Abstract:Anaplastic thyroid carcinoma (ATC) is rare but one of the most aggressive human cancers, and there is no effective treatments currently. Studies of immune microenvironment in ATC suggest that immunotherapy may benefit for ATC patients, and some studies about immunotherapy in ATC have been gradually conducted. Immune checkpoint inhibitors (given alone or combined with target agents) , chimeric antigen receptor T cell (CAR-T) , and personalized tumor vaccines (PTV) were expected to be the future direction of medical therapy for ATC.

Abstract:Management of low-risk thyroid carcinoma has been the hotspot in the field of thyroid malignancy. Although the management guidelines for the patients with low-risk thyroid carcinoma standardize the diagnosis and therapy, there still are some controversies. Because of the favorable prognosis of low-risk thyroid carcinoma, it's difficult to choose the optimal treatment from clinical follow-up, surgery in early stage or minimally invasive technology. However, radiofrequency ablation was controversial currently in the management of low-risk thyroid carcinoma more researches are necessary to guide the optimal treatment strategy for low-risk thyroid carcinoma. In line with the principle of comprehensive and standardized treatment, the treatment of low-risk thyroid cancer requires communication between doctors and patients, and a truly individualized treatment strategy based on the tumor, the patient's social psychological factors and other factors.

Abstract:Thyroid cancer in children and adolescents (referred to as "pediatric thyroid cancer" ) generally refers to thyroid malignant tumors occurred in subjects younger than 18 years of age. Although thyroid cancer is less common in childhood and adolescence, the incidence of pediatric thyroid cancer has been rising with the global increase of thyroid cancer in recent years. Although the clinical and pathological characteristics, and prognosis of pediatric thyroid cancer are different from those of adult patients, the current clinical management for pediatric thyroid cancer is mostly based on strategies for adult patients. Insufficient understanding of pediatric thyroid cancer can lead to undertreatment or overtreatment, which leads to negative impacts on the development of physiological, psychological and social ability in children. Therefore, it is of great significance to develop a standardized diagnosis and treatment schemes for pediatric thyroid cancer. Here we review epidemiology, clinical characteristics, management strategies, and present challenges of pediatric thyroid cancer based on the clinical studies and guidelines or consensus for pediatric thyroid cancer.

Abstract:Objective:　To explore the correlation between thyroid nodules and urinary iodine and its risk factors. Methods:　From January 2014 to December 2021, people who had thyroid nodules puncture in the Department of Endocrinology, The First People's Hospital of Yunnan Province, and participated in the "National Survey of Thyroid Diseases and Iodine Nutrition Status–2014" were selected as the research object. The patients with thyroid nodules confirmed by color Doppler ultrasound and cytopathology were divided into the benign thyroid nodule group and the malignant thyroid nodule group with a total of 3 206 cases. Urinary iodine value, thyroid stimulating hormone (TSH) , free triiodothyronine (FT3) , free thyroxine (FT4) , thyroid peroxidase antibody (TPOAb) , thyroglobulin antibody (TGAb) , blood biochemistry, and other related indicators were measured. SPSS 26.0 was used for t-test and rank sum test. Multivariate logistic regression analysis was used to analyze the risk factors. Results:　①The urinary iodine content (159.86 μg/L) in the thyroid nodule group was lower than that in the normal population (187.15 μg/L) , and the difference was statistically significant. The proportion of urinary iodine<100 μg/L was higher than that of urinary iodine>300 μg/L in the thyroid nodule group, and the composition ratio of iodine content in the thyroid nodule group was statistically different from that in the normal population (P<0.01) .②The median urinary iodine level in the benign thyroid nodule group (134.70 μg/L) was lower than that in the malignant thyroid nodule group (172.83 μg/L) .③According to the results of logistic regression analysis, as for gender, when the male assignment was 1 and the female assignment was 2 (OR=34.400, 95%CI=1.619-730.759, P=0.023) , the results showed that the risk of malignant thyroid nodules in women was 33.4 times higher than that in men. Urinary iodine (OR=1.018, 95%CI=1.000-1.036, P=0.048) , FT4 (OR=1.876, 95%CI=1.081-3.254, P=0.025) , TPOAb (OR=0.948, 95%CI=0.911-0.986, P=0.008) , triglyceride (OR=2.523, 95%CI=1.194-5.330, P=0.015) were the promoting factors for the occurrence of malignant thyroid nodules. Conclusion:　Urinary iodine, gender, FT4, TPOAb, and triglyceride are related to the prevalence of malignant thyroid nodules and promote the occurrence of malignant thyroid nodules. The distribution of iodine content in the normal group was significantly different from that in the thyroid nodule group.

