监测 rT3 并调整 LT3 剂量在治疗与婴儿肝血管瘤相关的消耗性甲状腺功能减退症中的优势。
Advantages of monitoring rT3 and dividing LT3 dose in the treatment of consumptive hypothyroidism associated with infantile hepatic hemangioma.
机构信息
Division of General Pediatrics, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Division of Pediatric Endocrinology and Metabolism, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
出版信息
J Pediatr Endocrinol Metab. 2022 Jul 8;35(11):1453-1456. doi: 10.1515/jpem-2022-0032. Print 2022 Nov 25.
OBJECTIVES
In consumptive hypothyroidism associated with infantile hepatic hemangiomas (IHH), elevated reverse triiodothyronine (rT3) is known due to elevated D3. This report shows that rT3 is a new indicator of IHH progression and that three divided doses of LT3 per day were more effective than a single dose.
CASE PRESENTATION
A 23 day-old boy was diagnosed with diffuse IHH and severe hypothyroidism with high rT3. Propranolol and LT4 were administered. Hemangiomas gradually diminished and rT3 decreased, but the thyroid-stimulating hormone remained elevated, and free triiodothyronine (fT3) did not normalize after 2 weeks of treatment. Liothyronine (LT3) was started as a single dose and then divided into three doses after 1 week, which stabilized thyroid function.
CONCLUSIONS
rT3 levels were less variable and decreased in conjunction with tumor shrinkage; thus, rT3 is an indicator of therapeutic outcomes for IHH. LT3 administered in divided doses aided in managing IHH-associated hypothyroidism.
目的
在与婴儿肝血管瘤（IHH）相关的消耗性甲状腺功能减退症中，已知由于 D3 升高而导致反三碘甲状腺原氨酸（rT3）升高。本报告显示，rT3 是 IHH 进展的一个新指标，每天分三次给予 LT3 比单次剂量更有效。
病例介绍
一名 23 天大的男孩被诊断为弥漫性 IHH 和严重甲状腺功能减退症，伴有高 rT3。给予普萘洛尔和 LT4。血管瘤逐渐减少，rT3 下降，但甲状腺刺激激素仍升高，治疗 2 周后游离三碘甲状腺原氨酸（fT3）仍未恢复正常。LT3 开始时给予单次剂量，1 周后分为 3 次剂量，稳定了甲状腺功能。
结论
rT3 水平的变化较小，与肿瘤缩小呈同步变化；因此，rT3 是 IHH 治疗效果的一个指标。分剂量给予 LT3 有助于治疗 IHH 相关的甲状腺功能减退症。
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