Izembart M, Nasser H, Heshmati H M, Vallée G
Service de Biophysique, CHU Necker Enfants-Malades, Paris.
Ann Biol Clin (Paris). 1987;45(4):412-7.
Laboratory tests to assess thyroid gland function have changed considerably over the past few years, with the development of techniques allowing for the direct routine determination of unbound thyroid hormones (tri and tetra-iodothyronine), the "ultra-sensitive" assay of serum concentrations of TSH (thyroid-stimulating hormone) and finally, the radioimmunological assay of anti TSH-receptor antibodies. In our study, which excluded patients having an excess of iodine or who had serious disease of an organ other than the thyroid, we assessed the impact of these parameters respectively on various disease categories. An innovation has been made in that anti TSH-receptor antibody assay is now possible in everyday practice while up to the present this was only possible in the hospital setting and with a limited number of cases: this titer is important as a classification parameter in diagnosing Grave's disease and has prognostic importance to monitor treatment of patients suffering from this disorder. The "ultrasensitive" version of measuring thyrotropic hormone requires a new strategy: TSH assessment becomes the first-line diagnosis test to evaluate thyroid function because it differentiates from control subjects, as well as patients with hyper ou hypothyroidism who are not receiving therapy. In other cases, dosing of the free hormones T3 and T4 remains a vital supplementary test.
在过去几年中，随着技术的发展，用于评估甲状腺功能的实验室检测方法发生了很大变化，这些技术使得直接常规测定未结合的甲状腺激素（三碘甲状腺原氨酸和四碘甲状腺原氨酸）、血清促甲状腺激素（TSH）浓度的“超灵敏”检测以及抗TSH受体抗体的放射免疫检测成为可能。在我们的研究中，排除了碘过量或患有甲状腺以外其他器官严重疾病的患者，我们分别评估了这些参数对各种疾病类别的影响。一项创新在于，抗TSH受体抗体检测现在在日常实践中就可以进行，而在此之前，这只能在医院环境中且针对有限数量的病例进行：该滴度作为诊断格雷夫斯病的分类参数很重要，并且对于监测患有这种疾病的患者的治疗具有预后意义。促甲状腺激素的“超灵敏”检测版本需要一种新策略：TSH评估成为评估甲状腺功能的一线诊断测试，因为它可以区分对照受试者以及未接受治疗的甲状腺功能亢进或减退患者。在其他情况下，游离激素T3和T4的定量测定仍然是一项重要的补充检测。