Abstract:Objective:　To compare the diagnostic efficacy of C-TIRADS and ACR TIRADS for benign and malignant thyroid nodules. Methods:　A retrospective analysis was performed on 321 thyroid nodules undergoing fine needle aspiration. The data of ultrasonographic image were collected. Ultrasonic physicians re-graded all nodules by C-TIRADS guideline and ACR TIRADS guideline. The receiver operating characteristic (ROC) curve of them was constructed, and the sensitivity, specificity and accuracy of C-TIRADS and ACR TIRADS were calculated and their diagnostic efficacy for thyroid nodules were compared. Results:　By C-TIRADS guideline, the risks of malignant thyroid nodules were as follows: 0.0% (0/10) in category 2, 5.0% (1/20) in category 3, 17.3% (22/127) in category 4a, 44.3% (43/97) in category 4b, 74.4% (32/43) in category 4c, and 91.7% (22/24) in category 5. By ACR TIRADS: 4.3% (1/22) in category 2, 3.4% (2/58) in category 3, 35.9% (52/145) in category 4, and 64.6% (62/96) in category 5. The area under curve (AUC) of C-TIRADS and ACR TIRADS were 0.798 (95%CI=0.749–0.840) and 0.765 (95%CI=0.715–0.810) , respectively, without statistically significant difference (P=0.081) . The maximum value of the Youden index was 0.467 and 0.382, and the corresponding cutoff values were C-TIRADS 4a and ACR-TIRADS 4, respectively. The sensitivity, specificity and accuracy of C-TIRADS were 81.82%, 84.00%and 83.18%, respectively, and those of ACR TIRADS were 81.82%, 60.00%and 68.22%respectively. The specificity and accuracy of C-TIRADS were higher than those of ACR TIRADS, and the difference was statistically significant (P=0.000, P=0.000) , but there was no statistically significant difference in sensitivity (P=1.000) . Conclusion:　C-TIRADS has better specificity and accuracy than ACR TIRADS in diagnosis of thyroid nodules.

Abstract:Objective:　To develop a Nomogram for predicting central lymph node metastases (CLNM) for that the status of central lymph nodes is important for determining the surgical strategy of papillary thyroid microcarcinoma (PTMC) . Methods:　PTMC patients who underwent thyroidectomy and central neck dissection in The First People’s Hospital of Changzhou from July 2019 to November 2020 were retrospectively retrieved. These patients were randomly divided into "modeling group" and "validation group" . Univariate and multivariate analyses were performed in the modeling group to determine the risk factors for CLNM. The Nomogram used to predict CLNM was developed and verified internally and externally. Results:　Independent risk factors related to CLNM (gender, maximum tumor diameter, number of lesions, aspect ratio, and margin) were included in the Nomogram. The calibration curve showed that the Nomogram was in good agreement with the CLNM prediction of actual clinical observation. The area under the curve of the Nomogram in the modeling group and the verification group were 0.759 and 0.757, respectively. Conclusion:　The Nomogram can objectively quantify the possibility of CLNM before surgery. Clinicians can use this model to assess the lymph node status of patients with PTMC and consider prophylactic central neck dissection in high-risk patients.

