放射性碘治疗后发生氮血症的甲状腺功能亢进猫的血清甲状腺素和促甲状腺激素浓度
Serum thyroxine and thyroid-stimulating hormone concentration in hyperthyroid cats that develop azotaemia after radioiodine therapy.
作者信息
Peterson M E, Nichols R, Rishniw M
机构信息
Animal Endocrine Clinic, New York, NY, 10025, USA.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA.
出版信息
J Small Anim Pract. 2017 Sep;58(9):519-530. doi: 10.1111/jsap.12695. Epub 2017 Jun 29.
OBJECTIVES
The objectives of this study were to determine which serum thyroid hormone test best identifies iatrogenic hypothyroidism in cats that develop azotaemia after radioiodine treatment and to determine which thyroid test best differentiates these azotaemic, hypothyroid cats from azotaemic, radioiodine-treated euthyroid cats, as well as from azotaemic cats with chronic kidney disease and no history of thyroid disease.
MATERIALS AND METHODS
A total of 42 hyperthyroid cats that developed azotaemia (serum creatinine ê220 µmol/L) after radioiodine treatment had serum concentrations of thyroxine and free thyroxine by dialysis and thyroid--stimulating hormone measured at 3, 6 and 12 months. Iatrogenic hypothyroidism was confirmed (n=28) or excluded (n=14) on the basis of thyroid scintigraphy. A total of 14 cats with chronic kidney disease and 166 clinically normal cats underwent similar serum thyroid testing and scintigraphy.
RESULTS
Concentrations of thyroxine and free thyroxine were lower and thyroid-stimulating hormone higher in hypothyroid cats than in all three groups of euthyroid cats (P<0·0001). Of the hypothyroid cats, thyroxine and free thyroxine concentrations were low in 15 (53·6%) and seven (25%), respectively. Low serum thyroxine and free thyroxine concentrations were also detected in seven (50%) and two (14·3%) of the cats with chronic kidney disease. Thyroid-stimulating hormone concentrations were elevated in all hypothyroid cats but remained within the reference interval in all three groups of euthyroid cats. Serum thyroid--stimulating hormone had a higher test sensitivity and specificity than either thyroxine or free thyroxine concentration.
CLINICAL SIGNIFICANCE
The finding of high serum thyroid-stimulating hormone concentrations best identifies feline iatrogenic hypothyroidism and differentiates it from non-thyroidal illness syndrome in cats that develop azotaemia after treatment.
目的
本研究的目的是确定哪种血清甲状腺激素检测方法能最好地识别在放射性碘治疗后发生氮血症的猫的医源性甲状腺功能减退症，并确定哪种甲状腺检测方法能最好地区分这些氮血症、甲状腺功能减退的猫与氮血症、接受放射性碘治疗的甲状腺功能正常的猫，以及与有慢性肾病且无甲状腺疾病史的氮血症猫。
材料与方法
共有42只甲状腺功能亢进的猫在放射性碘治疗后发生氮血症（血清肌酐≥220µmol/L），在3个月、6个月和12个月时通过透析测定其血清甲状腺素和游离甲状腺素浓度，并测量促甲状腺激素。根据甲状腺闪烁扫描确定医源性甲状腺功能减退症（n=28）或排除（n=14）。共有14只患有慢性肾病的猫和166只临床正常的猫接受了类似的血清甲状腺检测和闪烁扫描。
结果
甲状腺功能减退的猫的甲状腺素和游离甲状腺素浓度低于所有三组甲状腺功能正常的猫，促甲状腺激素高于它们（P<0.0001）。在甲状腺功能减退的猫中，甲状腺素和游离甲状腺素浓度分别有15只（53.6%）和7只（25%）较低。在患有慢性肾病的猫中，也分别有7只（50%）和2只（14.3%）检测到血清甲状腺素和游离甲状腺素浓度较低。所有甲状腺功能减退的猫促甲状腺激素浓度均升高，但所有三组甲状腺功能正常的猫促甲状腺激素浓度均保持在参考区间内。血清促甲状腺激素的检测敏感性和特异性高于甲状腺素或游离甲状腺素浓度。
临床意义
血清促甲状腺激素浓度升高的发现能最好地识别猫医源性甲状腺功能减退症，并将其与治疗后发生氮血症的猫的非甲状腺疾病综合征区分开来。
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