Volume 103 ·  Issue 05 ·  2023

The prevalence of thyroid diseases in China continues to increase, especially for hypothyroidism. This article focuses on the existing problems in the diagnosis and treatment of hypothyroidism in special groups, including obese patients, the elderly, children and pregnant women. The pathogenesis and intervention measures of obesity-induced hypothyroidism have been the hot research frontiers. The prevalence of subclinical hypothyroidism in the elderly is the highest, while its diagnostic criteria and treatment strategies are still controversial. The hazard and treatment of subclinical hypothyroidism and hypothyroxinemia during pregnancy have now become an international concern. And there also exist some problems in the screening, diagnosis and treatment of congenital hypothyroidism in children. So it is urgent to carry out high-quality clinical research to provide theoretical basis for clinical diagnosis and treatment, and carry out in-depth research on related mechanisms to establish a foundation for the construction of a scientific prevention and treatment system for hypothyroidism.

Methimazole is the most commonly used medication for hyperthyroidism with good effects and little adverse reactions. However, improper selection of initial dose will affect the efficacy, such as excessive dose is proven to various adverse reactions; insufficient dose can hardly achieve desired efficacy. Based on the literature and personal clinical experience, the author discusses the following clinical issues related to methimazole in the treatment of hyperthyroidism, including the selection of initial dose, dose adjustment and withdrawal of methimazole, drug therapy for patients with liver function injury, and management strategies for methimazole-related adverse reactions.

Iodine is an essential trace element for human and an antioxidant. It not only participates in the synthesis of thyroid hormone, but also plays a role in metabolic diseases. Previous studies mainly focused on the effect of iodine on thyroid diseases, but ignored the effect on metabolism. After the implementation of the universal salt iodization (USI) of China, the possible consequences of excessive iodine were emphasized while the harm of iodine deficiency was forgetten. The paper re-examines the effects of iodine nutrition on thyroid diseases and metabolism. Iodine deficiency can lead to an increased risk of iodine deficiency disorders and thyroid diseases, and increase prevalence of metabolic syndrome and its components. Moderate iodine excess is beneficial to metabolism, but it can increase the risk of hyperthyroidism and subclinical hypothyroidism. The average urinary iodine concentration in 100-299 μg/L is the appropriate iodine nutrition state. According to the present iodized content of salt in China, iodized salt is an economical and effective way to ensure adequate iodine nutrition.

Polycythemia vera (PV) is a subtype of myeloproliferative neoplasms (MPN), with the highest incidence. Thromboembolism is the most common complication of PV, which has significant effects on the quality of life and survival of patients. To standardize the diagnosis, treatment and prevention strategies of thromboembolism associated with PV, the Myelodysplastic Syndrome/Myeloproliferative Neoplasms (MDS/MPN) Association affiliated to Chinese Medicine Education Association has reached the following consensus based on available proofs from evidence-based medicine after repeated considerations. The consensus covers risk stratification, diagnosis and treatment of PV, multidisciplinary management of PV thromboembolism, and patient follow-up, thereby providing the reference for the standardized diagnosis, treatment and management of thromboembolism for Chinese PV patients.

Recently, the percutaneous endoscopic lumbar interbody fusion (PELIF) technique has become the most representative minimally invasive technique in spinal surgery. PELIF is widely used in the treatment of various degenerative diseases of the lumbar spine. However, this technique has a long learning curve with adverse consequences for the patient if the surgeon is unsure of the indications and contraindications of this technique. There is currently no expert consensus on PELIF in spinal surgery in China. To standardize the application of this technique in various diseases of the lumbar spine in China, the Chinese Study Group of Minimal Invasive Spinal Surgery, Chinese Association of Spine and Spinal Cord, and Chinese Study Group for Lumbar Spine, Chinese Association of Spine and Spinal Cord, of the Chinese Association of Rehabilitation Medicine have taken the lead in developing this Chinese expert consensus on the application PELIF through a modified Delphi survey study method for the reference of our colleagues. The consensus covers the following aspects of the PELIF: indications and contraindications, advantages and disadvantages, preoperative evaluation, anesthesia methods and surgical procedures, treatment and prevention of complications, and postoperative follow-up.

To explore the mutation characteristics of pathogenic genes in children with congenital hypothyroidism (CH) in Fujian.