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Abstract:Thyroid disease is one of the most common diseases in the elderly. Population-and clinical epidemiology-based studies have shown that the prevalence of thyroid diseases in the elderly is different from general adults, showing a unique "high and low" phenomenon: the prevalence of clinical hypothyroidism and subclinical hypothyroidism and thyroid nodules is higher; the prevalence of thyroid cancer is relatively low, whereas the recurrence rate and mortality are higher. Female, iodine deficiency, positive thyroid autoantibodies, disturbance of glucose and lipid metabolism increase the risk of thyroid diseases. Therefore, understanding the epidemiological characteristics of thyroid diseases in the elderly and identifying relevant risk factors will help promote the standardized management of thyroid diseases in the older population.

Abstract:In May 2021, the "Expert Consensus on Diagnosis and Treatment for Elderly with Thyroid Diseases in China" (herinafter as the "Consensus" ) was published on the Chinese Journal of Geriatrics and the Chinese Journal of Endocrinology and Metabolism, simultaneously. This is the first consensus on the diagnosis and treatment of thyroid diseases for the elderly in China, which is drafted by endocrinologists and geriatricians jointly. The Consensus consists of five parts, with a total of 40 recommendations. Based on the epidemiological data of China, as well as relevant literature and evidence from domestic and abroad studies, the Consensus focuses on comprehensive evaluation and screening of elderly patients with thyroid diseases; clinical characteristics and complications of senile hyperthyroidism and points for attention in treatment; complications of subclinical hypothyroidism in the elderly and individualized treatment options and goals; clinical characteristics and stratified management of differentiated thyroid carcinoma in the elderly. The Consensus is of great significance to improve the clinical diagnosis and treatment of senile thyroid diseases in China and to promote healthy aging.

Abstract:Objective:　To investigate the prevalence of thyroid nodules in the elderly in iodine-adequate area, and to explore the correlation between glucose metabolism disorders and thyroid nodules in the elderly. Methods:　A total of 2 037 elderly people (1 045 males, 51.3%) were enrolled from Suqian and Xuzhou in Jiangsu Province. All the participants underwent physical examination, biochemical test, and thyroid ultrasonography. Logistic regression was used to analyze the relationship between glucose metabolism and thyroid nodule prevalence, thyroid nodule number, thyroid nodule size, benign thyroid nodules and suspected malignant nodules. Results:　The prevalence of thyroid nodules in the elderly in iodine-adequate area was 35.1%, of which 42.4%were multiple nodules and 33.9%were nodules≥1 cm. There were significant differences in sex, waist circumference, fasting insulin level and insulin resistance index between the groups with and without thyroid nodules, single thyroid nodule group and multiple thyroid nodule group and nodule<1 cm group and nodule≥1 cm group (all P<0.05) . After the confounding factors were adjusted by the logistic regression model, results showed that fasting blood glucose, glycosylated hemoglobin and insulin resistance index were associated with the risk of thyroid nodule occurrence and the size of thyroid nodules. Conclusion:　Thyroid nodules is prevalent in the elderly in iodine-adequate area. Glucose metabolism disorder is significantly related to the prevalence and size of thyroid nodules.

Abstract:Objective:　To investigate the prevalence of thyroid diseases, and analyze the level of thyroid stimulating hormone (TSH) and the prevalence of dyslipidemia in elderly people in iodine excessive areas. Methods:　A total of 258 elderly people aged 65 and above were selected and divided into three groups according to age (65-69 years old, 70-74 years old and≥75 years old) . Each subject completed a questionnaire, physical examination, thyroid ultrasound and thyroid function test. Chi-square test was used to compare the prevalence of thyroid dysfunction and nodules and the prevalence of dyslipidemia under different TSH levels. Spearman correlation was used to analyze the correlation between age and TSH, and simple linear regression was used to establish the regression equation. Results:　The median urinary iodine concentration level of the elderly was 397.60 (225.58, 647.73) μg/L, and the total prevalence of thyroid diseases was 48.84% (126/258) . Among them, the prevalence of thyroid dysfunction and thyroid nodule were 24.42% (63/258) , and subclinical hypothyroidism was the most common thyroid dysfunction, with the prevalence of 22.48% (58/258) , and gradually increased with age (P<0.01) . Age was positively correlated with TSH level (correlation coefficient=0.31, P<0.001) . With the gradual increase of TSH level, the prevalence of high total cholesterol (TC) (P=0.020) , low high density lipoprotein cholesterin (P=0.010) and low density lipoprotein cholesterin (LDL-C) (P<0.01) gradually increased. When TSH level≥10 mU/L, the prevalence of high TC and high LDL-C were up to 66.67% (4/6) . Conclusion:　Subclinical hypothyroidism and thyroid nodules are the main thyroid diseases in the elderly in iodine excessive areas. TSH level increases gradually with age. With the gradual increase of TSH level, the prevalence of dyslipidemia in the elderly gradually increase, with high TC and high LDL-C being the most common.

