促甲状腺激素释放激素（TRH）试验为已知垂体疾病和低 T4 水平的患者的中枢性甲状腺功能减退症的诊断提供了有价值的信息。

The TRH test provides valuable information in the diagnosis of central hypothyroidism in patients with known pituitary disease and low T4 levels.

机构信息

Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.

Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark.

出版信息

Front Endocrinol (Lausanne). 2023 Oct 2;14:1226887. doi: 10.3389/fendo.2023.1226887. eCollection 2023.

DOI:10.3389/fendo.2023.1226887

PMID:37850100

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10577283/

Abstract

OBJECTIVE

To evaluate the value of the thyrotropin-releasing hormone (TRH) test in the diagnosis of central hypothyroidism (CH) in patients with pituitary disease.

METHODS

Systematic evaluation of 359 TRH tests in patients with pituitary disease including measurements of thyroxine (T4), TBG-corrected T4 (T4), baseline TSH (TSH) and relative or absolute TSH increase (TSH, TSH).

RESULTS

Patients diagnosed with CH (n=39) show comparable TSH (p-value 0.824) but lower T4 (p-value <0.001) and lower TSH increase (p-value <0.001) compared to patients without CH. In 54% (42 of 78 cases) of patients with low T4, the CH diagnosis was rejected based on a high TSH. In these cases, a spontaneous increase and mean normalization in T4 (from 62 to 73 nmol/L, p-value <0.001) was observed during the follow-up period (7.6 ± 5.0 years). Three of the 42 patients (7%) were started on replacement therapy due to spontaneous deterioration of thyroid function after 2.8 years. Patients diagnosed with CH reported significantly more symptoms of hypothyroidism (p-value 0.005), although, symptoms were reported in most patients with pituitary disease. The TRH test did not provide clinical relevant information in patients with normal T4 or patients awaiting pituitary surgery (78%, 281 of 359). There were only mild and reversible adverse effects related to the TRH test except for possibly one case (0.3%) experiencing a pituitary apoplexy.

CONCLUSION

The TRH test could be reserved to patients with pituitary disease, low T4 levels without convincing signs of CH. Approximately 50% of patients with a slightly decreased T4 were considered to have normal pituitary thyroid function based on the TRH test results.

摘要

目的

评估促甲状腺激素释放激素（TRH）试验在诊断垂体疾病患者中枢性甲状腺功能减退症（CH）中的价值。

方法

对 359 例垂体疾病患者的 TRH 试验进行系统评估，包括甲状腺素（T4）、甲状腺素结合球蛋白校正的 T4（T4）、基础 TSH（TSH）和相对或绝对 TSH 增加（TSH，TSH）的测量。

结果

与无 CH 的患者相比，诊断为 CH 的患者（n=39）的 TSH 相似（p 值 0.824），但 T4 较低（p 值<0.001）且 TSH 增加较低（p 值<0.001）。在 54%（78 例中的 42 例）低 T4 的患者中，由于高 TSH，拒绝了 CH 诊断。在这些情况下，在随访期间（7.6±5.0 年）观察到 T4 自发增加和平均正常化（从 62 至 73 nmol/L，p 值<0.001）。由于甲状腺功能在 2.8 年后自发恶化，3 例（7%）患者开始接受替代治疗。尽管大多数垂体疾病患者都有症状，但诊断为 CH 的患者报告的甲状腺功能减退症状明显更多（p 值 0.005）。在 T4 正常或等待垂体手术的患者中（78%，359 例中的 281 例），TRH 试验并未提供临床相关信息。除可能有 1 例（0.3%）发生垂体卒中外，TRH 试验仅引起轻度且可逆转的不良反应。