Introduction: Serum Thyrotropin (TSH) level is used to assess adequacy of levothyroxine dosing for patients with hypothyroidism. Some patients have raised TSH levels despite being on an adequate dose of levothyroxine ...Introduction: Serum Thyrotropin (TSH) level is used to assess adequacy of levothyroxine dosing for patients with hypothyroidism. Some patients have raised TSH levels despite being on an adequate dose of levothyroxine (100 mcg/day - 200 mcg/day). Aim: To evaluated the effect of advising patients to take their levothyroxine 45 - 60 minutes before breakfast on raised serum TSH levels. Patients and Methods: Rather than increase the dose, patients with raised TSH levels were asked to take their levothyroxine at least 45 - 60 minutes before breakfast and other oral medications. Thyroid Function Tests were assessed at base line and repeated after two months. Results: Data from ten patients who presented between 2008 and 2010 were analyzed (9 females, 1 male): With median (IQR) age: 39 (33 - 49) years and duration of hypothyroidism: 6 (3 - 7.8) years. Median (IQR) levothyroxine dose was 175 (144 - 250) mcg, serum free-Thyroxine (free-T4): 13 (10.5 - 17.1) pmol/L and serum TSH: 12.63 (6.2 - 48.3) mIU/L. After two months all patients demonstrated biochemical improvement;a decrease in serum TSH to 3.15 (0.4 - 6.1) mIU/L accompanied by an increase in serum free-T4 to 17.7 (14.8 - 21.3) pmol/L. Both changes were statistically significant (p < 0.05 and p < 0.01, respectively). The median (IQR) percentage TSH reduction was 83.5 (40.3 - 95.8) mIU/L and this bore no significant correlation with the initial TSH level (rs = 0.2, p = 0.58). Conclusion: Changing levothyroxine administration to 45 - 60 minutes before breakfast and other oral medications reduced TSH levels by 40% - 96% in all patients. We recommend this advice for all patients with hypothyroidism on adequate doses of levothyroxine but still appear biochemically under-replaced.展开更多
Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In t...Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit.展开更多
BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initi...BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine(10 mg).The patient transiently lost consciousness and developed atrial fibrillation during hospitalization.We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine,propranolol to control heart rate,hydrocortisone to correct severe thyrotoxicosis,and hemoperfusion to increase levothyroxine clearance.The patient recovered and was discharged.CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine,it is critical to monitor vital signs and initiate effective treatment.展开更多
BACKGROUND Yougui pills have long been used to treat hypothyroidism,usually in combination with levothyroxine sodium in clinical treatment,while their clinical efficacy and safety are still controversial when compared...BACKGROUND Yougui pills have long been used to treat hypothyroidism,usually in combination with levothyroxine sodium in clinical treatment,while their clinical efficacy and safety are still controversial when compared to levothyroxine treatment alone.AIM To explore the clinical efficacy and safety of Yougui pills combined with levothyroxine sodium in the treatment of hypothyroidism.METHODS This meta-analysis was performed in accordance with the PRISMA guidelines.Randomized controlled trials on Yougui pills in the treatment of hypothyroidism published from 2008 to May 2021 were searched in a total of 8 databases(4 databases in Chinese and 4 databases in English).The quality of the included studies was evaluated according to the Cochrane risk assessment tool.Weighted mean difference(WMD)was used for continuous variables,and relative risk(RR)was used for binary variables.Data were extracted,and the meta-analysis was conducted with the statistical software of Stata15.0 and RevMan5.0.RESULTS A total of 140 articles were retrieved,and 9 of them were finally included,with a total sample size of 936 