Abstract:Immune checkpoint inhibitors (ICPIS) can greatly improve the overall survival rate of tumor patients with significant efficacy. Currently, ICPIS have been approved for a variety of tumor treatments, bringing hope to many cancer patients. However, at the same time, due to the overactivation of the immune system, it can produce immune-related adverse reactions to all organs of the body. Thyroid related dysfunction is one of the relatively common endocrine adverse events in the treatment of ICPIS. This paper reviewed relevant literature and summarized the clinical characteristics of ICPIS from the perspectives of distribution, action characteristics, epidemiology and pathogenesis. In addition, how to screen high-risk patients in clinical work, as well as the differences and similarities of follow-up monitoring and treatment methods of ICPIS-related thyroid dysfunction in current domestic and foreign guidelines are discussed.

Abstract:Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disease, which is often coexisted with other autoimmune diseases, including systemic autoimmune disease, such as systemic lupus erythematosus, rheumatoid arthritis, and Sj?grens syndrome, and organ-specific autoimmune diseases, such as type 1 diabetes mellitus. AITD and these diseases have common genetic background and inducing factors, similar immune mechanism and histological characteristics. When AITD coexists with other autoimmune diseases, the severity, activity and prognosis of the disease change. There may be a causal relationship between them, which needs to be confirmed by more in-depth research.

Abstract:Objective:　To detect the number of regulatory T cells (Tregs) , follicular regulatory T cells (Tfrs) , follicular helper T cells (Tfhs) , and the expression of their surface molecules tumor necrosis factor receptor superfamily member 4 (OX40) and programmed-death factor 1 (PD-1) in peripheral blood of patients with Graves' disease (GD) . Methods:　A total of 23 newly-diagnosed GD patients (GD group) and 22 normal controls (NC group) were enrolled in this study. The proportions of Tregs (CD3⁺CD4⁺CD25⁺Foxp3⁺) , Tfrs (CD4⁺Foxp3⁺PD-1⁺CXCR5⁺) and Tfhs (CD4⁺Foxp3^-PD-1⁺CXCR5⁺) , and the expression of their surface molecules OX40 and PD-1 in peripheral blood of the two groups were detected by flow cytometry. The relationship between the pathogenesis of GD and Tregs, Tfrs, Tfhs, OX40 and PD-1 was analyzed. The correlations between the detection indexes and clinical indexes were also analyzed, and the clinical significance was preliminarily discussed. Results:　Compared with the NC group, the number of Tregs in the GD group was significantly increased, and the expression of PD-1 on Tregs was decreased. PD-1 expression on Tregs was significantly negatively correlated with TRAb level. The number of Tfrs was significantly decreased in newly-diagnosed GD patients, and OX40 expression was up-regulated on Tfrs. The number of Tfrs was negatively correlated with TRAb. Conclusion:　The low expression of PD-1 on Tregs may be involved in the pathogenesis of GD by affecting the function of Tregs. The number of Tfrs in GD patients is significantly reduced, and the expression of OX40 is significantly increased. OX40 may be involved in the pathogenesis of GD by affecting Tfrs and Tfhs homeostasis. These results may provide some new ideas for the clinical treatment of GD.

