Muir A, Daneman D, Daneman A, Ehrlich R
Department of Pediatrics, Hospital for Sick Children, University of Toronto.
Am J Dis Child. 1988 Feb;142(2):214-6. doi: 10.1001/archpedi.1988.02150020116044.
Congenital hypothyroidism (CH) can be due to an absent gland (athyrosis), an ectopic gland (usually lingual), or an inborn metabolic error (goiter). In this study, radionuclide scanning was compared with ultrasound (US) and serum thyroglobulin (Tg) concentration as a method of determining the cause of CH in 50 newborns. Mean serum Tg values were significantly lower in athyrotic children (7.9 pmol/L) than in either those with goitrous (149.1 pmol/L) or ectopic (60.5 pmol/L) glands, but there was marked overlap among all three groups. With the interpreter "blinded" to the radionuclide diagnosis, a cervical gland could be delineated reliably on US. All 12 goiters and five of five normal glands were identified. In contrast, the correlation between US and radionuclide scanning was poor in patients in whom there was no cervical thyroid tissue. Ultrasound failed to identify 13 lingual glands and was reported as normal in four of 12 children with no radionuclide uptake in the neck and biochemical hypothyroidism. Two children with absent thyroid glands on scanning were biochemically euthyroid. The serum of two others who had normal results of radionuclide studies showed persistent hypothyroidism. Thyroid scanning remains the most accurate diagnostic modality to determine the cause of CH. Serum Tg and cervical US have not been established as reliable alternatives.
先天性甲状腺功能减退症（CH）可能是由于甲状腺缺如（无甲状腺）、异位甲状腺（通常为舌甲状腺）或先天性代谢错误（甲状腺肿）所致。在本研究中，对50例新生儿进行了放射性核素扫描，并与超声（US）及血清甲状腺球蛋白（Tg）浓度进行比较，以确定CH的病因。无甲状腺患儿的平均血清Tg值（7.9 pmol/L）显著低于甲状腺肿患儿（149.1 pmol/L）或异位甲状腺患儿（60.5 pmol/L），但三组之间存在明显重叠。在对放射性核素诊断结果不知情的情况下，超声能够可靠地显示出颈部甲状腺。12例甲状腺肿及5例正常甲状腺均被识别。相比之下，对于颈部无甲状腺组织的患者，超声与放射性核素扫描之间的相关性较差。超声未能识别出13例舌甲状腺，在12例颈部无放射性核素摄取且生化检查为甲状腺功能减退症的患儿中，有4例超声报告为正常。2例扫描显示甲状腺缺如的患儿生化检查甲状腺功能正常。另外2例放射性核素检查结果正常的患儿血清显示持续存在甲状腺功能减退。甲状腺扫描仍然是确定CH病因最准确的诊断方法。血清Tg和颈部超声尚未被确立为可靠的替代方法。
