内分泌
词汇介绍
拓展阅读
解析
hypothyroidism 英 /,haɪpəʊ'θaɪrɒɪdɪz(ə)m]/ 美 /'haɪpo'θaɪrɔɪ'dɪzəm/
释 义 n. 甲状腺功能减退；甲状腺官能不足病
例 句 The risk factors responsible for hypothyroidism were not evident from the statistical analysis of these cases. 甲状腺功能减退的相应风险因素在这些病例的统计学分析中并不明显。
概述
概述
甲状腺功能减退症，也称为甲状腺功能低下，是一种内分泌系统疾病，主要因为甲状腺不能产生足够的甲状腺激素而发病。这可能会导致一些症状，如不能忍受寒冷，易疲倦，便秘，抑郁症，和体重增加。由于甲状腺肿，有时可能会出现颈部前部肿胀。怀孕期间未经治疗的甲状腺功能减退症可导致婴儿发生先天性碘缺乏综合症和智力发育延迟。
临床诊断
血液中甲状腺刺激素水平的实验室检测被认为是甲状腺功能减退症的最佳初始检测方法，TSH水平通常在几周后获得确认。在其他疾病的情况下，TSH水平可能是异常的，并且除非强烈怀疑甲状腺功能障碍，否则不鼓励住院患者进行TSH检测。TSH水平升高表明甲状腺没有产生足够的甲状腺激素，因此经常获得游离T4水平。在评估甲状腺功能减退症时，AACE不鼓励测量T3。在甲状腺内感觉没有任何肿块的甲状腺功能减退症的诊断不需要甲状腺成像，但是，如果甲状腺感觉异常，则建议进行诊断成像。甲状腺过氧化物酶（TPO）抗体的存在使得甲状腺结节更可能是由自身免疫性甲状腺炎引起的，但如果有任何疑问，可能需要进行针吸活检。
预防
通过向常用食物中添加碘可以预防人群中的甲状腺功能减退症。这项公共卫生措施已经消除了曾经常见的国家的地方性儿童甲状腺功能减退症。除了促进富含碘的食物的消费外，许多中度碘缺乏的国家已实施普遍食盐加碘（USI），孕妇和哺乳期妇女每日碘需求量比非孕妇多66%，但仍可能无法获得足够的碘。世界卫生组织建议孕妇和哺乳期妇女每天摄入250微克的碘。由于许多女性不能单独从膳食来源实现这一目标，美国甲状腺协会建议每日口服补充150微克。
复制标题甲状腺功能减退症TSH受体抗体检测不当的教训: 病例系列和文献综述
发表时间：2019-08-27
影响指数：3.6
作者： Arnaud Jannin
期刊：Clin Chem Lab Med
Autoimmune thyroid diseases (AITD) occur frequently, and two biological markers of thyroid autoimmunity are used routinely: anti-thyroid peroxidase antibodies (TPOAbs) and anti-thyrotropin receptor (TSHR) antibodies (TRAbs). According to the American guidelines, TPO-Abs should not be measured in every patient with hypothyroidism but in those with subclinical hypothyroidism, as in these cases results can modify patient management. Otherwise, measurement of TRAbs is recommended in all cases of hyperthyroidism for the diagnosis of Grave’s disease (GD). In contrast to TPO-Abs, TRAbs are directly responsible for thyroid dysfunction. Stimulating TRAbs, known as thyroid stimulating antibodies (TSAbs), activate the cAMP pathway through TSHR, leading to hyperthyroidism. In some patients, other TRAbs, known as thyroid blocking antibodies (TBAbs) act rather as competitive inhibitors of TSH binding to TSHR, thereby favoring hypothyroidism. The functional activity of TRAbs can be evaluated by a bioassay. The presence of TBAbs has been mainly described in GD, where a “switch” in the production of TSAbs towards TBAbs has been described. The prevalence of TBAbs in patients with AITD has been estimated at 9.3%. Despite a large amount of literature on these antibodies, data about the clinical presentation of hypothyroidic patients with TBAbs are scarce. Indeed, testing for TBAbs is recommended in pregnant women with a history of GD; it is also often done in patients with GD with difficulty in treatment adjustment or secondary progression towards hypothyroidism, as well as in patients with orbitopathy without GD. Between 2010 and 2017, a functional TRAbs bioassay was requested by the Department of Biology at Lille University for 39 patients, including 30 patients with such a background and nine patients having hypothyroidism without a history of hyperthyroidism or ophthalmopathy. We therefore reviewed the clinical presentation of these nine patients (Table 1).
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