Bauer Brent A, Elkin Peter L, Erickson Dana, Klee George G, Brennan Michael D
Division of Area General Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2002 Jun;77(6):587-90. doi: 10.4065/77.6.587.
An 87-year-old woman was referred for evaluation of nervousness, tremor, insomnia, and fatigue of 2 months' duration. Initial laboratory evaluation revealed a suppressed thyrotropin level and an elevated triiodothyronine level. A review of her medications revealed that she had started taking several dietary supplements at the recommendation of her chiropractor before the onset of symptoms. One of these was tiratricol (3,5,3'-triiodothyroacetic acid or Triac), a substance sold as a dietary supplement despite classification as a drug by the Food and Drug Administration. Tiratricol has weak thyromimetic effects, can inhibit pituitary thyrotropin secretion, and in higher doses can significantly stimulate metabolism. Such was the case with this patient who presented with signs, symptoms, and biochemical evidence of hyperthyroidism that promptly resolved after discontinuation of tiratricol therapy. To our knowledge, this is the first reported case of documented thyrotoxicosis secondary to tiratricol use. Because tiratricol is still available for sale on several Internet sites, this case emphasizes the importance of inquiring about the use of dietary supplements in all patients. The availability of such products on the Internet increases the already complex task of monitoring patients' use of dietary supplements.
一名87岁女性因持续2个月的紧张、震颤、失眠和疲劳前来接受评估。初步实验室检查显示促甲状腺激素水平降低，三碘甲状腺原氨酸水平升高。对其用药情况进行回顾发现，在症状出现前，她听从脊椎按摩师的建议开始服用几种膳食补充剂。其中一种是三甲曲沙（3,5,3'-三碘甲状腺乙酸或Triac），尽管被美国食品药品监督管理局归类为药物，但仍作为膳食补充剂出售。三甲曲沙具有微弱的拟甲状腺作用，可抑制垂体促甲状腺激素分泌，高剂量时可显著刺激新陈代谢。该患者就是如此，出现了甲状腺功能亢进的体征、症状和生化证据，停用三甲曲沙治疗后迅速缓解。据我们所知，这是首例有记录的因使用三甲曲沙继发甲状腺毒症的病例。由于三甲曲沙仍在多个网站上销售，该病例强调了询问所有患者膳食补充剂使用情况的重要性。此类产品在互联网上的可得性增加了监测患者膳食补充剂使用情况这一原本就复杂的任务。
