Bílek Radovan, Stárka Luboslav, Zamrazil Václav
Institute of Endocrinology, Národní 8, 116 94 Prague 1, Czech Republic.
Horm Mol Biol Clin Investig. 2013 Jun;13(2):13-7. doi: 10.1515/hmbci-2013-0006.
This article discusses the conditions that may lead to a phenomenon called dysthyronemia. Here, the thyroid gland has concentration of thyrotropin in circulation within the reference range, but the concentrations of free or total fractions of thyroid hormones are outside the reference range. Normal values of thyrotropin (TSH) and increased values of THs are referred to as hyperthyroxinemia, while normal values of thyrotropin and decreased values of thyroid hormone are hypothyroxinemia. As shown by our observations, it is a relatively frequent situation in the parallel determinations of TSH and free thyroxine, when results verging on hyperthyroxinemia were found in 7% of cases (6.74%, n=259,590), and also in the parallel sets of TSH and total triiodothyronine when hypotriiodothyroninemia reached 8.5% (8.48%, n=73,143). We are assuming that the main cause of hyperthyroxinemia in the free thyroxine and TSH system is the presence of autoantibodies against thyroxine in patients with autoimmune thyroid disease. The reason of hypotriiodothyroninemia in the system of triiodothyronine and TSH is a decreased concentration of thyroid binding globulin in postmenopausal women. Manufacturers of immunoanalytical kits should take into account the potential adverse effects of autoantibodies against thyroid hormones when measuring the results of immunoassay determination of the free fraction of these hormones.
本文讨论了可能导致一种称为甲状腺功能异常血症现象的情况。在此，甲状腺在循环中的促甲状腺激素浓度处于参考范围内，但甲状腺激素游离或总组分的浓度超出参考范围。促甲状腺激素（TSH）正常而甲状腺激素升高称为甲状腺素血症，促甲状腺激素正常而甲状腺激素降低则称为低甲状腺素血症。如我们的观察所示，在TSH和游离甲状腺素的平行测定中，这是一种相对常见的情况，其中7%的病例（6.74%，n = 259,590）出现接近甲状腺素血症的结果；在TSH和总三碘甲状腺原氨酸的平行测定中，低三碘甲状腺原氨酸血症达到8.5%（8.48%，n = 73,143）。我们假设在游离甲状腺素和TSH系统中甲状腺素血症的主要原因是自身免疫性甲状腺疾病患者中存在抗甲状腺素自身抗体。在三碘甲状腺原氨酸和TSH系统中低三碘甲状腺原氨酸血症的原因是绝经后女性甲状腺结合球蛋白浓度降低。免疫分析试剂盒制造商在测量这些激素游离组分的免疫测定结果时应考虑抗甲状腺激素自身抗体的潜在不利影响。
