K/AKT通路抑制剂LY294002,假手术组和模型组于损伤处注射生理盐水,每天1次,持续2周。干预结束后进行神经电生理检测,锇酸染色进行再生轴突计数,Western免疫印迹法检测面神经组织中p-AKT、NGF、BDNF蛋白的表达。采用SPSS 21.0软件包对数据进行统计学分析。结果： 假手术组正常神经髓鞘外未见新生轴突。与模型组相比,甲状腺素组和甲状腺素+LY组再生轴突数均升高,甲状腺素组显著高于甲状腺素+LY组（P<0.05）。与假手术组相比,模型组运动神经传导速度（MNCV）和波幅降低,潜伏期延长（P<0.05）;与模型组相比,甲状腺素组和甲状腺素+LY组MNCV、波幅升高,甲状腺素组显著高于甲状腺素+LY组（P<0.05）;与模型组相比,甲状腺素组和甲状腺素+LY组潜伏期缩短,甲状腺素组显著短于甲状腺素+LY组（P<0.05）。与假手术组相比,模型组p-AKT、NGF、BDNF蛋白相对表达量显著升高（P<0.05）;与模型组相比,甲状腺素组p-AKT蛋白相对表达量显著升高,甲状腺素+LY组显著降低（P<0.05）;与模型组相比,甲状腺素组和甲状腺素+LY组NGF、BDNF蛋白相对表达量升高,甲状腺素组显著高于甲状腺素+LY组（P<0.05）。结论： 甲状腺激素可有效促进小鼠面神经损伤轴突再生,改善神经电生理功能,其机制可能是通过促进AKT磷酸化而发挥调控作用。     

紧张性头痛患者甲状腺功能改变及其临床意义

目的 探讨紧张性头痛患者甲状腺功能改变及其临床意义。方法 选择2016年1月-2019年6月本院收治的120例紧张性头痛患者作为观察组,选择同时期来本院进行体检的120名健康人作为对照组,比较2组研究对象的一般资料、匹兹堡睡眠指数PSQI评分、汉密尔顿17项抑郁评分、蒙特利尔认知功能MoCA-C评分、疼痛视觉量表VAS评分,检测2组患者血清中促甲状腺激素TSH、总甲状腺素TT4、总三碘甲状腺原氨酸TT3、游离甲状腺素FT4、游离三碘甲状腺原氨酸FT3、甲状腺球蛋白抗体TGAb、甲状腺过氧化物酶抗体TPOAb水平。结果 2组患者的年龄、性别及受教育年限均无明显差异(P>0.05),观察组PSQI评分、HAMD-17评分、TSH、TPOAb、TGAb水平均明显高于对照组(P<0.05),MoCA评分、TT3、TT4、FT3、FT4水平均明显低于对照组(P<0.05),VAS评分与PSQI评分、HAMD-17评分、TSH、TPOAb、TGAb水平呈正相关,与认知功能MoCA评分、TT3、TT4、FT3、FT4水平呈负相关。结论 甲状腺功能低下及自身免疫性损伤与紧张性头痛的发生密切相关,甲状腺激素及相关抗体的检测有助于紧张性头痛的诊断及预后判定     

Hipertiroidismo como manifestación de la enfermedad trofoblástica gestacional: a propósito de un caso

Gestational trophoblastic disease (GTD) is a group of tumours caused by the hyperproliferation of trophoblast cells and is noted for its overproduction of hCG. Among its manifestations, there may be hyperthyroidism, due to the stimulating activity of hCG on TSH receptors. In most cases it is only a biochemical hyperthyroidism, with its presentation as symptomatic hyperthyroidism being much less frequent. We report the case of a patient with GTD, who at diagnosis presented with symptomatic hyperthyroidism. Treatment included surgical evacuation of the hydatidiform mole, as well as a beta-blocker and antithyroid drug treatment to relieve the symptoms.     

基于TCGA数据库乳头状甲状腺癌miRNA预后风险模型的建立与分析CSCD

目的构建基于微小RNA(miRNA)表达的预测乳头状甲状腺癌(papillary thyroid carcinoma,PTC)患者预后的生存模型。方法从TCGA数据库官方网站上下载PTC miRNA测序数据和患者的临床资料,利用R3.6.0软件中的edgeR包筛选表达失调的miRNA。利用单因素Cox及Lasso回归分析筛选出与患者预后相关的miRNA(P<0.05),进一步使用多因素Cox回归分析建立预后模型的风险评分方程risk score,构建生存预后模型,使用受试者工作特征曲线(ROC)来评价模型的敏感度和特异性。结果与正常甲状腺组织相比,PTC组织中失调表达的miRNA共有75个(|log foldchange|≥2,FDR<0.05),多因素Cox回归分析最终得到基于8个miRNA(hsa-mir-6730、hsa-mir-4709、hsa-mir-196a-2、hsa-mir-146b、hsa-mir-6860、hsa-mir-509-3、hsa-mir-513c、hsa-mir-515-1)的预测患者预后的风险模型。ROC曲线下面积(AUC)分析显示,该模型具有较好的敏感度和特异性(AUC>0.8)。结论成功构建了基于miRNA表达的风险预测模型,该模型可有效预测PTC患者的预后。     

