Department of Endocrinology, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
J Endocrinol Invest. 2012 Jan;35(1):25-7. doi: 10.3275/7684. Epub 2011 Apr 26.
The use of recombinant human TSH (rhTSH) is indicated to evaluate thyroid carcinoma patients. In recent years, some authors have reported that rhTSH could serve as a dynamic test of thyroid reserve. The aim of the present study was to determine whether or not rhTSH can predict the evolution from subclinical hypothyroidism (SH) to overt hypothyroidism.
Twenty-one women who met the diagnostic criteria of SH were enrolled. All patients received a single dose of rhTSH (0.1 mg). Basal blood samples for TSH, free T4 (fT4), thyroglobulin (Tg), and anti-thyoperoxidase and anti-Tg antibodies were obtained before and 1 day after rhTSH administration. All patients were followed for 2 yr, and blood samples were obtained every 6 months.
Twenty-four hours after rhTSH administration, the TSH level increased to >20 mU/l in 14 patients; the serum peak TSH levels remained <10 mU/l in only 5 patients. On follow-up, 7 women (33%) required L-T4 replacement therapy for overt hypothyroidism or a persistent TSH level >10 mlU/l. None of the parameters analyzed differed significantly between patients who developed overt hypothyroidism from those who had persistent SH.
The response of thyroid function tests to a single low dose of rhTSH is not useful in identifying those patients with SH who will develop overt hypothyroidism over a 2-yr period.
重组人促甲状腺激素（rhTSH）的使用被用于评估甲状腺癌患者。近年来，一些作者报告称 rhTSH 可作为甲状腺储备的动态测试。本研究的目的是确定 rhTSH 是否可以预测亚临床甲状腺功能减退症（SH）向显性甲状腺功能减退症的发展。
共纳入 21 名符合 SH 诊断标准的女性。所有患者均接受 rhTSH（0.1mg）单次给药。在 rhTSH 给药前和给药后 1 天，采集 TSH、游离 T4（fT4）、甲状腺球蛋白（Tg）、抗甲状腺过氧化物酶和抗 Tg 抗体的基础血样。所有患者均随访 2 年，每 6 个月采集一次血样。
rhTSH 给药后 24 小时，14 名患者的 TSH 水平升高至>20mU/L；仅 5 名患者的血清 TSH 峰值仍<10mU/L。随访期间，7 名女性（33%）因显性甲状腺功能减退症或持续 TSH 水平>10mlU/L需要 L-T4 替代治疗。在发展为显性甲状腺功能减退症的患者和持续存在 SH 的患者之间，分析的参数均无显著差异。
单次低剂量 rhTSH 对甲状腺功能测试的反应不能用于识别在 2 年内将发展为显性甲状腺功能减退症的 SH 患者。
