Haug E, Frey H M, Sand T
Acta Endocrinol (Copenh). 1977 Jun;85(2):335-44. doi: 10.1530/acta.0.0850335.
Thyrotrophin releasing hormone (TRH) tests were performed at 4 or 8 weeks intervals, after the initiation of anti-thyroid treatment in 15 patients with Graves' disease. All TRH test were negative as long as the serum levels of thyroxine (T4) and triiodothyronine (T3) were elevated, and normalization of the serum levels of these hormones always occurred before the response to iv TRH was restored. In 13 patients the time from the patients for the first time were registered as biochemically euthyroid varied from 0-9 months (mean 3.1 months), before TRH response was restored. Two patients were still TRH non-responsive at the end of the study, even though they had been biochemically euthyroid for as long as 17 and 18.5 months. The TRH test, therefore, is not helpful in the evaluation of the effect of anti-thyroid treatment in patients with Graves' disease. There was an increase in the serum level of (TSH) from 3.4 +/- 0.3 (SEM) to 4.3 +/- 0.5 (SEM) ng/ml (P less than 0.05), and a decrease in the serum level of total T4 from 19.4 +/- 1.1 (SEM) to 5.8 +/- 0.8 (SEM) microng/100 ml in 13 patients from the first examination until the last time they were examined before restored TRH response. This finding shows that the pituitary gland has retained its ability to synthesize and secrete TSH even though no TSH could be released by iv TRH. In 6 TRH non-responsive patients with Graves' disease, serum TSH levels were suppressed from 2.5 +/- 1.2 (SEM) ng/ml before the administration of a single dose of 3 mg T4 orally, to 0.9 +/- 0.2 (SEM) ng/ml, 7 days after the T4 administration. Thus, the negative feed-back effect on the pituitary gland of the thyroid hormones is operating in these patients. This finding indicates that the TRH non-responsiveness in euthyroid patients with Graves' disease is not due to pituitary depletion of TSH, since the negative feed-back effect of the thyroid hormones is operating normally.
在15例格雷夫斯病患者开始抗甲状腺治疗后，每隔4周或8周进行促甲状腺激素释放激素（TRH）试验。只要血清甲状腺素（T4）和三碘甲状腺原氨酸（T3）水平升高，所有TRH试验均为阴性，并且在静脉注射TRH的反应恢复之前，这些激素的血清水平总是先恢复正常。在13例患者中，从首次记录生化甲状腺功能正常到TRH反应恢复的时间为0至9个月（平均3.1个月）。两名患者在研究结束时仍对TRH无反应，尽管他们生化甲状腺功能正常已达17个月和18.5个月。因此，TRH试验无助于评估格雷夫斯病患者抗甲状腺治疗的效果。13例患者从首次检查到TRH反应恢复前最后一次检查，血清促甲状腺激素（TSH）水平从3.4±0.3（标准误）ng/ml升高至4.3±0.5（标准误）ng/ml（P<0.05），血清总T4水平从19.4±1.1（标准误）μg/100ml降至5.8±0.8（标准误）μg/100ml。这一发现表明，即使静脉注射TRH不能释放TSH，垂体仍保留合成和分泌TSH的能力。在6例对TRH无反应的格雷夫斯病患者中，口服单剂量3mg T4前血清TSH水平为2.5±1.2（标准误）ng/ml，T4给药7天后降至0.9±0.2（标准误）ng/ml。因此，甲状腺激素对垂体的负反馈作用在这些患者中起作用。这一发现表明，格雷夫斯病甲状腺功能正常患者对TRH无反应并非由于垂体TSH耗竭，因为甲状腺激素的负反馈作用正常发挥。
