Charrié A, Mesnard X, Tourniaire J
Laboratoire de Médecine Nucléaire, Hôpital de l'Antiquaille, Lyon.
Ann Endocrinol (Paris). 1999 Mar;60(1):40-4.
Intravenous TRH (200 micrograms Protiréline) injection was performed in 137 patients who had undergone thyroidectomy for differentiated thyroid carcinoma and treated by a suppressive thyroid therapy. Serum thyroid stimulating hormone (TSH) was measured before and 30 minutes after the injection. 143 tests were performed. The TSH method used was a chemiluminometric assay (Chiron Diagnostics). We study the analytical characteristics of the method. The limit of detection was 0.003 mUI/l. Interassay precision showed a functional sensitivity of 0.015 m UI/l with 20% interassay CV in agreement with the third generation criterion. There was a good correlation between TSH values at T0 and T30 minutes. In 143 tests, 40 (28%) showed a basal TSH value less than 0.003 mUI/l; delta TSH (TSH at T30-TSH at T0) was less than 0.015 mUI/l in about 68% of the cases and less than 0.031 mUI/l for the others. In 20% of the tests (29) TSH T0 were between 0.003 and 0.015 mUI/l and delta TSH less than 0.204 mUI/l. Finally the 74 remaining tests with a basal TSH value higher than the functional sensitivity of the method showed delta TSH less than 0.4 mUI/l if the TSH T0 was less than 0.05 mUI/l. The delta TSH remained less than 0.6 mUI/l if the TSH T0 was less than 0.1 mUI/l. Inversely, if TSH T0 was higher than 0.1 mUI/l delta TSH could be higher than 1.0 mUI/l. Third generation TSH assay allows us to abandon TRH test for the follow-up of thyroidectomized patients with suppressive thyroid hormonotherapy in so far as TSH assay is well established. We conclude that a basal TSH less than the functional sensitivity (0.015 mUI/l) can predict a TSH response to TRH stimulation test less than 0.2 mUI/l.
对137例因分化型甲状腺癌接受甲状腺切除术并接受甲状腺抑制治疗的患者进行了静脉注射促甲状腺激素释放激素（200微克普罗替林）。在注射前及注射后30分钟测量血清促甲状腺激素（TSH）。共进行了143次检测。所使用的TSH检测方法为化学发光分析法（Chiron诊断公司）。我们研究了该方法的分析特性。检测限为0.003 mUI/l。批间精密度显示功能灵敏度为0.015 mUI/l，批间变异系数为20%，符合第三代标准。T0和T30分钟时的TSH值之间存在良好的相关性。在143次检测中，40次（28%）显示基础TSH值低于0.003 mUI/l；约68%的病例中，TSH变化值（T30时的TSH减去T0时的TSH）低于0.015 mUI/l，其他病例低于0.031 mUI/l。在20%的检测（29次）中，T0时的TSH在0.003至0.015 mUI/l之间，TSH变化值低于0.204 mUI/l。最后，其余74次基础TSH值高于该方法功能灵敏度的检测显示，如果T0时的TSH低于0.05 mUI/l，TSH变化值低于0.4 mUI/l。如果T0时的TSH低于0.1 mUI/l，TSH变化值仍低于0.6 mUI/l。相反，如果T0时的TSH高于0.1 mUI/l，TSH变化值可能高于1.0 mUI/l。就TSH检测已经成熟而言，第三代TSH检测使我们能够放弃对接受甲状腺抑制激素治疗的甲状腺切除患者进行促甲状腺激素释放激素试验来进行随访。我们得出结论，基础TSH低于功能灵敏度（0.015 mUI/l）可预测促甲状腺激素释放激素刺激试验的TSH反应低于0.2 mUI/l。
