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甲状腺功能减退症伴多发性肌炎样综合征三例

【摘要】 目的 提高对甲状腺功能减退致多肌炎综合征的认识。方法 报道3例甲状腺功能减退症致多肌炎综合征的临床特点。男2例,年龄分别为33、38岁；女1例,年龄64岁,均表现为四肢近端肌肉肌无力,肌酶显著升高。结果 2例男性诊断为原发性甲状腺功能减退症,女性为亚临床型甲状腺功能减退症,甲状腺激素替代治疗后效果好。结论 临床上对有肌病表现、肌酶显著升高的患者须注意有无甲状腺功能减退症,多发性肌炎样综合征,应注意筛查甲状腺功能。

Hypothyroidism and risk of atrial fibrillation: a meta-analysis

ObjectivesTo systematically review the relationship between hypothyroidism and the risk of atrial fibrillation.MethodPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cohort and case-control studies on the association between hypothyroidism and atrial fibrillation from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 5 cohort studies involving 574 268 subjects and 18 059 atrial fibrillation cases were included. The results of meta-analysis showed that hypothyroidism was not associated with atrial fibrillation (OR=1.10, 95%CI 0.75 to 1.61, P=0.62). From subgroup analysis, no relationship was identified in community population (OR=0.97, 95%CI 0.72 to 1.29, P=0.82) and cardiac surgery patients (OR=1.22, 95%CI 0.58 to 2.53, P=0.60).ConclusionsHypothyroidism does not increase the risk of atrial fibrillation. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Research progress on the relationship between hypothyroidism and atrial fibrillation

Atrial fibrillation is one of the most common arrhythmias, which can cause embolism, heart failure, cardiac arrest, and other cardiovascular deaths, causing a serious economic burden on patients. Scholars have begun to explore the relationship between atrial fibrillation and hypothyroidism, including clinical hypothyroidism, subclinical hypothyroidism, and threshold state of thyroid function, which means that thyroid stimulating hormone, free triiodothyronine, and free thyroxine are high or low in the normal range. This article reviews the occurrence and mechanism of hypothyroidism promoting atrial fibrillation, and aims to provide a basis for clinical intervention in patients with hypothyroidism to reduce the occurrence of atrial fibrillation.

甲状腺功能减退合并抗利尿激素分泌失调综合征致低钠血症一例

Safety and effectiveness of total hip arthroplasty in patients with hypothyroidism

ObjectiveTo evaluate the safety and effectiveness of total hip arthroplasty (THA) in patients with hypothyroidism.MethodsSixty-three patients with hypothyroidism (hypothyroidism group) and 63 euthyroid patients without history of thyroid disease (control group) who underwent primary unilateral THA between November 2009 and November 2018 were enrolled in this retrospective case control study. There was no significant difference between the two groups in gender, age, body mass index, hip side, reason for THA, American Society of Anesthesiology (ASA) classification, preoperative hemoglobin (Hb) level, and preoperative Harris score (P>0.05). The perioperative thyroid stimulating hormone (TSH) and thyroxine (T4) levels, the hypothyroidism-related and other complications during hospitalization, the decrease in Hb, perioperative total blood loss, blood transfusion rate, length of hospital stays, and 90 days readmissions rate in the two groups were recorded and evaluated. The periprosthetic joint infection, aseptic loosening of the prosthesis, and hip Harris score during follow-up were recorded.ResultsThe differences in the TSH and T4 of hypothyroidism group between pre- and 3 days post-operation were significant (P>0.05) and no hypothyroidism-related complications occurred after THA. The decrease in Hb and perioperative total blood loss in the hypothyroidism group were significantly higher than those in the control group (P<0.05), but there was no significant difference between the two groups in terms of transfusion rate, length of hospital stays, and 90 days readmission rates (P>0.05). No significant difference in the rate of complications (liver dysfunction, heart failure, pulmonary infection, urinary infection, and wound complication) between the two groups was found (P>0.05) except for the rate of intramuscular vein thrombosis which was significantly lower in the hypothyroidism group, and the rate of postoperative anemia which was significantly higher in the hypothyroidism group (P<0.05). The two groups were followed up 1.0-9.9 years (mean, 6.5 years). At last follow-up, Harris score in both groups were significantly higher than those before operation (P<0.05). An increase of 39.5±12.3 in hypothyroidism group and 41.3±9.3 in control group were recorded, but no significant difference was found between the two groups (t=0.958, P=0.340). During the follow-up, 1 case of periprosthetic joint infection occurred in the hypothyroidism group, no loosening or revision was found in the control group.ConclusionWith the serum TSH controlled within 0.5-3.0 mU/L and T4 at normal level preoperatively, as well as the application of multiple blood management, hypothyroid patients can safely go through THA perioperative period and effectively improve joint function, quality of life, and obtain good mid-term effectiveness.

