Kirkegaard C, Bregengård C
Medical Department E, Frederiksberg Hospital, Copenhagen, Denmark.
Horm Metab Res. 1988 Jun;20(6):357-9. doi: 10.1055/s-2007-1010835.
Twenty-five patients with nodular goitre who had thyroid hormone levels within normal ranges and an absent thyrotropin (TSH) response to TSH releasing hormone (TRH) as measured by a conventional radioimmunoassay with a lower detection limit of 0.6 mU/l were studied. Based on these data, and the clinical evaluation patients were divided into a hyperthyroid group (n = 12) and a euthyroid group (n = 13). The samples from the TRH test were reanalyzed by an immunoradiometric TSH assay with a detection limit of 0.05 mU/l. Basal serum TSH showed a considerable overlap between the two groups, but values above 0.10 mU/l were always associated with euthyroidism. Using this level of discrimination 76% of the patients were correctly classified. A TSH response to TRH of 0.10 mU/l provided a better discrimination allowing a correct diagnosis in 92% of the patients. It is concluded that serum TSH as measured by a sensitive assay is suitable as a first line test in patients with nodular goitre. However, patients with basal serum TSH levels below 0.10 mU/l need further investigation with a TRH-test. A TSH response to TRH above 0.10 mU/l seems to secure euthyroidism, whereas lower responses almost always are associated with hyperthyroidism.
对25例结节性甲状腺肿患者进行了研究，这些患者的甲状腺激素水平在正常范围内，且通过检测下限为0.6 mU/l的传统放射免疫分析法测定，其促甲状腺激素（TSH）对促甲状腺激素释放激素（TRH）无反应。基于这些数据以及临床评估，将患者分为甲亢组（n = 12）和甲功正常组（n = 13）。对TRH试验的样本采用检测下限为0.05 mU/l的免疫放射法重新检测TSH。两组患者的基础血清TSH有相当程度的重叠，但TSH值高于0.10 mU/l总是与甲功正常相关。以此鉴别水平，76%的患者被正确分类。TSH对TRH的反应为0.10 mU/l时鉴别效果更佳，92%的患者能得到正确诊断。结论是，用灵敏分析法测定的血清TSH适合作为结节性甲状腺肿患者的一线检测方法。然而，基础血清TSH水平低于0.10 mU/l的患者需要进一步进行TRH试验检查。TSH对TRH的反应高于0.10 mU/l似乎可确保甲功正常，而较低的反应几乎总是与甲亢相关。
