Tagami Tetsuya, Hagiwara Hanae, Kimura Takashi, Usui Takeshi, Shimatsu Akira, Naruse Mitsuhide
Clinical Research Institute, Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto 612-8555, Japan.
Thyroid. 2007 Aug;17(8):767-72. doi: 10.1089/thy.2007.0003.
Graves' disease (GD) is one of the most common thyroid diseases that cause hyperthyroidism. Gestational transient thyrotoxicosis (GTT) is nonautoimmune hyperthyroidism that occurs in women with a normal pregnancy. Postpartum transient thyroiditis (PTT) is a destructive thyroiditis induced by autoimmune mechanism in the postpartum period. Hyperthyroidism due to GD usually tends to improve during the course of gestation and exacerbate after delivery. When the patient with treated GD presents with thyrotoxicosis in the early pregnancy or in the postpartum period, differential diagnosis of exacerbation of GD with GTT or PTT is important because the latter disorders are fundamentally transient. To evaluate the incidence of GTT and PTT in a GD population, we investigated the thyroid functions, thyrotropin receptor antibodies (TRAb), and human chorionic gonadotropin (hCG) during pregnancy and for 1 year after delivery for 39 pregnancies in 34 women with GD. The incidence of GTT was 26% (10/39) of pregnancies. The peak value of hCG in the GTT group ([23.7 +/- 14.5] x 10(4) IU/mL, n = 9) was significantly higher than that in the non-GTT group ([13.3 +/- 4.7] x 10(4) IU/mL, n = 19). The incidence of PTT was 44% (17/39) of deliveries. The free triiodothyronine (FT(3))/free thyroxine (FT(4)) ratio of the exacerbation group of GD (3.1 +/- 1.0, n = 10) at the time of thyrotoxicosis after delivery was significantly higher than that of the PTT group (2.5 +/- 0.4, n = 16). The peak TRAb value of the exacerbation group of GD (72.5 +/- 121.7 IU/L, n = 10) at the time of thyrotoxicosis after delivery was also significantly higher than that of the PTT group (1.4 +/- 0.8 IU/L, n = 16). In conclusion, the high peak value of hCG is valuable for suspecting GTT, and the high FT(3)/FT(4) ratio is valuable for suspecting recurrence in the patients with GD. In both situations, changes of TRAb were also valuable in differentiating the recurrence of GD from GTT or PTT.
格雷夫斯病（GD）是引起甲状腺功能亢进症最常见的甲状腺疾病之一。妊娠期一过性甲状腺毒症（GTT）是发生于正常妊娠女性的非自身免疫性甲状腺功能亢进症。产后一过性甲状腺炎（PTT）是产后由自身免疫机制诱发的破坏性甲状腺炎。GD所致的甲状腺功能亢进症在妊娠期间通常趋于改善，而在产后加重。当接受治疗的GD患者在妊娠早期或产后出现甲状腺毒症时，鉴别GD病情加重与GTT或PTT很重要，因为后两种疾病本质上是一过性的。为评估GD人群中GTT和PTT的发生率，我们对34例患有GD的女性的39次妊娠进行了研究，检测了她们妊娠期间及产后1年的甲状腺功能、促甲状腺激素受体抗体（TRAb）和人绒毛膜促性腺激素（hCG）。GTT在妊娠中的发生率为26%（10/39）。GTT组（n = 9）的hCG峰值（[23.7±14.5]×10⁴IU/mL）显著高于非GTT组（[13.3±4.7]×10⁴IU/mL，n = 19）。PTT在分娩中的发生率为44%（17/39）。产后甲状腺毒症时GD病情加重组（n = 10）的游离三碘甲状腺原氨酸（FT₃）/游离甲状腺素（FT₄）比值（3.1±1.0）显著高于PTT组（2.5±0.4，n = 16）。产后甲状腺毒症时GD病情加重组（n = 10）的TRAb峰值（72.5±121.7 IU/L）也显著高于PTT组（1.4±0.8 IU/L，n = 16）。总之，hCG的高峰值对怀疑GTT有价值，高FT₃/FT₄比值对怀疑GD患者复发有价值。在这两种情况下，TRAb的变化对鉴别GD复发与GTT或PTT也有价值。
