van Hamersvelt H W, Kreutzer H J, Tertoolen J F, Thijssen J H, Koppeschaar H P
Neth J Med. 1989 Oct;35(3-4):192-200.
In this study of 103 patients with suspected thyroid dysfunction, the diagnostic value of a single basal immunofluorometric (IFMA) TSH measurement was evaluated and compared with the classical TRH test with RIA-TSH measurements, plasma TT4 concentrations and FT4I. A single basal TSH determination accurately predicted the TRH-stimulated TSH response, making the TRH test redundant in most patients. Because undetectable basal TSH did not always exclude a small rise in TSH, the TRH test could still be indicated in patients receiving thyroxine suppression therapy for thyroid cancer. Basal TSH differentiated accurately between euthyroidism and thyroid dysfunction, especially at the decision values of 0.20 and 4.0 mU/l, as proposed in this study. For diagnosis of clinical and subclinical hypo- and hyperthyroidism, additional measurement of TT4 and/or FT4I is necessary. A 2-yr follow-up of patients with subclinical thyroid dysfunction did not show progression to clinical disease. In some of the patients with subclinical hypothyroidism, substitution therapy with thyroxine had been started after initial testing. Indications for treatment of subclinical thyroid dysfunction are discussed.
在这项针对103例疑似甲状腺功能障碍患者的研究中，评估了单次基础免疫荧光法（IFMA）促甲状腺激素（TSH）检测的诊断价值，并将其与采用放射免疫分析法检测TSH、血浆总甲状腺素（TT4）浓度和游离甲状腺素指数（FT4I）的经典促甲状腺激素释放激素（TRH）试验进行比较。单次基础TSH测定能准确预测TRH刺激后的TSH反应，使得TRH试验在大多数患者中变得多余。由于基础TSH检测不到并不总是排除TSH有小幅升高的可能，对于接受甲状腺癌甲状腺素抑制治疗的患者，TRH试验仍可能有必要进行。如本研究中所提出的，基础TSH能准确区分甲状腺功能正常与甲状腺功能障碍，尤其是在0.20和4.0 mU/l的判定值时。对于临床及亚临床甲状腺功能减退和亢进的诊断，还需要额外检测TT4和/或FT4I。对亚临床甲状腺功能障碍患者进行的为期2年的随访未显示病情进展为临床疾病。在一些亚临床甲状腺功能减退患者中，初始检测后已开始使用甲状腺素替代治疗。文中讨论了亚临床甲状腺功能障碍的治疗指征。