cases.The main meta-analysis results are as follows:(1)The group of Yougui pills combined with levothyroxine sodium had a significantly higher overall response rate than the group of levothyroxine sodium(RR=1.20,95%CI 1.12,1.28,P<0.00001);(2)Yougui pills combined with levothyroxine sodium achieved significantly better efficacy than levothyroxine sodium alone in alleviating adverse symptoms[standard mean difference(SMD)=-1.10,95%CI:-1.37,-0.84,P<0.00001];(3)The level of thyrotropin stimulating hormone in the group of Yougui pills combined with levothyroxine sodium was significantly lower than in the control group of levothyroxine sodium(WMD=-1.38,95%CI:-2.10,-0.67,P=0.00001);(4)The level of free triiodothyronine in the group of Yougui pills combined with levothyroxine sodium was higher than that in the control group of levothyroxine sodium(WMD=0.41,95%CI:0.03,0.79,P=0.03);(5)The level of free thyroxine in the group of Yougui pills combined with levothyroxine sodium was significantly higher than that in the control group of levothyroxine sodium(SMD=0.83,95%CI:0.44,1.22,P≤0.0001);and(6)The adverse reactions in the group of Yougui pills combined with levothyroxine sodium were significantly less than those in the control group of levothyroxine sodium(RR=0.33,95%CI:0.20,-0.53,P<0.00001).CONCLUSION In the treatment of hypothyroidism,the combination of Yougui pills with levothyroxine sodium may be better than levothyroxine sodium treatment alone.展开更多
Rationale: Levothyroxine is the most commonly used agent in thyroid hormone replacement therapy. Although there are many hypothyroid patients who use levothyroxine as a treatment, high level of thyroid stimulating hor...Rationale: Levothyroxine is the most commonly used agent in thyroid hormone replacement therapy. Although there are many hypothyroid patients who use levothyroxine as a treatment, high level of thyroid stimulating hormone is found in a limited number of levothyroxine overdose cases worldwide.Patient concern: A 34-year-old male patient taking 4.5 mg levothyroxine for suicide. Diagnosis: Overdose of levothyroxine. Interventions: The patient was admitted to the intensive care unit for follow-up treatment. Cardiac rithym and vital parameters of patient were closely monitored. Outcomes: The patient discharged without any life-threatening complications. Lessons: Patient with initial high thyroid stimulating hormone levels may not be in hyperthyroidism crisis by levothyroxine poisoning.展开更多
Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Dep...Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.展开更多
Objective:To study the protective effect of levothyroxine on myocardial and cerebral ischemia reperfusion injury during surgery under cardiopulmonary bypass.Methods: Patients who underwent valve replacement under card...Objective:To study the protective effect of levothyroxine on myocardial and cerebral ischemia reperfusion injury during surgery under cardiopulmonary bypass.Methods: Patients who underwent valve replacement under cardiopulmonary bypass in Mianyang Central Hospital between March 2015 and December 2017 were selected and randomly divided into the Euthyrox group who received preoperative levothyroxine therapy and the control group who received routine preoperative intervention. The myocardial and cerebral injury indexes, pro-inflammatory and adhesion molecules as well as antioxidant indexes were measured before operation and 12 h after operation.Results: Twelve hours after operation, serum cTnI, LDH, CK-MB, H-FABP, NSE, S100B, CD11b/CD18, sP-selectin, IL-1 and IL-10 contents as well as SjvO2 levels of both groups were higher than those before operation whereas Cu-Zn SOD, CAT and GSH-Px contents were lower than those before operation, and serum cTnI, LDH, CK-MB, H-FABP, NSE, S100B, CD11b/CD18, sP-selectin, IL-1 and IL-10 contents as well as SjvO2 level of Euthyrox group were lower than those of control group whereas Cu-Zn SOD, CAT and GSH-Px contents were higher than those of control group.Conclusions:Levothyroxine has protective effect on the myocardial and cerebral ischemia reperfusion injury induced by inflammation and oxidative stress during surgery under cardiopulmonary bypass.展开更多
