2022年 · 第102卷第06期

Thyroid-associated ophthalmopathy (TAO) is a refractory complication of Graves' disease (GD). Stimulatory thyrotropin receptor (TSAb) can bind to the TSH receptor (TSHR) /insulin-like growth factor Ⅰ receptor (IGF-IR) complex expressed by GD-orbital fibroblasts (GD-OF) to promote the development OF TAO. IGF-IR is a necessary component for TSHR to initiate cell signaling. teprotumumab, as a monoclonal antibody that blocks IGF-IR, was approved by the U.S. Food and Drug Administration for the treatment of TAO in 2020, but the potential mechanism of this drug for the treatment of TAO still needs to be further clarified.

To further evaluate the effect of iron nutrition status on thyroid function in pregnant women in areas with mild iodine deficiency, this study used a multi-stage, scale-proportional stratified and cluster sampling method in Belgium to detect blood triiodothyronine (T3), free T3 (fT3), tetraiodothyronine (T4), free T4 (fT4), TSH, urine iodine concentration (UIC), hemoglobin (Hb), serum ferritin (SF, SF<15 μ g/L suggests iron deficiency) and soluble transferrin receptor (sTfR) levels, and the body iron reserve (BIS) was calculated by formula as a more sensitive index to judge iron deficiency. The median UIC of women included in the first and third trimester of pregnancy was 117 and 132 μ g/L, respectively, suggesting mild iodine deficiency. Multiple linear regression analysis suggested that UIC was an important predictor of Tg, rather than fT4, T4, fT3 or TSH levels during pregnancy. Among the enrolled women in first and third trimester pregnancy, SF<15 μ g/L patients accounted for 6.2% and 39.6%, respectively. BIS in the third trimester of pregnancy showed that the proportion of hypoFT4aemia in patients with iron deficiency was significantly higher than that in patients with iron sufficiency (24% vs 14%, P<0.05）。 Furthermore, the predictive value of SF, BIS and Hb on thyroid function indexes was analyzed by multiple linear regression. The results showed that SF and BIS were important predictors of fT4 and T4 levels in the first trimester, while Hb was a predictor of fT4 levels in the first and third trimester and T4 levels in the third trimester.

Over the past 40 years, the rate of childhood obesity has increased more than 3-fold and persists at a high rate into adulthood, significantly increasing the risk of metabolic-related diseases. Previous studies have suggested that children with intrauterine exposure to gestational diabetes mellitus (GDM) or obese mothers have a higher predisposition to obesity, but little is known about the mechanisms underlying this phenomenon. Therefore, the researchers designed this study to investigate the relationship between daily energy intake (EI), brain reward area response to food cues, and obesity in children who had been exposed to GDM or obese mothers. A total of 159 children aged 7 to 11 years were enrolled, and daily EI was calculated for two visits within 24 h. Among them, 102 patients underwent MRI scans to explore responses to food cues in the reward areas of the brain, including the anterior orbit, frontal cortex (OFC), insula, amygdala, ventral striatum, and dorsal striatum. BMI Z-score, body fat percentage, waist-to-height ratio (WtHR), and waist-to-hip ratio (WHR) were used to assess the degree of obesity. The results of this study found that exposure to GDM significantly increased daily EI and WHR, and an increase of 1,000 calories in daily EI was associated with an increase of 0.028 in WHR; Children exposed to GDM before 26 weeks had higher responsiveness to OFC food cues (OFC had a strong motivating effect on food rewards). Differences remained significant after adjusting for children's age/sex, mother's education and race/ethnicity, mother's pre-pregnancy BMI, and children's physical activity levels. It was ultimately suggested that children exposed to GDM ate 165 more calories per day than unexposed individuals, while early exposed individuals ate the most calories per day and also had a higher WHR, with daily EI explaining a 36% association between children's GDM exposure and WHR. Maternal obesity was not significantly associated with daily EI or brain reward area responsiveness to food cues. However, maternal pre-pregnancy BMI was significantly associated with all obesity indicators, and the results of BMI Z-score, WtHR and WHR remained significant after adjusting for the above important factors.