Mann K, Saller B, Mehl U, Hörmann R, Moser E
Department of Internal Medicine II, University of Munich, FRG.
Nuklearmedizin. 1988 Feb;27(1):24-8.
Basal and TRH-stimulated TSH levels were determined in 72 patients with differentiated thyroid cancer on hormonal treatment, using a highly sensitive immunoradiometric assay (IRMAclon, Henning). 43 patients were under treatment with levothyroxine (T4), 29 patients with triiodothyronine (T3). In 33/43 patients (77%) under T4- and in 18/29 patients (62%) under T3-treatment basal TSH levels were below 0.1 mU/l and levels stimulated with 200 micrograms TRH i.v. were below 0.5 mU/l. 3 patients showed a significant response (to above 0.5 mU/l) in the TRH test despite basal values of less than 0.1 mU/l. In 2 patients with elevated basal TSH levels (0.23 and 0.60 mU/l, resp.) in the IRMAclon, total suppression of TSH secretion was suggested by a failure of TSH to rise after TRH. By retesting these samples in an own TSH IRMA, basal and stimulated TSH values were below 0.1 mU/l. In conclusion, basal and TRH-stimulated TSH levels are well correlated in most patients with thyroid cancer under hormonal treatment. However, in some cases (5/72) determination of basal TSH could not clearly define the degree of thyrotropic suppression. Thus, TRH testing is still necessary to establish definitely complete TSH suppression in patients with thyroid carcinoma under suppressive treatment.
采用高灵敏度免疫放射分析方法（IRMAclon，亨宁公司），对72例接受激素治疗的分化型甲状腺癌患者测定基础促甲状腺激素（TSH）水平及促甲状腺激素释放激素（TRH）刺激后的TSH水平。43例患者接受左甲状腺素（T4）治疗，29例患者接受三碘甲状腺原氨酸（T3）治疗。在接受T4治疗的43例患者中有33例（77%），接受T3治疗的29例患者中有18例（62%），基础TSH水平低于0.1 mU/l，静脉注射200微克TRH刺激后的水平低于0.5 mU/l。3例患者尽管基础值低于0.1 mU/l，但在TRH试验中仍有显著反应（升至0.5 mU/l以上）。在IRMAclon检测中，有2例患者基础TSH水平升高（分别为0.23和0.60 mU/l），TRH刺激后TSH未升高，提示TSH分泌完全受抑制。通过用我们自己的TSH免疫放射分析方法重新检测这些样本，基础及刺激后的TSH值均低于0.1 mU/l。总之，在大多数接受激素治疗的甲状腺癌患者中，基础及TRH刺激后的TSH水平相关性良好。然而，在某些情况下（72例中有5例），基础TSH的测定不能明确界定促甲状腺素抑制的程度。因此，对于接受抑制治疗的甲状腺癌患者，仍有必要进行TRH试验以明确确定TSH是否完全被抑制。