The clinical data of 116 unrelated CH children diagnosed in Fujian Provincial Maternal and Child Health Hospital from January 2019 to September 2020 were retrospectively analyzed, including 50 females and 66 males, with an average age of (20±10) days at diagnosis. Targeted exome sequencing technology was used to detect the mutation frequency, type and distribution characteristics of 29 genes related to thyroxine synthesis or thyroid development.

Three hundred and fifty-one potential functional mutations were detected in 105 of 116 CH patients, with a detection rate of 90.5% (105/116). DUOX2 (66.4%, 77/116) was the most frequent mutated gene, followed by TG (23.3%, 27/116), DUOXA1 (23.3%, 27/116), and TPO (12.1%, 14/116), which were all involved in thyroid hormone synthesis. Among the 105 children with CH, 70 cases carried double allele mutation. Except for 3 cases of thyroid dysplasia related genes (2 cases of TSHR and 1 case of GLIS3), the rest were also related to thyroid hormone synthesis. The gene with the highest carrier rate was DUOX2 (68.8%, 59/70), followed by TG (8.6%, 6/70), TPO (4.3%, 3/70), DUOXA2 (1.4%, 1/70) and DUOXA1 (1.4%, 1/70).

The main mutated genes in CH children in Fujian are the key genes involved in thyroid hormone synthesis, such as DUOX2, TG and TPO.

To explore the relationship between gene polymorphism of killer cell immunoglobulin-like receptor (KIR) and its ligand-specific human leukocyte antigen C (HLA-C) and Graves′ disease (GD).

Case-control study. A total of 118 unrelated GD patients (GD group) admitted to Shandong Provincial Hospital from January 2011 to December 2017 and 108 age-and sex-matched healthy controls (healthy control group) were included. The KIR genotype and its ligand HLA-C allele were detected by polymerase chain reaction sequence-specific primers (PCR-SSP). The distribution of KIR/HLA-C gene combination in GD patients and control population was analyzed to explore its association with the occurrence of GD.

In GD group, there were 29 males and 89 females, aged (38±14) years. In the healthy control group, there were 28 males and 80 females, aged (37±13) years. Compared with the healthy control group, the occurrence frequency of HLA-Cw01 was higher in GD group[36.4%(43/118) vs 18.5%(20/108), P=0.003], and the occurrence frequency of HLA-Cw03 and HLA-Cw06 was lower in GD group[11.9%(14/118) vs 39.8%(43/108), P<0.001; 9.3%(11/118) vs 18.5%(20/108), P=0.045]. The frequency of KIR2DL1/HLA-C2 gene combination in GD group was lower than that in control group [17.8%(21/118) vs 34.3%(37/108), P=0.005]. Logistic regression analysis showed that KIR2DL1/HLA-C2 gene combination was a protective factor for GD occurrence (OR=0.308, 95%CI: 0.126-0.752, P=0.010).

The polymorphism of KIR/HLA-C gene is related to GD. The low expression of KIR2DL1/HLA-C2 in GD patients may be a protective factor for GD.

To observe the prevalence and related factors of thyroid diseases in different iodine intake areas from 2015 to 2017 after the implementation of national salt iodization policy in China for 20 years.

A cross-sectional survey. Multi-stage stratified cluster random sampling was used to randomly select subjects meeting the inclusion criteria from 31 provinces, municipalities and autonomous regions in China from January 2015 to December 2017, and stratified by age and sex. The survey included questionnaire, physical examination and thyroid ultrasonography. At the same time, the concentrations of serum thyrotropin, thyroxine, thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TgAb) and urinary iodine were measured.To determine whether the patient has a certain thyroid disease according to the above results. Different iodine nutrition areas were defined according to urinary iodine concentration, and the influence of iodine nutrition status in different iodine intake areas on thyroid diseases was analyzed.