The thyroid hormones, triiodothyronine and thyroxine, play important roles in cognitive function during the mammalian lifespan. However, thyroid hormones have not yet been used as a therapeutic agent for normal age-re...The thyroid hormones, triiodothyronine and thyroxine, play important roles in cognitive function during the mammalian lifespan. However, thyroid hormones have not yet been used as a therapeutic agent for normal age-related cognitive deficits. In this study, CD-1 mice(aged 24 months) were intraperitoneally injected with levothyroxine(L-T4; 1.6 μg/kg per day) for 3 consecutive months. Our findings revealed a significant improvement in hippocampal cytoskeletal rearrangement of actin and an increase in serum hormone levels of L-T4-treated aged mice. Furthermore, the survival rate of these mice was dramatically increased from 60% to 93.3%. The Morris water maze task indicated that L-T4 restored impaired spatial memory in aged mice. Furthermore, level of choline acetyltransferase, acetylcholine, and superoxide dismutase were increased in these mice, thus suggesting that a possible mechanism by which L-T4 reversed cognitive impairment was caused by increased activity of these markers. Overall, supplement of low-dosage L-T4 may be a potential therapeutic strategy for normal age-related cognitive deficits.展开更多
Objective To investigate the effects of substitutive and suppressive doses of levothyroxine on bone metabolism in patients with differentiated thyroid carcinoma after surgery and 131I ablation. Methods The patients, w...Objective To investigate the effects of substitutive and suppressive doses of levothyroxine on bone metabolism in patients with differentiated thyroid carcinoma after surgery and 131I ablation. Methods The patients, who had received levothyroxine(L-T4) for at least 3 years for treating their differentiated thyroid carcinoma after surgery and 131I therapy, were classified into substitutive group and suppressive group according to the levels of serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH). We compared the levels of FT3, FT4, TSH, serum parathyroid hormone (PTH), serum calcium (Ca), serum phosphate (P), serum alkaline phosphates (ALP) and Bone mineral density (BMD) to those of healthy volunteers well matched for sex, age, menopausal status, and body mass index (BMI). Results No significant differences were found in the bone density and biochemical parameters of bone metabolism of the subjects treated with substitutive or suppressive doses of L-T4 compared with the control subgroup. No significant differences were observed among the subgroups according to accumulative doses of 131I. No bone fracture was found in all the patients. Conclusion The substitutive and suppressive doses of L-T4 are safe and necessary for patients with differentiated thyroid carcinoma after surgery and 131I therapy. Such treatment for 3 years is not associated with increased risk of osteoporosis. Much longer term of follow up is still needed in patients receiving substitutive and suppressive doses of L-T4.展开更多
To the Editor: On March 9, 2018, a 31-year-old woman presented with liver dysfunction after thyroid cancer surgery. She was physically healthy;had no chronic diseases, such as hypertension and diabetes;had no history ...To the Editor: On March 9, 2018, a 31-year-old woman presented with liver dysfunction after thyroid cancer surgery. She was physically healthy;had no chronic diseases, such as hypertension and diabetes;had no history of infectious diseases, such as hepatitis and tuberculosis;had no history of drugs, food allergies, smoking, and alcohol consumption;and presented no obvious complaints during the disease course. B-ultrasound in the physical examination 3 years prior showed “left thyroid-occupying position.” On February 5, 2018, she