Abstract:Objective:　To evaluate the correlation between thyrotropin receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) levels, and to compare the clinical ability of TRAb and TSI in predicting methimazole responsiveness in patients with Graves' disease (GD) . Methods:　A total of 2 145 patients treated in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from January 2020 to December 2021 were recruited. The correlations between free thyroxine (FT4) , TRAb and TSI levels were assessed by Pearson correlation analysis. Of the 2 145 patients, 50 GD patients treated with methimazole were followed up in our center. Baseline characteristics, thyroid autoantibody levels and doses of methimazole during treatment (Δ_methimazole) were retrospectively analyzed. Clinical predictors of rapid responsiveness to methimazole in GD patients were identified by logistic regression analysis. Results:　TRAb level was strongly correlated with TSI level in GD patients (P<0.001) . FT4, TRAb and Δ_methimazolewere significantly correlated with rapid responsiveness to methimazole in GD patients treated with≥10 mg/d methimazole (all P<0.05) , and TSI was not statistically significant. While all indicators were not correlated with the rapid responsiveness to methimazole in GD patients treated with<10 mg/d methimazole (all P>0.05) . The receiver operating characteristic (ROC) curves revealed that FT4 level was the optimal predictor of rapid responsiveness to methimazole in GD patients. Conclusion:　TRAb level is closely correlated with TSI level in GD patients. Compared with TRAb, TSI is likely less predictive of methimazole responsiveness.

Abstract:Objective:　To evaluate the relationships of thyroid hormone levels and thyroid hormone sensitivity with simplified insulin sensitivity indexes in euthyroid individuals. Methods:　The study enrolled 4 909 euthyroid individuals who underwent a health examination at The First Hospital of China Medical University between January 2017 and December 2018. Thyroid feedback quantile-based index (TFQI) and free triiodothyronine to free thyroxine ratio (FT3/FT4) were calculated to reflex thyroid hormone sensitivity. Simplified insulin sensitivity indexes included triglyceride glucose index (TyG) , TyG-body mass index, TyG-waist circumference, triglyceride to high-density lipoprotein-cholesterol ratio, visceral adiposity index and lipid accumulation product. Results:　Multiple linear regression analyses showed that FT3/FT4, FT3 and thyroid stimulating hormone (TSH) were positively associated with TyG (β=1.651, 0.122 and 0.060, respectively) ; FT4was negatively associated with TyG (β=-0.026, all P=0.000) . Logistic regression showed that, with 1 SD increase in FT3/FT4, the odds ratio for high TyG, which was defined as the highest quartiles was 1.282, 95%confidence interval was from 1.193 to 1.379. The risk for high TyG increased with the increases of FT3 and TSH, and decreased with the increase of FT4. Other simplified insulin sensitivity indexes showed similar relationships with the above thyroid parameters. These results were remained when we grouped people according to gender, body mass index, and the levels of thyroid autoantibodies. TFQI was only associated with a part of simplified insulin sensitivity indexes. Conclusion:　Simplified insulin sensitivity indexes are associated with thyroid hormone sensitivity and serum hormone levels. They provided an easy tool for evaluating the relationships between thyroid function and insulin sensitivity.

Abstract:Objective:　To summarize and analyze the data of thyroid function of patients with immunoglobulin 4-related disease (IgG4-RD) , so as to raise the clinicians' awareness on monitoring the thyroid function of patients. Methods:　The clinical data of IgG4-RD patients who were hospitalized and diagnosed in Peking University First Hospital from July 2005 to September 2020 were collected through searching the electronic medical record retrieval system by using "immunoglobulin 4-related diseases" as the key word. We analyzed the thyroid function status and the changes before and after the treatment of IgG4-RD patients and the changes of thyroid function of some patients with follow-up data. Results:　A total of 89 IgG4-RD patients (69 males and 20 females) were enrolled in the current study. Among 66 patients (74.2%) with thyroid function test results, 21 patients had thyroid dysfunction, including non-thyroid illness syndrome (NTIS, n=12) , subclinical or overt hypothyroidism (n=8) and central hypothyroidism (n=1) . Among them, 5 patients had the follow-up results, 3 patients got the normalization of thyroid function during the course of treatment and one patient remained subclinical hypothyroidism. And the decreased T3 level was improved in one patient with NTIS. Conclusion:　Thyroid dysfunction is common in IgG4-RD patients, and NTIS is the main manifestation. The etiology of thyroid dysfunction in patients with IgG4-RD needs to be identified. The thyroid dysfunction may be restored in some patients with the treatment of IgG4-RD.