福建平潭综合实验区2013—2015年甲状腺癌发病调查分析

目的 调查核实平潭综合实验区甲状腺癌是否高发,并分析其发病特征。方法 选择福建省肿瘤发病报告系统中发病日期为2013—2015年的平潭户籍甲状腺癌病例;通过查阅医院病历资料核实基本信息和诊断信息,随访排除非户籍病例。计算粗发病率、标化率、累积率,分析甲状腺癌在不同性别、年龄发病情况,及不同病理类型和不同大小肿瘤的构成。中国人口标化率根据2000年中国标准人口构成计算,世界人口标化率按Segi′s世界人口构成计算。结果 2013—2015年平潭综合实验区甲状腺癌新发病例共881例;其中男性205例,女性676例。甲状腺癌粗发病率为69.30/10万,中标率为65.27/10万;男性粗发病率及中标率分别为31.78/10万和29.87/10万;女性粗发病率及中标率分别为107.95/10万和101.19/10万;女性发病是男性的3.18倍。男、女性中位发病年龄分别为46岁和47岁。男性在40-年龄组达到发病高峰,女性在45-年龄组和55-年龄组形成两个发病高峰。乳头状癌、滤泡状癌、髓样癌及其他病理类型占比分别为96.52%、1.80%、0.60%和1.08%。肿瘤最大径≤10 mm的微小癌占77.29%。结论 平潭综合实验区甲状腺癌发病高于同期福建省及全国平均水平,以乳头状癌为主,微小癌占比较高。     

中药雾化吸入联合常规疗法与护理措施干预甲状腺癌术后声音嘶哑效果分析

目的:观察在常规治疗与护理基础上加用中药雾化吸入治疗甲状腺癌术后声音嘶哑的效果。方法:纳入120例气阴两虚型甲状腺癌术后声音嘶哑患者,应用随机数字表法分为2组各60例,2组均采用常规治疗与护理措施干预,观察组加用中药雾化吸入治疗,2组疗程均为1个月。治疗前后评价2组患者的声音嘶哑情况评分,评价患者在观察期的用药依从性,出院前评价护理满意度,并比较2组的治疗效果。结果:治疗1个月后,观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。观察组患者的用药依从性情况较好,绝大多数患者能够按时按量用药,不受症状波动的影响,2组比较,差异有统计学意义(P<0.05)。观察组护理满意度高于对照组,差异有统计学意义(P<0.05)。结论:在常规治疗与护理基础上加用中药雾化吸入干预甲状腺癌术后声音嘶哑,可有效改善声音嘶哑、提高疗效,提高患者的用药依从性和对护理措施的满意度。     

Differentiated thyroid carcinoma in sporadic and familial presentations of acromegaly: A case series

BackgroundIn acromegaly, chronic growth hormone (GH) and insulin-like growth factor-1 (IGF-1) exacerbate comorbidities in multiple organs. Differentiated thyroid carcinoma (DTC) has been reported as being a comorbid condition in acromegaly. Acromegaly is usuallysporadic, but 5% of cases may be genetic. The most frequent inheritable form of acromegaly is related to germline mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene. Epidemiological data on the relationship between active acromegaly, its familial forms and DTC are sparse. We present the investigation of a FIPA family (familial isolated pituitary adenoma) with homogeneous acromegaly and 6 sporadic acromegaly patients with DTC.Patients and methodsA study of 59 acromegaly patients assessed thyroid nodules on ultrasound and fine-needle aspiration biopsy following the ATA 2015 criteria. We diagnosed 7 differentiated thyroid carcinomas. Resected thyroid carcinoma tissues were stained using an anti-AIP antibody. Analysis of germline and tumor-derived DNA for variants in the AIP and MEN1 genes were performed in the FIPA kindred.ResultsWe describe one FIPA patient and 6 sporadic acromegaly cases with DTC. The FIPA family (AIP mutation negative) consisted of two sisters, one of whom had a DTC with intermediate risk and incomplete structural response to therapy. In our study, DTC in sporadic acromegaly had a low recurrence rate (6/6), and excellent response to therapy (6/6). Immunohistochemistry for AIP showed similar or increased staining intensity in DTC versus normal thyroid tissue.ConclusionIn our cohort of sporadic and familial forms of acromegaly with DTC, AIP did not appear to influence thyroid cancer progression.