Horimoto M, Nishikawa M, Uno C, Yoshikawa N, Taniguchi N, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Endocrinol Jpn. 1988 Dec;35(6):841-8. doi: 10.1507/endocrj1954.35.841.
To investigate the relationship between TSH and abnormal thyroid stimulator(s) in patients with hyperthyroid Graves' disease in whom normal thyroid hormone levels in the serum were maintained by antithyroid drug therapy and in patients with euthyroid Graves' disease, determinations were made of the TSH concentration, action of thyroid stimulating immunoglobulins (TSAb and TBII), and T3 suppression. Out of thirty-three patients with hyperthyroid Graves' disease, twelve patients with subnormal TSH levels were all non-suppressible according to the T3 suppression test results and the detectability of TSAb and/or TBII was as high as 75%. In three out of five patients with euthyroid Graves' disease, the serum TSH level was subnormal. All three showed non-suppressibility in the T3 suppression test and positive action of either TSAb or TBII. One of them became clinically thyrotoxic when the TSAb activity was further increased and TBII became positive, and was therefore diagnosed as having hyperthyroid Graves' disease. The present findings suggest that there are still abnormal thyroid stimulator(s) in patients with hyperthyroid Graves' disease who have low TSH, even if their thyroid hormone concentrations remain normal. Moreover, it is likely that some of the patients with euthyroid Graves' disease are actually in a state of subclinical hyperthyroidism because of the presence of abnormal thyroid stimulator(s).
为了研究甲状腺功能亢进型格雷夫斯病患者（通过抗甲状腺药物治疗维持血清甲状腺激素水平正常）以及甲状腺功能正常型格雷夫斯病患者中促甲状腺激素（TSH）与异常甲状腺刺激物之间的关系，对TSH浓度、甲状腺刺激免疫球蛋白（TSAb和TBII）的作用以及T3抑制进行了测定。在33例甲状腺功能亢进型格雷夫斯病患者中，12例TSH水平低于正常的患者根据T3抑制试验结果均为不可抑制，且TSAb和/或TBII的可检测率高达75%。在5例甲状腺功能正常型格雷夫斯病患者中，有3例血清TSH水平低于正常。这3例患者在T3抑制试验中均表现为不可抑制，且TSAb或TBII有阳性作用。其中1例患者当TSAb活性进一步升高且TBII呈阳性时出现临床甲状腺毒症，因此被诊断为甲状腺功能亢进型格雷夫斯病。目前的研究结果表明，甲状腺功能亢进型格雷夫斯病患者TSH水平低时，即使其甲状腺激素浓度保持正常，仍存在异常甲状腺刺激物。此外，由于存在异常甲状腺刺激物，一些甲状腺功能正常型格雷夫斯病患者可能实际上处于亚临床甲状腺功能亢进状态。
