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新生儿筛查时发现先天性甲状腺功能减低症伴促甲状腺素轻度升高的儿童之甲状腺功能纵向研究
Longitudinal study of thyroid function in children with mild hyperthyrotropinemia at neonatal screening for congenital hypothyroidism
Leonardi D, Polizzotti N, Carta A  2009/5/27 10:49:00 
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J Clin Endocrinol Metab, 2008,
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Abstract
Objective:
Long-term outcome of thyroid function in children with very short lasting neonatal hyperthyrotropinemia (“false positive” at neonatal screening) was studied in an observational, prospective study.

Thyroid function and morphology were evaluated in 44 “false positive” children up to advanced childhood (8.0±0.7 years of age). In these children a high prevalence (50%) of subclinical hypothyroidism in early childhood (2.8±0.5 years) had already been described.

Results:
At average 5.3 years subclinical hypothyroidism persisted in 19/44 (43.2%) children and, more specifically, in 2/3 of those who had increased TSH in early childhood. Euthyroidism was present in all cases that were euthyroid in early childhood, although they had TSH and FT3 values significantly higher than control children with a normal TSH at birth (TSH=2.6±0.7 vs 1.5±0.6mU/L, p<0.001; FT3=4.9±0.8 vs 3.9±0.9pmol/L, p<0.01). Thyroid morphology alterations were frequent in the group of children with subclinical hypothyroidism.

At average 8.0 years, subclinical hypothyroidism persisted in 14/44 (31.8%) children. In all other children TSH and thyroid hormones were confirmed within the normal range.

Conclusions:
This prospective longitudinal study confirms that newborns “false positive” at neonatal screening have a high risk to develop persistent subclinical hypothyroidism. The prevalence of hypothyroidism decreases with increasing age, but it is still high (over 30%) in late childhood. Even those “false positive” children that maintain euthyroidism in late childhood have an average TSH value that, although within the normal range, is higher than in normal controls, a possible marker of minor congenital thyroid function abnormalities
 

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疾病资源中心  疾病资源中心
病例分析 <span class="ModTitle_Intro_Right" id="EPMI_Home_MedicalCases_Intro_div" onclick="javascript:window.location='http://www.elseviermed.cn/tabid/127/Default.aspx'" onmouseover="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.cursor='pointer';document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='underline';" onmouseout="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='none';">[栏目介绍]</span>  病例分析 [栏目介绍]

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者,女,69岁。2009年1月无明显诱因下出现乏力,当时程度较轻,未予以重视。2009年3月患者乏力症状加重,尿色逐渐加深,大便习惯改变,颜色变淡。4月18日入我院感染科治疗,诉轻度头晕、心慌,体重减轻10kg。无肝区疼痛,无发热,无腹痛、腹泻、腹胀、里急后重,无恶性、呕吐等。入院半月前于外院就诊,查肝功能:ALT 601IU/L,AST 785IU/L,TBIL 97.7umol/L,白蛋白 41g/L,甲状腺功能:游离T3 30.6pmol/L,游离T4 51.9pmol/L,心电图示快速房颤。
 

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