Schlienger J L, Cherfan J, Drawin T, Sacrez A
Service de Médecine interne, Hôpital de Hautepierre, CHU, Strasbourg.
Presse Med. 1988 Apr 30;17(16):787-90.
The incidence of hyperthyroidism in patients with continuous arrhythmia due to atrial fibrillation was evaluated prospectively by means of the "ultrasensitive" assay of thyroid-stimulating hormone (TSH). When the result was abnormal, free thyroxine fractions (FT4) and free triiodothyronine fractions (FT3) were measured, and in some cases a thyrotropin-releasing hormone (TRH) test and a thyroid gland scintigraphy were performed. Among 50 unselected patients with continuous arrhythmia due to atrial fibrillation, 12 had a low TSH baseline level. In 7 of them, high FT4 and/or FT3 levels provided evidence of hyperthyroidism. In the remaining 5 patients FT4 and FT3 levels were normal, but TSH response to TRH was suppressed and scintigraphy showed a high nodular or lobular uptake. In a control series of 50 age- and sex- matched subjects without thyroid disorders or dysrhythmia, TSH level was low in only one case with insufficient response to TRH, but the scintigraphic image did not suggest nodular hyperthyroidism. It is concluded that systematic TSH assays can detect those atrial fibrillations which are consecutive to, or aggravated by hyperthyroidism, even asymptomatic. We regard this assay as indispensable to evaluate continuous arrhythmia due to atrial fibrillation, even when an apparently causative underlying heart disease is present.
通过促甲状腺激素（TSH）的“超敏”检测法，对因心房颤动导致持续性心律失常的患者进行前瞻性甲状腺功能亢进症发病率评估。当检测结果异常时，测量游离甲状腺素组分（FT4）和游离三碘甲状腺原氨酸组分（FT3），部分病例还进行促甲状腺激素释放激素（TRH）试验和甲状腺闪烁扫描。在50例未经挑选的因心房颤动导致持续性心律失常的患者中，12例患者TSH基线水平较低。其中7例患者，FT4和/或FT3水平升高，证实存在甲状腺功能亢进症。其余5例患者FT4和FT3水平正常，但TSH对TRH的反应受到抑制，闪烁扫描显示有高结节或小叶摄取。在50例年龄和性别匹配、无甲状腺疾病或心律失常的对照受试者中，仅1例TSH水平较低，对TRH反应不足，但闪烁扫描图像未提示结节性甲状腺功能亢进症。结论是，系统的TSH检测可以检测出那些由甲状腺功能亢进症引起或因甲状腺功能亢进症而加重的心房颤动，即使是无症状的。我们认为，即使存在明显的潜在病因性心脏病，该检测对于评估因心房颤动导致的持续性心律失常也是必不可少的。