had undergone surgery at our hospital. Laboratory findings on February 6, 2018 revealed white blood cells (WBCs) 9.06 × 10^9/L (3.50–9.50 × 10^9/L);neutrophils (NEs) 5.66 × 10^9/L (1.80–6.30 × 10^9/L);triiodothyronine (T3) 0.94 (0.80–2.00) ng/mL;thyroxine (T4) 6.4 (5.1–14.1)μg/dL;free T3 (FT3) 3.95 (3.10–6.80) pmol/L;free T4 (FT4) 15.57 (12.00–22.00) pmol/L;thyroid-stimulating hormone (TSH) 2.56 (0.27–4.20) mU/L;thyroid peroxidase antibody (TPOAb) 8.2 (0–34.0) IU/mL;thyroglobulin antibody (TgAb)<10 (≤115) IU/mL;total bilirubin (T-BIL) 21.5 (5.0–22.0)μmol/L;direct bilirubin (D-BIL) 6.3 (0–10.2)μmol/L;alanine transaminase (ALT) 27.5 (7.0–40.0) U/L;aspartate transaminase (AST) 22.7 (13.0–35.0) U/L;and alkaline phosphatase (ALP), 48.9 (35.0–100.0) U/L. Hepatitis C antibody, hepatitis B surface antigen, and hepatitis B core antibody immunoglobulin M tested negative. On February 7, 2018, intra-operative pathology during left thyroidectomy indicated micro-papillary carcinoma. On February 11, 2018, she was discharged and prescribed levothyroxine tablets A (LTA;Merck KGaA, Darmstadt, Germany) 100 μg and calcium carbonate D3 tablets (CC-D3;Pfizer, China) 600 mg once daily.展开更多
文摘Introduction: Serum Thyrotropin (TSH) level is used to assess adequacy of levothyroxine dosing for patients with hypothyroidism. Some patients have raised TSH levels despite being on an adequate dose of levothyroxine (100 mcg/day - 200 mcg/day). Aim: To evaluated the effect of advising patients to take their levothyroxine 45 - 60 minutes before breakfast on raised serum TSH levels. Patients and Methods: Rather than increase the dose, patients with raised TSH levels were asked to take their levothyroxine at least 45 - 60 minutes before breakfast and other oral medications. Thyroid Function Tests were assessed at base line and repeated after two months. Results: Data from ten patients who presented between 2008 and 2010 were analyzed (9 females, 1 male): With median (IQR) age: 39 (33 - 49) years and duration of hypothyroidism: 6 (3 - 7.8) years. Median (IQR) levothyroxine dose was 175 (144 - 250) mcg, serum free-Thyroxine (free-T4): 13 (10.5 - 17.1) pmol/L and serum TSH: 12.63 (6.2 - 48.3) mIU/L. After two months all patients demonstrated biochemical improvement;a decrease in serum TSH to 3.15 (0.4 - 6.1) mIU/L accompanied by an increase in serum free-T4 to 17.7 (14.8 - 21.3) pmol/L. Both changes were statistically significant (p < 0.05 and p < 0.01, respectively). The median (IQR) percentage TSH reduction was 83.5 (40.3 - 95.8) mIU/L and this bore no significant correlation with the initial TSH level (rs = 0.2, p = 0.58). Conclusion: Changing levothyroxine administration to 45 - 60 minutes before breakfast and other oral medications reduced TSH levels by 40% - 96% in all patients. We recommend this advice for all patients with hypothyroidism on adequate doses of levothyroxine but still appear biochemically under-replaced.
文摘Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit.
文摘BACKGROUND The literature on thyrotoxicosis caused by excessive ingestion of exogenous thyroid hormone is limited,and most cases reported have involved pediatric clinical studies.CASE SUMMARY A 21-year-old woman initially presented with palpitation and chest tightness after an overdose of levothyroxine(10 mg).The patient transiently lost consciousness and developed atrial fibrillation during hospitalization.We used propylthiouracil to decrease the peripheral conversion of T4 to T3 and inhibit the synthesis of endogenous thyroxine,propranolol to control heart rate,hydrocortisone to correct severe thyrotoxicosis,and hemoperfusion to increase levothyroxine clearance.The patient recovered and was discharged.CONCLUSION For patients with thyrotoxicosis after taking excess levothyroxine,it is critical to monitor vital signs and initiate effective treatment.
基金Supported by the National Natural Science Foundation of China,No.81973754Shaanxi University of Traditional Chinese Medicine Innovation Team Project,No.2019-QN06.
