| Objective: To investigate the characteristics of Hashimoto's thyroiditis with normal thyroid function in patients with thyroid nodules,and to study the correlation between autoimmune thyroiditis and insulin resistance in patients with thyroid nodules.Clear nature and its etiology research provide basis and new ideas.Methods:From July 2015 to August 2017,a total of 256 patients with thyroid nodule were examined by fine needle aspiration cytology in 2 endocrine departments of our hospital.Except for 70 cases of diabetes mellitus and 14 cases of postoperative thyroid neoplasms,2 cases of PCOS patients and 3 cases of patients in the course of hormone impulse therapy,a total of 167 cases,including 111 cases of single thyroid nodule,There were 56 cases with two or more nodules.In this study,111 patients with single thyroid nodule underwent fine needle aspiration cytology examination were selected as experimental group,and 86 healthy persons(50 women,50 females)who were examined in our department of endocrinology at the same time were selected.36 male patients were investigated by questionnaire,physical examination,biochemical examination and thyroid ultrasound examination.Anthropometric indexes such as height,weight,waist circumference were used.Fasting morning(8 hours overnight fasting)take cubital vein blood to measure free thyroid hormone FT4,free triiodothyronine(FT3),sensitive-thyroid stimulating hormone(s TSH),antithyroglobulin antibody.Serum glucose and insulin levels were measured by oral glucose tolerance test(OGTT)and insulin release test.The differences between the two groups were compared: SPSS21.0 software was used to analyze the data,all the data were tested by normal distribution and homogeneity of variance,and T test was used between the mean of two samples of normal distribution.Two groups of data with non-normal distribution were tested by rank sum test,and the rates were compared by chi-square test.The correlation of the three diseases was analyzed by person correlation analysis,and the difference was statistically significant(P < 0.05).Results:1.A total of 197 subjects(19-79 years old,mean age 46.80 ±12.46)were included in the study,of which 111 cases(female 75,male 36,age 22-79 years,mean age 48.70 ±12.20)in the thyroid nodule group(experimental group)and 86 healthy persons(control group,50 cases)were included in the study.There were 36 males aged19-66 years with an average age of 44.35 ±12.45 years old.Statistical analysis showedthat there was no significant difference in age,sex,height,weight,waist circumference between the two groups,and there was significant difference in BMI between the experimental group and the control group.There were significant differences in FT4 and FT3?TPOAb?TGAb,but there was no statistical significance,but the measured value of s TSH in the thyroid nodule group was significantly higher than that in the control group(P<0.05).2.to evaluate the insulin resistance between the two groups,there were significant differences in FPG?FINS ?2h glucose?2h insulin and HOMR-index between the experimental group and the control group.The detection rate of insulin resistance in thyroid nodule group was 46.85 and that in control group was 24.42.There was statistical difference between the two groups(P < 0.05).The standard of insulin resistance was HOMR-index ? 2.380(75 percentile of IR value in control group).3.the levels of s TSH in thyroid nodule group and control group were(3.21 ±3.68)and(2.29 ±0.83),TPOAb respectively(209.04 ±385.65)and(120.47±282.27),TGAb(82.79 ±116.57)and(58.19 ±114.45)respectively.There was no significant difference between the two groups.The detection rate of TPOAb in thyroid nodule group was 33.33 and that in control group was 34.23.The detection rate of TPOAb in control group was 24.42 and 15.12.The positive rate of AITD in thyroid nodule group was higher than that in control group,and the positive rate of TGAb in thyroid nodule group was higher than that in control group.There was significant difference between the two groups(P<0.05).4.The thyroid nodule IR group was compared with the non-IR thyroid nodule group.The levels of FT4 were(17.33 ±10.36 and 15.35 ±6.33),the levels of FT3 were(4.32 ±0.52)and(4.49 ±0.61),TPOAb were(289.43 ±474.34)and(138.19 ±270.79),TGAb were(92.16 ±137.31)and(74.54 ±95.09),s TSH were(2.64 ±2.01)and(3.71±4.65)respectively.There was statistical difference in TPOAb and TGAb.But there was no statistical difference in the levels of s TSH,free T4,TGAb and TPOAb between the control group and the control + non-IR group.Comparison of IR between thyroid nodule IR group and control group,The levels of FT4 were(17.33 ±10.36)and(16.22 ±3.72),the levels of FT3 were(4.32 ±0.52)and(4.53 ±0.35),TPOAb were(289.43 ±474.34)and(197.89 ±383.28),TGAb levels were(92.16 ±137.31)and(73.98 ±133.60),s TSH levels were(2.64 ±2.01)and(2.40±1.21)respectively;in the insulin resistance group,the TGAb levels of thyroid nodule group were higher than that of thyroid nodule group(2.64 ±2.01)and(2.40 ±1.21),respectively.The level of TGAb and TPOAb in group A was higher than that in control group,and the difference of P<0.05 was statistically significant.The prevalence of AITD in the former group increased compared with that in the latter group,while there was no significant difference in free T3,T4 and s TSH.There was no significant difference in the levels of free T3 and free T4 TGAb?TPOAb between the non-IR group and the control group.The levels of TSH were(3.71 ±4.65)and(2.25 ±0.66)(P < 0.05),respectively.The difference was statistically significant.5.According to the pathological results of liquid-based cytological examination of thyroid nodules,thyroid nodules were classified into benign,uncertain and malignant.The relationship between IR?AITD and thyroid nodule was analyzed.The malignant rate of thyroid nodules with insulin resistance was higher than that of patients without insulin resistance,and the difference between the two groups was statistically significant,while there was no clear relationship between AITD and benign and malignant thyroid nodules.6.Pearson correlation analysis among 22 thyroid nodules,insulin resistance and AITD three diseases showed that there was a positive correlation between AITD and IR,IR and thyroid nodules,AITD and thyroid nodules.Conclusion:1.In this study,compared with the control group,there were statistical differences in the index of 2 h glucose and 2 h insulin between the thyroid nodule group and the control group,indicating that the level of blood glucose regulation in the thyroid nodule group was lower than that in the normal group to some extent.2.There was a positive correlation between AITD and IR?IR and TN? AITD and TN.3.According to the pathological results of fine needle aspiration cytology,the malignant rate of thyroid nodule with insulin resistance was higher than that without insulin resistance.The malignant rate of AITD combined with thyroid nodules was higher than that of simple thyroid nodules,but there was no significant difference between the two groups. |
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