A total of 78 470 adults were included, including 39 893 in the area of moderate iodine, 28 779 in the area of adequate iodine, and 9 798 in the area of excessive iodine.In the above three regions, the prevalence of subclinical hyperthyroidism (hyperthyroidism) was 0.45% (95%CI: 0.39%-0.52%), 0.50%(95%CI: 0.35%-0.70%)and 0.27%(95%CI: 0.20%-0.35%), respectively, with statistical significance(χ²=6.92, P=0.003). The prevalence of subclinical hypothyroidism (hypothyroidism) was 11.36% (95%CI: 10.73%-12.02%), 13.57%(95%CI: 11.70%-15.69%) and 16.18%(95%CI: 12.41%-20.82%), respectively, with statistical significance(χ²=5.08, P=0.009). The prevalence rates of Graves′ disease, TPOAb, goiter and thyroid nodule among the three regions were statistically significant (all P<0.05). There were no significant differences in the prevalence of clinical hyperthyroidism and clinical hypothyroidism and the positive rate of TgAb among the three regions (all P>0.05). Multivariate logistic regression model analysis showed that excess iodine was a risk factor for subclinical hypothyroidism (OR=1.24, 95%CI: 1.06-1.44), and a protective factor for thyroid nodules (OR=0.73, 95%CI: 0.57-0.94). Iodine overdose was a risk factor for subclinical hypothyroidism (OR=1.47, 95%CI: 1.08-2.01), while it was a protective factor for subclinical hyperthyroidism (OR=0.56, 95%CI: 0.41-0.77), and TPOAb positive (OR=0.93, 95%CI: 0.87-0.99), goiter (OR=0.33, 95%CI: 0.17-0.66) and thyroid nodule (OR=0.77, 95%CI: 0.61-0.97).

There are significant differences in the prevalence of subclinical hyperthyroidism, subclinical hypothyroidism, positive TPOAb, thyroid nodule and goiter in different iodine intake regions. Different iodine intake levels have an effect on the incidence of thyroid diseases.

To observe the effect of surgical procedures and general anesthesia exposure (<2 h) in early childhood on neurodevelopmental outcomes in school-age.

A total of 147 children aged 6-12 years old, who received surgery under general anesthesia (<2 h) at the age of 0-2 years in Children′s Hospital of Nanjing Medical Universityfrom June 2009 to December 2012 were retrospectively enrolled in this study (from June 2018 to December 2021) as exposure group, including 76 males and 71 females, with a mean age of (8.8±1.6) years. All the cases were divided into single-exposure group (n=65) and multiple-exposure group (≥2 times, n=82) according to different times of anesthesia exposure. According to the cohort of exposure group, 160 healthy children of the same age with no history of surgery under general anesthesia were recruited from the community from June 2018 to December 2021 as the control group, including 87 males and 73 females, and aged (8.6±1.9) years. A variety of standardized neurological tests including Wechsler intelligence scale for children fourth edition (WSC-Ⅳ), integrated visual and auditory continuous performance test (IVA-CPT), Swanson Nolan and Pelham, version Ⅳ (SNAP-Ⅳ), children sensory integration capacity development rating scale (CSIC), and social living ability scale were performed in all subjects by a child health specialist who failed to know the details. The primary outcome was the full-scale IQ (FSIQ) in WISC-Ⅳ, and the secondary outcomes were IVA-CPT, SNAP-Ⅳ, CSIC, and social living ability scale.

The FSIQ of single-exposure, multiple-exposure and control groups was 105.4±14.1, 100.9±10.2 and 103.6±13.5, respectively, with no statistically significant difference (F=2.37, P=0.095). The FSIQ of different first age exposure groups (aged 0-6 months, 7-12 months and 1-2 years) was 99.8±10.2, 104.5±10.5 and 104.4±14.5, respectively, with no statistically significant difference (F=2.39, P=0.095). The FSIQ of different exposure duration groups (0-59 min, 60-119 min and control group) was 102.8±11.3, 103.0±13.7 and 103.6±13.5, respectively, with no statistically significant difference (F=0.13, P=0.882). As for the secondary outcomes, the scores of visual persistence quotient in single-exposure, multiple-exposure and control groups were 94.8±10.5, 94.0±10.9 and 100.6±17.7, with a statistically significant difference (F=6.96, P=0.001). In terms of locomotion in social living ability scale, the score of the three groups was 10.0±0.2, 10.2±0.6 and 10.4±0.7, respectively, with a statistically significant difference (F=10.61, P<0.001), but all were within the standard range.

The surgical procedures and general anesthesia exposure within 2 hours in early childhood has no effect on the overall FSIQ in school age, but has a slight impacts on the visual persistence quotient of IVA-CPT and the locomotion score of social living ability scale.

To compare the safety and diagnostic efficiency of CT-guided trans-organ and non-trans-organ large needle biopsy in the diagnosis of pancreatic space-occupying lesions.