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Abstract:Objective:　To evaluate the level of serum free testosterone (FT) and to investigate the relevant factors of FT in male patients with type 2 diabetes mellitus (T2DM) . Methods:　A retrospective study was conducted on 303 male patients with T2DM aged between 18-70 years and another age-matched 303 healthy individuals were selected as controls. We compared the difference of demographic and clinical indicators in different FT levels. According to the serum FT level, T2DM patients were divided into Q1 group, Q2 group,Q3 group and Q4 group by quartile method. Spearman rank correlation analysis and logistic regression analysis was conducted to analyze the revalent factors of the decrease of serum FT in T2DM patients. Results:　The level of serum FT in men with T2DM was significantly lower than that in control group, and decreased with age. Spearman rank correlation analysis showed that FT was negatively correlated with age (r=-0.402, P<0.001) , BMI (r=0.215, P=0.001) , duration of diabetes (r=-0.121, P=0.035) , and positively correlated with total cholesterol (TC) (r=0.115, P=0.049) , 25- (OH) D₃ (r=0.340, P<0.001) , and thyroid-stimulating hormone (TSH) (r=0.231, P=0.025) . Multivariate logistic regression analysis showed that after adjustment for age, distribution, history of diabetes, smoking and alcohol consumption, high BMI (OR=1.101, 95%CI=1.023-1.183, P=0.009) , high HbA1c (OR=1.175, 95%CI=1.060-1.302, P=0.002) , low 25- (OH) D₃ (OR=0.937, 95%CI=0.900-0.975, P=0.001) , and low TSH (OR=0.838, 95%CI=0.710-0.989, P=0.037) were closely related to low FT level. Conclusion:　T2DM patients have lower level of FT than healthy men and the low of serum FT level may be related to high BMI, high HbA1c, low 25- (OH) D₃and low TSH.

Abstract:Objective:　To compare the remission of early abnormal glucose metabolism in patients with polycystic ovary syndrome (PCOS) treated with metformin, pioglitazone and their combination, and to explore the effective clinical treatment of early abnormal glucose metabolism in patients with PCOS. Methods:　A total of 150 patients diagnosed with PCOS according to Rotterdam criteria accompanied with abnormal glucose metabolism were enrolled from the Department of Endocrinology and Metabolism of The Second Affiliated Hospital of Chongqing Medical University from March 2018 to September 2020. According to different treatment drugs, they were equally randomized into three groups: group A (50 patients) treated with metformin (1 500 mg/d) , group B (50 patients) treated with pioglitazone (30 mg/d) and group C (50 patients) treated with their combination (metformin 1 000 mg/d, pioglitazone 30 mg/d) . The levels of fasting and 2 h postprandial blood glucose, hemoglobin A1c (HbA1c) , homeostasis model assessment-insulin resistance (HOMA-IR) , and fasting insulin were observed in the three groups before and after the three-month treatment, and the clinical treatment effects, especially the remission of early abnormal glucose metabolism, were evaluated in the three groups. Results:　The improvement rate of 2 h postprandial blood glucose, fasting insulin and HOMA-IR after the treatment, the remission rate of abnormal glucose metabolism in group B and C were significantly higher than those in group A (P<0.05) . There were no significant differences in the improvement rate of the fasting blood glucose and HbA1c after the treatment among the three groups (P>0.05) . Conclusion:　Pioglitazone and their combination have a better therapeutic effect on the metabolism of PCOS patients, which can effectively reduce blood glucose and improve insulin resistance, helping to alleviate the early abnormal glucose metabolism of PCOS patients, providing a theoretical basis for clinical treatment and improving the long-term quality of life of PCOS patients.

