Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland.
Clin Endocrinol (Oxf). 2011 Mar;74(3):281-8. doi: 10.1111/j.1365-2265.2010.03815.x.
Alterations in the hypothalamo-pituitary-thyroid axis have been reported following growth hormone (GH) administration in both adults and children with and without growth hormone deficiency. Reductions in serum free thyroxine (T4), increased tri-iodothyronine (T3) with or without a reduction in serum thyroid-stimulating hormone secretion have been reported following GH replacement, but there are wide inconsistencies in the literature about these perturbations. The clinical significance of these changes in thyroid function remains uncertain. Some authors report the changes are transient and revert to normal after a few months or longer. However, in adult hypopituitary patients, GH replacement has been reported to unmask central hypothyroidism biochemically in 36-47% of apparently euthyroid patients, necessitating thyroxine replacement and resulting in an attenuation of the benefit of GH replacement on quality of life in those who became biochemically hypothyroid after GH replacement. The group at highest risk are those with organic pituitary disease or multiple pituitary hormone deficiencies. It is therefore prudent to monitor thyroid function in hypopituitary patients starting GH therapy to identify those who will develop clinical and biochemical features of central hypothyroidism, thus facilitating optimal and timely replacement.
生长激素（GH）治疗可导致生长激素缺乏症和非生长激素缺乏症的成人和儿童的下丘脑-垂体-甲状腺轴发生改变。GH 替代治疗后，血清游离甲状腺素（T4）降低，三碘甲状腺原氨酸（T3）增加，伴有或不伴有血清促甲状腺激素分泌减少，但文献中关于这些变化的报道差异很大。这些甲状腺功能变化的临床意义尚不确定。一些作者报告这些变化是短暂的，在几个月或更长时间后恢复正常。然而，在成年垂体功能减退症患者中，GH 替代治疗已被报道在 36-47%的看似甲状腺功能正常的患者中生化性地引发中枢性甲状腺功能减退症，需要甲状腺素替代治疗，并导致那些在 GH 替代治疗后发生生化性甲状腺功能减退症的患者生活质量受益减弱。风险最高的是那些患有垂体器质性疾病或多种垂体激素缺乏症的患者。因此，对于开始 GH 治疗的垂体功能减退症患者，监测甲状腺功能以识别那些将出现中枢性甲状腺功能减退症临床和生化特征的患者是谨慎的，从而便于进行最佳和及时的替代治疗。
