Metabolic Disease Management Guideline for National Metabolic Management Center(2nd edition) / 中华内分泌代谢杂志

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Implication of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with thyrotoxicosis: significance in differential diagnosis / 中华内分泌代谢杂志

Objective The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as the biomarkers to predict systemic inflammation. However, there is less study to investigate the association between the biomarkers and thyrotoxicosis. Methods A total of 1 012 healthy subjects and 1 599 newly diagnosed thyrotoxicosis patients were enrolled in this study, including 978 in Graves′ disease (GD group), 452 in Hashimoto′s thyroiditis (HT group), and 169 in subacute thyroiditis (SAT group) groups. The clinical characteristics were retrospectively extracted from the medical records. The NLR and PLR at the baseline were calculated, the correlations between the NLR, PLR, and the clinical characteristics were analyzed. Results The NLR and PLR in SAT patients were significantly higher than those in the control, GD, and HT groups (all P<0.01), but were similar among the last three groups. The NLRs were positively correlated with white blood cell counts (r=0.5, P<0.01) and erythrocyte sedimentation rates (r=0.4, P<0.01), while the PLR was positively correlated with FT4 (r=0.16, P<0.05) and erythrocyte sedimentation rate (r=0.47, P<0.01). The SAT patients with abnormal liver function showed higher NLR and PLR compared the patients with normal liver function (all P<0.01). Based on the receiver operating characteristic curve, when to predict SAT patient with autoimmune thyrotoxicosis, the best cutoff value of NLR was 2.0 (sensitivity 80.5%, specificity 76.9%, area under curve 0.833), and the best cutoff value of PLR was 150 (sensitivity 64.3%, specificity 84.2%, area under curve 0.801). Conclusions The NLR and PLR values exhibited a dignostic value in the differentiation of SAT from autoimmune thyrotoxicosis.

Mechanism of persistent thyrotropin suppression in euthyroid patients with Graves′ disease after treatment / 中华内分泌代谢杂志

Objective To explore the mechanism of persistent thyrotropin suppression in euthyroid patients with Graves′ disease after antithyroid drugs (ATD) treatment. Methods A prospective clinical study was performed in 122 patients with newly diagnosed Graves′ disease. All the patients were treated with 30 mg methimazole or 300 mg propylthiouracil daily, to whom L-T4was added, aiming at normalizing FT3 and FT4 but avoiding elevated TSH level. When the patients were clinically and biochemically euthyroid for at least 3 months, their blood levels of thyroid hormones, TSH, TSH receptor antibody(TRAb) and thyroid peroxidase antibody(TPOAb) were detected again and the cases were divided into two groups according to negative or positive TRAb. Results After treatment as long as (7.1±1.1) months, stable euthyroid status was restored for 3 months. When the patients reached the euthyroid state, 64 of them still had detectable TRAb levels, and 58 became negative TRAb. The two groups had similar levels of FT3 and FT4, but patients with positive TRAb had lower TSH level than patients with negative TRAb[0.044 mIU/L(0.001-4.163 mIU/L) vs 1.749 mIU/L(0.079-4.646 mIU/L),P＜0.01]. In addition, the TSH level was negatively correlated with TRAb level (r=-0.539, P＜0.01), and not with FT3, FT4 levels or other factors. Conclusion The present study showed that elevated TRAb level is associated with persistent suppression of TSH in patients with Graves′ disease after being rendered euthyroid. This finding may be due to the binding of TRAb to pituitary TSH receptor.

Prognostic factors in the relapse of Graves disease / 中华内科杂志

Objective To evaluate the variables which can be used as prognostic factors in predicting the outcome of Graves disease(GD)after treatment with antithyroid drugs.Methods We performed a retrospective audit of 204 patients with newly diagnosed Graves disease consecutively at the Ruijin Hospital.Results Overall,110 patients(53.9%)were considered to be treatment failures.Age at the time of diagnosis was(31.0±12.2)years in the successful group and(36.3±14.0)years in the failure group.Free T3(FT3)was(25.60±9.52)pmol/L and(19.16±6.38)pmol/L in the failure and the successful group(P=0.001).FT3 to FT4 ratio and thyrotrophin recptor antibody(TRAb)levels were higher in the failure group(P=0.001).Logistic regression analysis showed that thyroid size,FT3 to FT4 ratio and TRAb at the time of diagnosis were associated with failure outcome.The patients reached euthyroid state at 3,6,9 and 12 months respectively and in the failure group the patients with continued thyrotropin suppression were more than those in the successful group(P=0.001).Conclusions Graves disease patients with large thyroid size,high levels of TRAb and FT3 to FT4 ratio before drug treatment are more likely to fail to respond to antithyroid drug treatment.We also found that patients with continuing thyrotropin suppression and attainmen of euthyroid state in the course of treatment had low remission rate and prolonged therapy.