甲状腺功能减退症和甲状腺切除术后患者经左甲状腺素治疗后促甲状腺激素-甲状腺激素反馈控制敏感性降低。血清三碘甲状腺原氨酸是否参与其中？
Decreased sensitivity of thyrotropin-thyroid hormone feedback control in hypothyroid and athyreotic patients treated with levothyroxine. Is serum triiodothyronine involved?
机构信息
Department of otorhinolaryngology, head and neck surgery, Sisters of Mercy university hospital center, medical school, university of Zagreb, Zagreb, Croatia.
Department of endocrinology, Sisters of Mercy university hospital center, medical school, university of Zagreb, Zagreb, Croatia.
出版信息
Ann Endocrinol (Paris). 2018 Apr;79(2):62-66. doi: 10.1016/j.ando.2017.11.003. Epub 2018 Mar 9.
OBJECTIVES
The search for optimal therapy for hypothyroidism is challenging and complex and is still going on. We investigated TSH-thyroid hormone feedback control in hypothyroid and athyreotic patients properly treated with levothyroxine (LT4), based on normal TSH values.
MATERIAL AND METHODS
We randomly selected 150 hypothyroid, 110 athyreotic and 210 euthyroid subjects, determined their serum T4, T3 and TSH values and calculated T4/TSH and T3/T4 ratios.
RESULTS
The TSH distribution in hypothyroidism was significantly shifted to the higher and that in athyreosis to the lower values from the normal distribution in euthyroid controls. This TSH-thyroid hormone dissociation in hypothyroidism was characterized with higher T4 and higher matched TSH values. We found 5% hypothyroid and 10% athyreotic patients normalize TSH only with hyperthyroxinemia. Serum T3 was lower in both hypothyroid groups and unaffected by a higher LT4 dose and higher serum T4 in athyreosis.
CONCLUSION
Our results suggest that the decreased serum T3 is a major cause of impaired TSH-thyroid hormone feedback control in hypothyroidism treated with LT4.
目的
寻找治疗甲状腺功能减退症的最佳疗法具有挑战性且复杂，目前仍在进行中。我们基于正常 TSH 值，研究了经左甲状腺素（LT4）适当治疗的甲状腺功能减退症和无甲状腺患者的 TSH-甲状腺激素反馈控制。
材料和方法
我们随机选择了 150 名甲状腺功能减退症患者、110 名无甲状腺患者和 210 名甲状腺功能正常患者，测定了他们的血清 T4、T3 和 TSH 值，并计算了 T4/TSH 和 T3/T4 比值。
结果
甲状腺功能减退症患者的 TSH 分布明显向高值偏移，无甲状腺患者的 TSH 分布向低值偏移，与甲状腺功能正常对照组的正态分布不同。这种甲状腺功能减退症中的 TSH-甲状腺激素分离表现为 T4 升高和匹配的 TSH 值升高。我们发现，5%的甲状腺功能减退症患者和 10%的无甲状腺患者仅通过甲状腺素血症使 TSH 正常化。两组甲状腺功能减退症患者的血清 T3 均较低，且不受 LT4 剂量增加和无甲状腺患者血清 T4 升高的影响。
结论
我们的研究结果表明，血清 T3 降低是 LT4 治疗甲状腺功能减退症时 TSH-甲状腺激素反馈控制受损的主要原因。
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