Murata Yoshiharu
Research Institute of Environmental Medicine, Nagoya University.
Nihon Rinsho. 2012 Nov;70(11):1951-7.
Resistance to thyroid hormone (RTH) is a syndrome in which the responsiveness of end organs to thyroid hormone (TH) is reduced. Given that the TH-responsive end-organs include pituitary thyrotrophs, almost all patients with RTH manifest unsuppressed thyrotropin (TSH) despite elevated free-T4 and free-T3 levels. This abnormal finding in the thyroid function test is termed "syndrome of inappropriate secretion of TSH" (SITSH) or "central hyperthyroidism". Patients with TSH-secreting pituitary tumors(TSHoma) also manifest SITSH. Thus, the differential diagnosis of RTH vs. TSHoma is sometimes difficult and challenging. In this review article, the etiology of RTH and diagnostic approach for SITSH are explained and an algorithm for differential diagnosis of RTH vs. TSHoma is proposed.
甲状腺激素抵抗（RTH）是一种终末器官对甲状腺激素（TH）反应性降低的综合征。鉴于TH反应性终末器官包括垂体促甲状腺细胞，几乎所有RTH患者尽管游离T4和游离T3水平升高，但促甲状腺激素（TSH）仍未被抑制。甲状腺功能检查中的这一异常发现被称为“不适当TSH分泌综合征”（SITSH）或“中枢性甲状腺功能亢进”。分泌TSH的垂体瘤（TSHoma）患者也表现为SITSH。因此，RTH与TSHoma的鉴别诊断有时困难且具有挑战性。在这篇综述文章中，解释了RTH的病因和SITSH的诊断方法，并提出了RTH与TSHoma鉴别诊断的算法。
