O'Hare J, Abuaisha B, Barrett E
Dept of Medicine, Limerick Regional Hospital, Dooradoyle, Ireland.
Ir Med J. 1991 Jun;84(2):70-2.
The aim of this study was determine (a) the causes of hyperthyroxinaemia and (b) the biochemical profile of thyrotoxicosis in a general hospital laboratory for one year using a sensitive TSH assay. Total T4 (TT4) and TSH were measured in all 8,382 samples and TT3, free T4, free T3 and thyroxine binding globulin (TBG) in selected cases. TT4 was elevated in 215 (2.6%). 159 (74%) were due to thyrotoxicosis; 41 (19%) to elevated TBG and 15 (7%) non-thyroidal illness. Thyrotoxicosis (serum TSH less than 0.15m U/1) occurred in 223 (2.7%) of all patients and was diagnosed with high TT4 in 159 (71%), normal due to intercurrent illness. 352 (4%) patients had suppressed TSH while all thyroid hormone values were normal. Thus TT4 may be elevated from causes other than thyrotoxicosis sufficiently frequently to necessitate routine TSH measurements. While Normal TSH measurements nearly always excludes thyrotoxicosis, suppressed values are insufficient to establish a diagnosis or monitor thyroxine replacement therapy.
本研究的目的是使用灵敏的促甲状腺激素（TSH）检测法，在一家综合医院实验室中，确定（a）甲状腺素血症的病因，以及（b）甲状腺毒症的生化特征，为期一年。对所有8382份样本检测了总甲状腺素（TT4）和TSH，并对部分病例检测了三碘甲状腺原氨酸（TT3）、游离甲状腺素、游离三碘甲状腺原氨酸和甲状腺素结合球蛋白（TBG）。215份样本（2.6%）的TT4升高。其中159份（74%）是由甲状腺毒症引起；41份（19%）是由于TBG升高，15份（7%）是由非甲状腺疾病引起。所有患者中，223例（2.7%）发生甲状腺毒症（血清TSH低于0.15mU/L），其中159例（71%）TT4升高被诊断为此病，另有部分因并发疾病导致TSH正常。352例（4%）患者TSH受抑制，但所有甲状腺激素值均正常。因此，TT4升高可能由甲状腺毒症以外的原因引起，且频率足以使常规TSH检测成为必要。虽然TSH正常几乎总能排除甲状腺毒症，但受抑制的值不足以确立诊断或监测甲状腺素替代治疗。
