Dulgeroff A J, Geffner M E, Koyal S N, Wong M, Hershman J M
Endocrinology and Metabolism Division, West Los Angeles Veterans Administration Medical Center, California 90073.
J Clin Endocrinol Metab. 1992 Oct;75(4):1071-5. doi: 10.1210/jcem.75.4.1400873.
Although a number of patients with generalized resistance to thyroid hormone have been treated with bromocriptine (Brc), only one previously reported patient with nontumoral TSH-mediated hyperthyroidism, presumably due to pituitary resistance to thyroid hormone (PRTH), has been successfully treated with bromocriptine (Brc). In addition, several studies suggested that the T3 analog 3,5,3'-triiodothyroacetic acid (Triac) may control hyperthyroidism in patients with PRTH. In the current study a patient with PRTH diagnosed at age 15 yr underwent separate therapeutic trials with Brc and Triac, during which time physical parameters, thyroid function tests, systolic time intervals (STI), and oxygen consumption (VO2) were measured. On Brc therapy (12.5 mg/day), heart rate decreased (108 to 72/min), TSH decreased (5.7 to 1.2 mU/L), T3 decreased (9.9 to 1.7 nmol/L), free T4 decreased (205 to 21 pmol/L), STI lengthened (left ventricular ejection time, 0.389 to 0.405 s), and VO2 did not change (164 to 162 mL/min). We found no significant clinical improvement with a maximal dose of Triac (2.1 mg/day), only minimal reduction in goiter size; mild decreases in T3 (9.9 to 6.7 nmol/L), free T4 (205 to 113 pmol/L), and TSH (5.7 to 5.4 mU/L); no change in STI (left ventricular ejection time, 0.389 to 0.401 sec); and an increase in O2 consumption (VO2, 164 to 209 mL/min). Thus, the results favor Brc as effective therapy for this patient with PRTH.
尽管已有多位全身性甲状腺激素抵抗患者接受了溴隐亭（Brc）治疗，但之前仅有1例非肿瘤性促甲状腺激素（TSH）介导的甲状腺功能亢进患者（推测因垂体性甲状腺激素抵抗[PRTH]所致）成功接受了溴隐亭（Brc）治疗。此外，多项研究表明，T3类似物3,5,3'-三碘甲状腺乙酸（Triac）可能控制PRTH患者的甲状腺功能亢进。在本研究中，1例15岁时确诊为PRTH的患者分别接受了Brc和Triac的治疗试验，在此期间测量了身体参数、甲状腺功能检查、收缩期时间间期（STI）和耗氧量（VO2）。接受Brc治疗（12.5mg/天）时，心率下降（从108次/分钟降至72次/分钟），TSH下降（从5.7mU/L降至1.2mU/L），T3下降（从9.9nmol/L降至1.7nmol/L），游离T4下降（从205pmol/L降至21pmol/L），STI延长（左心室射血时间，从0.389秒增至0.405秒），VO2未改变（从164ml/分钟降至162ml/分钟）。我们发现，最大剂量的Triac（2.1mg/天）未带来显著的临床改善，仅甲状腺肿大小略有减小；T3（从9.9nmol/L降至6.7nmol/L）、游离T4（从205pmol/L降至113pmol/L）和TSH（从5.7mU/L降至5.4mU/L）轻度下降；STI无变化（左心室射血时间，从0.389秒降至0.401秒）；耗氧量增加（VO2，从164ml/分钟增至209ml/分钟）。因此，结果表明Brc是该PRTH患者的有效治疗方法。
