左旋甲状腺素治疗对甲状腺疾病患儿尿黄体生成素测量的负面影响。
The negative impact of levothyroxine treatment on urinary luteinizing hormone measurements in pediatric patients with thyroid disease.
机构信息
Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Pediatrics, Division of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye.
出版信息
Front Endocrinol (Lausanne). 2023 Dec 12;14:1236710. doi: 10.3389/fendo.2023.1236710. eCollection 2023.
OBJECTIVES
Previous studies suggest urinary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) measurements by immunofluorometric assays (IFMA) as noninvasive alternatives to serum assays for puberty assessment. However, these studies excluded patients with other endocrine disorders and those taking medications. Besides, the recent discontinuation of IFMA manufacturing is a concern. We explored the utility of luminometric assays (LIA) for urinary gonadotropins and thyroid-stimulating hormone (TSH) determinations in euthyroid patients with thyroid pathologies.
METHODS
We used LIA and IFMA assays to measure serum and first-morning-voided (FMV) urine LH, FSH, and TSH concentrations in euthyroid patients with various thyroid disorders. Of the 47 euthyroid patients with normal serum TSH (S-TSH) levels, 14 were receiving levothyroxine therapy.
RESULTS
FMV total urinary LH (U-LH) concentrations correlated significantly with those measured in serum using either LIA (r=0.67, <.001) or IFMA (r=0.83, =.003) in patients not receiving levothyroxine treatment; however, no significant correlation could be detected in patients receiving levothyroxine regardless of the assay method (for LIA: r=0.50, =.08 and IFMA r=0.44, =.15). Urinary TSH (U-TSH) concentrations correlated poorly with those in serum in both the untreated and the treated groups (r=-0.13, =.49, and r=-0.45, =.11, respectively).
CONCLUSION
FMV total U-LH determinations by LIA can be used to assess pubertal development in patients with thyroid pathology, provided the euthyroid patient is not on levothyroxine treatment. U-TSH measurements by LIA cannot replace invasive S-TSH measurements at least in patients with normal S-TSH levels. Further research may reveal the utility of U-TSH determinations in patients with elevated S-TSH levels.
目的
先前的研究表明，通过免疫荧光分析（IFMA）测量尿液黄体生成素（LH）和卵泡刺激素（FSH）可作为评估青春期的非侵入性替代方法，而无需进行血清检测。然而，这些研究排除了患有其他内分泌疾病和正在服用药物的患者。此外，最近 IFMA 制造的停产令人担忧。我们探讨了发光免疫分析（LIA）在甲状腺疾病患者中用于测定尿液促性腺激素和促甲状腺激素（TSH）的效用。
方法
我们使用 LIA 和 IFMA 测定法测量了患有各种甲状腺疾病的甲状腺功能正常的患者的血清和晨尿（FMV）中的 LH、FSH 和 TSH 浓度。在 47 名甲状腺功能正常（S-TSH 正常）的甲状腺功能正常的患者中，有 14 名正在接受左甲状腺素治疗。
结果
在未接受左甲状腺素治疗的患者中，FMV 总尿 LH（U-LH）浓度与使用 LIA（r=0.67，<0.001）或 IFMA（r=0.83，<0.003）测量的血清浓度显着相关；然而，在接受左甲状腺素治疗的患者中，无论使用哪种测定方法，都未发现显着相关性（对于 LIA：r=0.50，<0.08 和 IFMA r=0.44，<0.15）。未治疗组和治疗组的 U-TSH 浓度与血清浓度相关性差（r=-0.13，<0.49 和 r=-0.45，<0.11）。
结论
在甲状腺疾病患者中，LIA 测定 FMV 总 U-LH 可用于评估青春期发育，但前提是甲状腺功能正常的患者未接受左甲状腺素治疗。LIA 测定 U-TSH 不能替代至少在 S-TSH 水平正常的患者中的侵袭性 S-TSH 测量。进一步的研究可能会揭示 U-TSH 测定在 S-TSH 水平升高的患者中的效用。
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