The clinical data of 367 patients with pancreatic mass who underwent CT-guided percutaneous biopsy in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2022 were retrospectively analyzed, including 211 males and 156 females, aged 18 to 87 (60.7±11.8) years old. They were divided into a trans-organ route group (n=142) and a non-trans-organ route group (n=225) according to whether traversing the organs during the procedures. The imaging data, pathological results, puncture process and complications of patients of the two groups were recorded. The successful rate for obtaining tissue,one-time successful diagnosis rate, accuracy, sensitivity, specificity, false negative rate and the incidence of complications were compared between the two groups.

There was no significant difference in baseline data between the two groups (all P>0.05).There were 28, 57, 24, and 33 biopsies were performed via a pathway traversing liver, stomach, small bowel and colon, respectively. The overall sampling success rates of the two groups were 100%.The one-time successful diagnosis rate did not show statistically difference between the two groups [86.6%(123/142) vs 87.1%(196/225),P=0.892]. There was no statistically difference in accuracy, sensitivity and false negative rates between trans-organ route group and non-trans-organ routegroup [92.3%(131/142) vs 92.0%(207/225), 91.8% (123/134) vs 90.0%(190/211) and 8.2% (11/134) vs 10.0%(21/211), all P>0.05]. The specificity was 100% in both groups. The common complications of the two groups were increased pancreatic amylase and hematoma, and there was no significant difference in the incidence of complications between the trans-organ route group and the non-trans-organ route group [10.6% (15/142) vs 12.4% (28/225), P=0.585]. In the trans-organ route group, 5 patients had increased pancreatic amylase and 10 patients had local hematoma, all of which were improved after conservative treatment. In the non-organ route group, 11 patients had elevated pancreatic amylase, and 17 patients had local hematoma, 1 case received surgical treatment due to bleeding, the rest were improved by conservative treatment.

CT-guided percutaneous transabdominal organ large needle biopsy of pancreatic space-occupying lesions has the comparable diagnostic efficiency and safety as non-transabdominal organ approach.

To determine the optimal examination duration by evaluating the detection rate of epileptiform discharges (EDs) with different examination duration of video-electroencephalography (EEG) in outpatients.

Patients with EDs who underwent 4-hour EEG examination from Xuanwu Hospital, Capital Medical University from October 2020 to November 2021 were retrospectively enrolled, and the detection rates of EDs were calculated with examination duration of 0-0.5 h, 0-1 h, 0-2 h, 0-3 h, and 0-4 h (group A, B, C, D and E), respectively. For each patient, EDs in each hour (group H1, group H2, group H3, group H4) were counted, and the standardized amount of EDs was calculated. For each patient, EDs in wakefulness, drowsiness, non-rapid eye movement-Ⅰ (NREM-Ⅰ), NREM-Ⅱ and NREM-Ⅲ were counted, and the standardized amount of EDs in each state was calculated. Meanwhile, the sleep duration per hour of each patient was also counted (group H1′, group H2′, group H3′, group H4′). The Wilcoxon paired test was used for intergroup comparison to determine the optimal examination duration.

A total of 80 patients were enrolled, and aged [M(Q₁, Q₃)]31 (21, 39) years (range: 5-68 years). There were 38 males and 42 females. The detection rate of EDs was 42.5% (34/80) in group A, 81.3% (65/80) in group B, and 100.0% (80/80) in group C, group D and group E, respectively. The standardized amount of EDs of H1, H2, H3 and H4 was 24.8% (7.8%, 44.2%), 41.5% (25.9%, 63.3%), 15.1% (1.3%, 27.8%) and 1.3% (0, 14.5%), respectively. The standardized amount of EDs of H2 was significantly higher than that of H1, H3 and H4 (all P<0.05). The standardized amount of EDs in wakefulness, drowsiness, NREM-Ⅰ, NREM-Ⅱ and NREM-Ⅲ were 9.6% (0, 28.2%), 3.6% (0, 16.9%), 3.3% (0, 11.8%), 47.3% (21.9%, 72.5%) and 0 (0, 11.5%), respectively. The standardized amount of EDs in NREM-Ⅱ was significantly higher than that in wakefulness, drowsiness, NREM-Ⅰ and NREM-Ⅲ (all P<0.05). The sleep duration in the group of the H1′, H2′, H3′ and H4′ was 13.6 (2.5, 23.6), 35.8 (16.5, 54.2), 14.5(0, 34.7) and 0 (0, 14.6) minutes, respectively. The sleep duration in the group of the H2′ group was significantly longer than that in the group of H1′, H3′ and H4′ (all P<0.05).

