Woolf P D
Am J Med. 1977 Sep;63(3):343-7. doi: 10.1016/0002-9343(77)90271-6.
Four women, aged 17 to 23, were evaluated for secondary amenorrhea of 12 to 36 months' duration. All were considered to have hypothalamic hypothyroidism on the basis of low thyroxine (T4) concentrations, inappropriately low thyrotropin (TSH) levels, with a normal TSH response to thyrotropin-releasing hormone (TRH, 500 microgram intravenously) in three, and absence of a pituitary lesion. Nevertheless, menses did not resume after adequate replacement with thyroid hormone. Investigation of the pituitary-gonadal axis revealed a normal increase in both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) following the intravenous administration of gonadotropin-releasing hormone (GnRH). Three subjects received clomiphene citrate, 100 mg/day for five days, but a normal menstrual cycle was not induced. It is concluded that the amenorrhea was not due to thyroid hormone deficiency but, like the hypothyroidism, to a hypothalamic abnormality involving secretion of the appropriate releasing hormone.
对4名年龄在17至23岁之间的女性进行了评估，她们有持续12至36个月的继发性闭经。基于低甲状腺素（T4）浓度、促甲状腺激素（TSH）水平异常低，其中3名对促甲状腺激素释放激素（TRH，静脉注射500微克）的TSH反应正常，且无垂体病变，所有患者均被认为患有下丘脑性甲状腺功能减退症。然而，在充分补充甲状腺激素后月经仍未恢复。对垂体-性腺轴的研究显示，静脉注射促性腺激素释放激素（GnRH）后，促黄体生成素（LH）和促卵泡生成素（FSH）均正常增加。3名受试者接受了柠檬酸氯米芬治疗，每天100毫克，共5天，但未诱导出正常的月经周期。结论是闭经并非由于甲状腺激素缺乏，而是与甲状腺功能减退症一样，是由于涉及适当释放激素分泌的下丘脑异常所致。
