Nikolai T F, Mulligan G M, Gribble R K, Harkins P G, Meier P R, Roberts R C
Department of Endocrinology, Marshfield Clinic, Wisconsin 54449.
J Clin Endocrinol Metab. 1990 Apr;70(4):1108-13. doi: 10.1210/jcem-70-4-1108.
In 1986 it was reported that a high percentage of women with premenstrual syndrome (PMS) were found to have thyroid hypofunction (TH), mostly subclinical hypothyroidism, as defined by an augmented response of TSH to TRH, and that all affected women had complete relief of PMS symptoms with L-T4 therapy. We studied baseline thyroid function (T4, T3 uptake, T3, TSH, and TSH response to TRH) in 15 normal women (group 1) and 44 women with PMS and treated 22 of the PMS women with L-T4 (group 2; 1.6 micrograms L-T4/kg dose) and the other half with placebo (group 3) for 2 months in a double blinded protocol. We found no evidence of thyroid dysfunction in group 2 or 3, except for 1 subject with slightly elevated TSH (6.2 microIU/mL) and moderate augmented response to TRH (change in TSH, 65 microIU/mL). During the treatment phase we found a complete relief of symptoms in 6 (27%), a partial relief of symptoms in 6 (27%), and some relief of symptoms in 12 (54%) in group 2. Whereas in group 3, 10 (45%) had complete relief, 5 (23%) had partial relief, and 15 (68%) had some relief of symptoms. These results show that 1) there is no significant thyroid disease in PMS; and 2) L-T4 is no better than placebo in treatment of PMS. We conclude that the high incidence of thyroid hypofunction previously reported in PMS is due to an unusually low TSH level for the limit of the normal range for the TRH stimulation test.
1986年有报道称，经促甲状腺激素释放激素（TRH）刺激后促甲状腺激素（TSH）反应增强，表明患有经前综合征（PMS）的女性中很大比例存在甲状腺功能减退（TH），大多为亚临床甲状腺功能减退，且所有受影响的女性经L - T4治疗后经前综合征症状完全缓解。我们研究了15名正常女性（第1组）和44名患有经前综合征女性的基础甲状腺功能（T4、T3摄取、T3、TSH以及TSH对TRH的反应），并采用双盲方案对22名患有经前综合征的女性给予L - T4治疗（第2组；剂量为1.6微克L - T4/千克体重），另一半给予安慰剂（第3组），为期2个月。我们发现第2组或第3组中除1名受试者TSH略有升高（6.2微国际单位/毫升）且对TRH反应中度增强（TSH变化为65微国际单位/毫升）外，没有甲状腺功能障碍的证据。在治疗阶段，我们发现第2组中6名（27%）症状完全缓解，6名（27%）症状部分缓解，12名（54%）症状有所缓解。而在第3组中，10名（45%）症状完全缓解，5名（23%）症状部分缓解，15名（68%）症状有所缓解。这些结果表明：1）经前综合征患者中不存在明显的甲状腺疾病；2）L - T4在治疗经前综合征方面并不比安慰剂更好。我们得出结论，先前报道的经前综合征患者中甲状腺功能减退的高发病率是由于TRH刺激试验正常范围下限的TSH水平异常低所致。