The study recommends 2 hours video-EEG in outpatients, which not only ensures the detection rate of EDs, but also facilitates patient cooperation and optimizes the allocation of medical resources.

Anaplastic thyroid carcinoma (ATC) is one of the most malignant tumors. However, in recent years, the prognosis of the disease has also changed quietly, and there have been reports of successful clinical treatment and significantly prolonged survival time. Based on the successful treatment of a 79-year-old patient and more than three years of follow-up, as well as the clinical analysis of 45 ATC patients, the author deeply believes that it is necessary to re-examine the understanding of ATC and urgently adjust the clinical strategies. If ATC can be diagnosed early and treated by comprehensive treatment based on radical surgery, the prognosis of a considerable number of patients can be greatly improved, the overall survival time will be greatly prolonged, and a considerable number of patients may achieve clinical cure. In addition, genetic testing and targeted therapy bring a new hope for the survival of some patients.

Hypothyroidism (hypothyroidism) is closely related to cognitive function, and its performance varies from age to age. The cognitive impairment of fetal and neonatal onset is the most severe, and it is easy to leave lifelong sequelae; In adult patients, the relationship between hypothyroidism and cognitive impairment is still controversial. Existing opinions suggest that the different manifestations of this cognitive impairment in different age groups may be related to the different periods of hypothyroidism in the process of nervous system development, which presents a time-dependent relationship, but its specific mechanism has not been fully elucidated, which may be related to immune factors. This paper summarizes the relationship between hypothyroidism and cognitive impairment in different age groups and its possible mechanisms.

Autoimmune thyroiditis and primary Sjogren's syndrome are the most common autoimmune diseases. Whether comorbidity is an overlap of autoimmune diseases or different manifestations of the same disease, and whether there is a causal relationship between the two, it is still unclear. Patients with primary Sjogren's syndrome combined with autoimmune thyroiditis often have more severe clinical manifestations. This paper reviews the common genetic basis, environmental influencing factors, immune mechanism and histological characteristics of the relationship between autoimmune thyroiditis and primary Sjogren's syndrome.

Since 1996, the compulsory universal salt iodization policy has been implemented nationwide. In the 20 years of policy implementation and revision, the iodine nutritional status of the Chinese population experienced 5 consecutive years of excess iodine, 10 years of super-sufficient iodine and 5 years of moderate iodine. In order to gain a more accurate and comprehensive understanding of the changes in the prevalence of thyroid diseases in mainland China from 2009 to 2015 with the transition from excessive iodine to moderate iodine status, this study provides data from two population-based repeated cross-sectional surveys with nationally representative surveys; Furthermore, this study determined changes in thyroid stimulating hormone levels. Both cross-sectional surveys used a multi-stratified phased random sampling approach to include participants aged 18 years and older from seven geographic regions across the country who had lived in the chosen community for at least 5 years; If female, require not to be pregnant. After excluding participants with missing information on gender, age, thyroid function, and thyroid ultrasound, a total of 14 925 participants in 2009 and 12 553 participants in 2015 were included in this study.

Recent studies have shown that hysterosalpingography (HSG) with oil-soluble contrast agent (OSCM) improves pregnancy rates. However, OSCM has a high iodine content and may lead to iodine excess due to the long half-life of iodine element. Therefore, the investigators conducted a prospective cohort study to clarify the safety of OSCM HSG, particularly iodine overdose and its effect on thyroid function. The study included 196 women who met the inclusion criteria without significant hypothyroidism (hypothyroidism) or hyperthyroidism (hyperthyroidism). All participants received and completed the OSCM HSG (Auckland, 2019 – 2021), with compliance>95%. Participants were monitored for thyrotropin (TSH), free thyroxine (FT4), and urinary iodine concentration (UIC) for 24 consecutive weeks in this study.

The number of COVID-19 infections is gradually increasing worldwide. Based on the COVID-19 vaccines developed by different research institutions, clinical data show that they can alleviate severe COVID-19. But at the same time there are concerns about the possibility of vaccination-induced thyroid dysfunction. Hypothyroidism As a common condition worldwide, there are indications that COVID-19 patients with hypothyroidism have a poor prognosis, possibly due to the role that thyroid hormones play in the immune system.