文摘BACKGROUND Yougui pills have long been used to treat hypothyroidism,usually in combination with levothyroxine sodium in clinical treatment,while their clinical efficacy and safety are still controversial when compared to levothyroxine treatment alone.AIM To explore the clinical efficacy and safety of Yougui pills combined with levothyroxine sodium in the treatment of hypothyroidism.METHODS This meta-analysis was performed in accordance with the PRISMA guidelines.Randomized controlled trials on Yougui pills in the treatment of hypothyroidism published from 2008 to May 2021 were searched in a total of 8 databases(4 databases in Chinese and 4 databases in English).The quality of the included studies was evaluated according to the Cochrane risk assessment tool.Weighted mean difference(WMD)was used for continuous variables,and relative risk(RR)was used for binary variables.Data were extracted,and the meta-analysis was conducted with the statistical software of Stata15.0 and RevMan5.0.RESULTS A total of 140 articles were retrieved,and 9 of them were finally included,with a total sample size of 936 cases.The main meta-analysis results are as follows:(1)The group of Yougui pills combined with levothyroxine sodium had a significantly higher overall response rate than the group of levothyroxine sodium(RR=1.20,95%CI 1.12,1.28,P<0.00001);(2)Yougui pills combined with levothyroxine sodium achieved significantly better efficacy than levothyroxine sodium alone in alleviating adverse symptoms[standard mean difference(SMD)=-1.10,95%CI:-1.37,-0.84,P<0.00001];(3)The level of thyrotropin stimulating hormone in the group of Yougui pills combined with levothyroxine sodium was significantly lower than in the control group of levothyroxine sodium(WMD=-1.38,95%CI:-2.10,-0.67,P=0.00001);(4)The level of free triiodothyronine in the group of Yougui pills combined with levothyroxine sodium was higher than that in the control group of levothyroxine sodium(WMD=0.41,95%CI:0.03,0.79,P=0.03);(5)The level of free thyroxine in the group of Yougui pills combined with levothyroxine sodium was significantly higher than that in the control group of levothyroxine sodium(SMD=0.83,95%CI:0.44,1.22,P≤0.0001);and(6)The adverse reactions in the group of Yougui pills combined with levothyroxine sodium were significantly less than those in the control group of levothyroxine sodium(RR=0.33,95%CI:0.20,-0.53,P<0.00001).CONCLUSION In the treatment of hypothyroidism,the combination of Yougui pills with levothyroxine sodium may be better than levothyroxine sodium treatment alone.
文摘Rationale: Levothyroxine is the most commonly used agent in thyroid hormone replacement therapy. Although there are many hypothyroid patients who use levothyroxine as a treatment, high level of thyroid stimulating hormone is found in a limited number of levothyroxine overdose cases worldwide.Patient concern: A 34-year-old male patient taking 4.5 mg levothyroxine for suicide. Diagnosis: Overdose of levothyroxine. Interventions: The patient was admitted to the intensive care unit for follow-up treatment. Cardiac rithym and vital parameters of patient were closely monitored. Outcomes: The patient discharged without any life-threatening complications. Lessons: Patient with initial high thyroid stimulating hormone levels may not be in hyperthyroidism crisis by levothyroxine poisoning.
文摘Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.
文摘Objective:To study the protective effect of levothyroxine on myocardial and cerebral ischemia reperfusion injury during surgery under cardiopulmonary bypass.Methods: Patients who underwent valve replacement under cardiopulmonary bypass in Mianyang Central Hospital between March 2015 and December 2017 were selected and randomly divided into the Euthyrox group who received preoperative levothyroxine therapy and the control group who received routine preoperative intervention. The myocardial and cerebral injury indexes, pro-inflammatory and adhesion molecules as well as antioxidant indexes were measured before operation and 12 h after operation.Results: Twelve hours after operation, serum cTnI, LDH, CK-MB, H-FABP, NSE, S100B, CD11b/CD18, sP-selectin, IL-1 and IL-10 contents as well as SjvO2 levels of both groups were higher than those before operation whereas Cu-Zn SOD, CAT and GSH-Px contents were lower than those before operation, and serum cTnI, LDH, CK-MB, H-FABP, NSE, S100B, CD11b/CD18, sP-selectin, IL-1 and IL-10 contents as well as SjvO2 level of Euthyrox group were lower than those of control group whereas Cu-Zn SOD, CAT and GSH-Px contents were higher than those of control group.Conclusions:Levothyroxine has protective effect on the myocardial and cerebral ischemia reperfusion injury induced by inflammation and oxidative stress during surgery under cardiopulmonary bypass.
