Boutin J M, Matte R, D'Amour P, Gilbert F, Havrankova J, Bélanger R, Chartrand R, Zakarija M
Clin Endocrinol (Oxf). 1986 Nov;25(5):579-88. doi: 10.1111/j.1365-2265.1986.tb03612.x.
The nature of the thyroid disorder presented by patients with normal T4 and T3 but blunted TSH response to TRH has not been clarified. In this study, we compared thyroid function tests in 16 such patients with those of 14 controls and 10 hyperthyroid patients. Basal total T4, free T4, total T3, iodine uptake and cholesterol of the study group were similar to controls but significantly (P less than 0.001) lower than in hyperthyroid patients, except for cholesterol which was higher. In contrast, the basal TSH, increase in TSH after TRH stimulation, and decrease of T4 during T3 suppression tests were similar to data obtained in hyperthyroid patients but significantly (P less than 0.001) lower than in controls. Pulse rate was mid-way between the control and the hyperthyroid group. Thyroid stimulating antibody (TSAb) was measured with human thyroid cells in culture; the assay was positive in four subjects in the 16-patient group and in all hyperthyroid patients tested. TSH stimulation test showed a hyporesponse in iodine uptake in the four patients with positive TSAb (26 +/- 29%), as well as in hyperthyroid patients (6 + 5%). However, there was a hyper-response to TSH (213 +/- 52%) in the remaining 12 patients in the group, none of whom had TSAb. Thus TSAb is not seen as responsible for the thyroid disorder in the majority of patients with normal T3 and T4 and absent or blunted TSH response to TRH; surprisingly, most of these patients have thyroid hypersensitivity to TSH. These two characteristics, absence of TSAb and hypersensitivity to TSH, delineate a thyroid disorder clearly different from Graves' disease.
甲状腺素（T4）和三碘甲状腺原氨酸（T3）水平正常但促甲状腺激素（TSH）对促甲状腺激素释放激素（TRH）反应迟钝的患者所呈现的甲状腺疾病本质尚未明确。在本研究中，我们比较了16例此类患者与14例对照者及10例甲状腺功能亢进患者的甲状腺功能测试结果。研究组的基础总T4、游离T4、总T3、碘摄取量和胆固醇水平与对照组相似，但除胆固醇水平较高外，均显著低于甲状腺功能亢进患者（P<0.001）。相比之下，基础TSH、TRH刺激后TSH的升高以及T3抑制试验期间T4的降低与甲状腺功能亢进患者的数据相似，但显著低于对照组（P<0.001）。脉搏率介于对照组和甲状腺功能亢进组之间。采用培养的人甲状腺细胞检测甲状腺刺激抗体（TSAb）；在16例患者组中有4例受试者检测结果为阳性，所有接受检测的甲状腺功能亢进患者检测结果均为阳性。TSH刺激试验显示，4例TSAb阳性患者的碘摄取反应低下（26±29%），甲状腺功能亢进患者也是如此（6±5%）。然而，该组其余12例患者对TSH有高反应（213±52%），他们均无TSAb。因此，在大多数T3和T4水平正常且TSH对TRH反应缺失或迟钝的患者中，TSAb并非甲状腺疾病的病因；令人惊讶的是，这些患者中的大多数对TSH具有甲状腺超敏反应。TSAb缺失和对TSH超敏这两个特征明确界定了一种与格雷夫斯病明显不同的甲状腺疾病。