Abstract:Objective:　To establish a mouse model of polycystic ovary syndrome (PCOS) with abnormal glucose and lipid metabolism by combining dihydrotestosterone (DHT) and high-fat diet. Methods:　Sixteen 3-week-old clean grade female C57BL/6 mice were randomly divided into two groups for intervention for 6 weeks: the experimental group (8 mice) was treated with subcutaneous injection of DHT+high-fat diet, and the control group (8 mice) was treated with subcutaneous injection of organic solvent+ordinary diet. After the intervention, the estrous cycle, sex hormone level, ovarian pathology, body mass, blood glucose, blood lipid, subcutaneous and visceral fat depot of the two groups were compared to determine the success of the model. Results:　After the intervention, the level of serum DHT in the experimental group was about 3 times higher than that in the control group (P=0.000) . After continuous observation for 14 days, the experimental group had no estrous cycle, while the control group had regular estrous cycle. The time of diestrus in the experimental group was significantly longer than that in the control group (P=0.001) , while the duration of proestrous (P=0.006) and estrous (P=0.000) was shorter than that in the control group. Under light microscope, the ovaries in the experimental group showed polycystic changes, the layers of granulosa cells decreased, the proliferation and thickness of theca cells increased, no corpus luteum was found, the number of small antral follicles (P=0.043) and large antral follicles (P=0.000) increased significantly, and the proportion of unhealthy follicles in small antral follicles (P=0.011) and large antral follicles (P=0.001) also increased significantly. The fasting blood glucose level (P=0.001) , area under the curve of IPGTT (P=0.012) and IPITT (P=0.007) in the experimental group were significantly larger than those in the control group. The weight increase of mice in the experimental group was significantly higher than that in the control group (P=0.005) , and the mass of retroperitoneal (P=0.007) , parametral (P=0.006) and inguinal (P=0.018) fat depot, serum triglyceride (P=0.009) and total cholesterol (P=0.000) were higher than those in the control group. Conclusion:　The combination of DHT and high-fat diet can induce polycystic ovarian changes, estrous cycle changes and abnormal glucose and lipid metabolism in mice, which provides a mouse model for the experimental study of the pathogenesis of PCOS.

Abstract:Secondary hyperparathyroidism (SHPT) often occurs in patients with chronic renal disease (CKD) due to long-term vitamin D deficiency, hypocalcemia and hyperphosphatemia. Almost all CKD patients gradually develop this situation after dialysis. SHPT is the leading cause of death in patients with chronic renal failure. However, drug therapy is gradually tolerated with the development of the disease, leading to the need for surgical treatment. Surgery for SHPT is suitable for patients with refractory SHPT that cannot be controlled by medical drugs and whose parathyroid glands are significantly enlarged on imaging examination. The surgical methods include subtotal parathyroidectomy, total parathyroidectomy with autotransplantation, and total parathyroidectomy. However, the best choice for SHPT remains controversial. Recurrence of SHPT is the most common postoperative complication, Intraoperative imaging of indocyanine green and intraoperative para-thyroid hormone assay can be used to improve the surgery. In a word, SHPT has a high incidence and poor prognosis. There are still many problems in surgical treatment that need further study.

Abstract:Secondary hyperparathyroidism (SHPT) is one of the most common severe complications in chronic kidney disease patients and characterized by elevated parathyroid hormone (PTH) . Studies have confirmed that PTH mRNA-related binding proteins and miRNAs regulate the stability and expression of PTH mRNA, thereby mediating its post-transcriptional regulatory mechanism and playing an essential role in the high level of PTH in SHPT. The potential clinical application value of post-transcriptional regulation in the diagnosis and treatment of SHPT remains further explored. This paper reviews the current progression in the post-transcriptional regulation mechanism of the PTH gene in SHPT.