基金supported by the National Natural Science Foundation of China,No.81273416Fundamental Research Funds for the Central Universities,No.XDJK2013A030
文摘The thyroid hormones, triiodothyronine and thyroxine, play important roles in cognitive function during the mammalian lifespan. However, thyroid hormones have not yet been used as a therapeutic agent for normal age-related cognitive deficits. In this study, CD-1 mice(aged 24 months) were intraperitoneally injected with levothyroxine(L-T4; 1.6 μg/kg per day) for 3 consecutive months. Our findings revealed a significant improvement in hippocampal cytoskeletal rearrangement of actin and an increase in serum hormone levels of L-T4-treated aged mice. Furthermore, the survival rate of these mice was dramatically increased from 60% to 93.3%. The Morris water maze task indicated that L-T4 restored impaired spatial memory in aged mice. Furthermore, level of choline acetyltransferase, acetylcholine, and superoxide dismutase were increased in these mice, thus suggesting that a possible mechanism by which L-T4 reversed cognitive impairment was caused by increased activity of these markers. Overall, supplement of low-dosage L-T4 may be a potential therapeutic strategy for normal age-related cognitive deficits.
基金grants from Foundation of Shanghai Science and Technology, China (024119053).
文摘Objective To investigate the effects of substitutive and suppressive doses of levothyroxine on bone metabolism in patients with differentiated thyroid carcinoma after surgery and 131I ablation. Methods The patients, who had received levothyroxine(L-T4) for at least 3 years for treating their differentiated thyroid carcinoma after surgery and 131I therapy, were classified into substitutive group and suppressive group according to the levels of serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH). We compared the levels of FT3, FT4, TSH, serum parathyroid hormone (PTH), serum calcium (Ca), serum phosphate (P), serum alkaline phosphates (ALP) and Bone mineral density (BMD) to those of healthy volunteers well matched for sex, age, menopausal status, and body mass index (BMI). Results No significant differences were found in the bone density and biochemical parameters of bone metabolism of the subjects treated with substitutive or suppressive doses of L-T4 compared with the control subgroup. No significant differences were observed among the subgroups according to accumulative doses of 131I. No bone fracture was found in all the patients. Conclusion The substitutive and suppressive doses of L-T4 are safe and necessary for patients with differentiated thyroid carcinoma after surgery and 131I therapy. Such treatment for 3 years is not associated with increased risk of osteoporosis. Much longer term of follow up is still needed in patients receiving substitutive and suppressive doses of L-T4.
文摘To the Editor: On March 9, 2018, a 31-year-old woman presented with liver dysfunction after thyroid cancer surgery. She was physically healthy;had no chronic diseases, such as hypertension and diabetes;had no history of infectious diseases, such as hepatitis and tuberculosis;had no history of drugs, food allergies, smoking, and alcohol consumption;and presented no obvious complaints during the disease course. B-ultrasound in the physical examination 3 years prior showed “left thyroid-occupying position.” On February 5, 2018, she had undergone surgery at our hospital. Laboratory findings on February 6, 2018 revealed white blood cells (WBCs) 9.06 × 10^9/L (3.50–9.50 × 10^9/L);neutrophils (NEs) 5.66 × 10^9/L (1.80–6.30 × 10^9/L);triiodothyronine (T3) 0.94 (0.80–2.00) ng/mL;thyroxine (T4) 6.4 (5.1–14.1)μg/dL;free T3 (FT3) 3.95 (3.10–6.80) pmol/L;free T4 (FT4) 15.57 (12.00–22.00) pmol/L;thyroid-stimulating hormone (TSH) 2.56 (0.27–4.20) mU/L;thyroid peroxidase antibody (TPOAb) 8.2 (0–34.0) IU/mL;thyroglobulin antibody (TgAb)<10 (≤115) IU/mL;total bilirubin (T-BIL) 21.5 (5.0–22.0)μmol/L;direct bilirubin (D-BIL) 6.3 (0–10.2)μmol/L;alanine transaminase (ALT) 27.5 (7.0–40.0) U/L;aspartate transaminase (AST) 22.7 (13.0–35.0) U/L;and alkaline phosphatase (ALP), 48.9 (35.0–100.0) U/L. Hepatitis C antibody, hepatitis B surface antigen, and hepatitis B core antibody immunoglobulin M tested negative. On February 7, 2018, intra-operative pathology during left thyroidectomy indicated micro-papillary carcinoma. On February 11, 2018, she was discharged and prescribed levothyroxine tablets A (LTA;Merck KGaA, Darmstadt, Germany) 100 μg and calcium carbonate D3 tablets (CC-D3;Pfizer, China) 600 mg once daily.