德阳地区健康体检人群中甲状腺功能检查的结果分析

目的 了解德阳地区健康体检人群中甲状腺功能检查（甲功）的异常情况，并分析异常类型及人群分布特点。 方法 收集医院体检中心2014年1月－9月体检人群的甲功检查报告，结合体检者个人信息，对甲功指标游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺素和抗体指标抗甲状腺球蛋白抗体（TgAb）、促甲状腺激素受体抗体（TRAb）、抗甲状腺过氧化物酶抗体（TPOAb）进行统计分析。 结果 在1 220例体检人群中，甲功指标异常201例（16.48%）；临床甲功异常[甲状腺功能亢进症（甲亢）+甲状腺功能减退（甲减）]检出率为1.14%，亚临床甲功指标异常（亚临床甲亢+亚临床甲减）检出率15.33%。甲功指标异常者中57.71%合并抗体指标阳性；1 019例甲功正常者中抗体指标异常183例（17.96%），其中抗体指标阳性率由高到低分别为TPOAb 9.62%、TgAb 8.24%、TRAb 4.12%。甲功指标异常在40～49岁年龄段检出率最高，达18.48%。 结论 德阳地区健康体检人群中甲功检查异常检出率较高，健康体检能及时发现亚临床甲功异常，尤其应该注重40～49岁人群的甲功检查。

心脏病合并甲状腺功能减退症患者的外科治疗

目的 总结心脏病合并甲状腺功能减退症患者行外科手术治疗的临床经验。 方法 回顾性分析2001年9月至2009年5月解放军总医院19例心脏病合并甲状腺功能减退症患者行外科手术治疗的临床资料，男7例，女12例；年龄50～76岁，平均年龄63.20岁。冠心病15例，主动脉瓣狭窄1例，房间隔缺损1例，慢性心包炎2例；均合并甲状腺功能减退症。所有患者术前给予左旋甲状腺素钠（40~120 mg/d）口服治疗，根据其耐受程度、促甲状腺激素和甲状腺激素水平调整用量，将甲状腺激素水平调整至基本正常。行体外循环冠状动脉旁路移植术6例，非体外循环冠状动脉旁路移植术9例，房间隔缺损修补术1例，主动脉瓣置换术1例，心包剥脱术2例。术后按原剂量或加量口服左旋甲状腺素钠片，检测手术前、后甲状腺激素指标的改变。 结果 无手术死亡，术后所有患者均未发生低三碘甲状腺原氨酸（T3）综合征，甲状腺功能指标与术前比较均有不同程度的降低，以血清总三碘甲状腺原氨酸和血清游离三碘甲状腺原氨酸降低最为明显，体外循环手术患者下降幅度更大。术后继续给予甲状腺素钠口服，并持续服用维持量的甲状腺素钠。随访19例，随访时间4～7个月，随访期间均持续服用维持量的甲状腺素钠，心功能分级（NYHA）Ⅰ级14例，Ⅱ级5例；患者恢复正常生活。 结论 合并甲状腺功能减退症的心脏病患者行心脏手术是安全、可行的，体外循环和非体外循环心脏手术后甲状腺激素均有所降低，体外循环手术患者下降更明显，术后应警惕发生低T3综合征和低T3、T4综合征。

Perioperative Management of Total Knee Replacement and Total Hip Replacement in Hypothyroidism Patients

目的　探讨髋或膝关节置换术（THR/TKR）并存甲状腺功能减退症（甲减）患者围手术期的处理策略。方法　2009年1月－2011年12月收治30例行THR/TKR并存甲减患者，其中男8例，女22例，平均年龄62.4岁。处理要点包括术前纠正甲状腺激素水平；术中缩短手术时间，减少出血量，选择性应用糖皮质激素；术后补充甲状腺激素，预防感染及深静脉血栓形成，改善胃肠功能。评价指标包括围手术期血压、心率变化，胃肠功能状况，切口愈合时间，甲状腺功能水平，黏液性水肿昏迷等并发症发生率；术前及术后Harris及特种外科医院评分系统（HSS）评分等。 结果　术后心率变化大，非致命性心律失常者20例；血压控制平稳；术后甲状腺功能变化不明显，无黏液性水肿昏迷、心包积液及呼吸窘迫等严重并发症发生。随访1个月，术前HSS评分平均28分，术后86分；术前Harris评分平均32分，术后87分。 结论　术前控制血清促甲状腺素在0.5～3.0 mU/L以内，总甲状腺素、游离甲状腺素至正常水平，是有效预防甲减患者THR/TKR围手术期并发症的关键；综合应用左甲状腺素片、糖皮质激素和抗凝治疗是安全渡过围手术期的重要保证。

Subclinical thyroid dysfunction and risk of atrial fibrillation: a meta-analysis

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.

Thyroid dysfunction and osteoporosis: a bidirectional, two-sample Mendelian randomization study

Objective To explore the potential causal relationship between thyroid dysfunction and osteoporosis (OP) through bidirectional two-sample Mendelian randomization (MR) analysis to provide genetic evidence for the risk association between thyroid dysfunction and OP, and provide reference for early prevention and treatment of OP. Methods Causal relationships were estimated based on data from genome-wide association studies for hypothyroidism (n=410141), hyperthyroidism (n=460499), Hashimoto thyroiditis (n=395640), and OP (n=212778). The inverse variance weighted method was used as the main analysis method, and the other four methods were used as the supplementary analysis methods to evaluate the causal effect of thyroid dysfunction and OP. Results The results of inverse variance weighted method showed that hypothyroidism [odds ratio (OR)=1.097, 95% confidence interval (CI) (1.017, 1.183), P=0.017], hyperthyroidism [OR=1.089, 95%CI (1.000, 1.186), P=0.049] and Hashimoto thyroiditis [OR=1.190, 95%CI (1.054, 1.343), P=0.005] were positively correlated with the causal effect of OP. The results of reverse MR analysis did not support that OP would increase the risk of hypothyroidism, hyperthyroidism or Hashimoto thyroiditis (P>0.05). In the bidirectional MR analyses, there was no heterogeneity in Cochran Q detection, MR-Egger intercept test results showed that there was no horizontal pleotropy, and the leave-one-out method analysis results showed that the MR analysis results were reliable. Conclusion Hypothyroidism, hyperthyroidism, and Hashimoto thyroiditis increase the risk of OP, while OP is not found to increase the risk of thyroid dysfunction in reverse studies.