Gut Paweł, Matysiak-Grześ Magdalena, Fischbach Jakub, Klimowicz Aleksandra, Gryczyńska Maria, Ruchała Marek
Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
Contemp Oncol (Pozn). 2012;16(3):273-5. doi: 10.5114/wo.2012.29299. Epub 2012 Jul 6.
Differentiated thyroid cancer is one of the most common endocrine cancers. Typical standard treatment includes total thyroidectomy with partial lymphadenectomy, then depending on the indications, treatment with iodine isotope 131-I. A prerequisite to conduct the therapy is to obtain endogenic thyroid-stimulating hormone (TSH) stimulation (TSH > 30 µU/ml). We describe two patients with differentiated thyroid carcinoma in whom no rise in serum TSH was observed after withdrawal of thyroxine. In one patient TSH deficiency was due to partial hypopituitarism secondary to a tumor of the pituitary gland. In the second patient the TSH level was suppressed by metabolically active thyroid tissue within bilateral ovarian teratomas. The problems with TSH growth after withdrawal of thyroxine requires additional studies to identify the cause. Above two possible reasons for the lack of TSH stimulation after withdrawal of thyroxine were presented. In the case of non-TSH stimulation due to hypopituitarism both control tests and isotope treatment should be carried out using stimulation by recombinant human TSH (rhTSH).
分化型甲状腺癌是最常见的内分泌癌之一。典型的标准治疗包括甲状腺全切术加部分淋巴结清扫术，然后根据指征用碘同位素131-I进行治疗。进行该治疗的一个前提是获得内源性促甲状腺激素（TSH）刺激（TSH>30 μU/ml）。我们描述了两名分化型甲状腺癌患者，在停用甲状腺素后未观察到血清TSH升高。在一名患者中，TSH缺乏是由于垂体肿瘤继发部分垂体功能减退。在第二名患者中，双侧卵巢畸胎瘤内代谢活跃的甲状腺组织抑制了TSH水平。停用甲状腺素后TSH升高的问题需要进一步研究以确定原因。本文提出了停用甲状腺素后缺乏TSH刺激的上述两种可能原因。对于因垂体功能减退导致的非TSH刺激，应使用重组人TSH（rhTSH）刺激进行对照试验和同位素治疗。
