Herrmann J, Lehr H J, Kröll H J, Rusche H J, Rudorff K H, Krüskemper H L
Dtsch Med Wochenschr. 1975 Nov 7;100(45):2319-23. doi: 10.1055/s-0028-1106542.
In a 41-year-old woman and a 3-year-old girl, both of them with T3-thyrotoxicosis, serum levels of total and free T4 and T3 were measured serially during anti-thyroid drug treatment. Attempts to substitute thyroxine during the antithyroid treatment had to be interrupted because the patients became hyperthyroid again with excessive increases in total and free serum T3, even when concentrations of total and free T4 were brought to subnormal levels. The increased conversion of administered thyroxine ceased later on and higher amounts of oral T4 were tolerated after one year of treatment. In both patients there was an extremely low serum T4/T3 ratio, differing in this respect significantly from six other patients with T3-thyrotoxicosis and 41 patients with "conventional" T3/T4-hyperthyroidism. It is concluded that, in patients with T3-thyrotoxicosis due to excessive peripheral T4 to T3 conversion, substitution during antithyroid drug treatment should be either with very low doses of thyroxine or with triiodothyronine in divided daily doses. In such cases the level of serum T3 represents the most reliable biochemical measurement for the control of treatment, serum T4 levels being irrelevant.
在一名41岁女性和一名3岁女孩中,她们均患有T3甲状腺毒症,在抗甲状腺药物治疗期间连续测定了血清总T4、游离T4和T3水平。在抗甲状腺治疗期间尝试替代甲状腺素时不得不中断,因为即使将血清总T4和游离T4浓度降至正常水平以下,患者仍会再次出现甲状腺功能亢进,血清总T3和游离T3过度升高。给予的甲状腺素转化增加在后期停止,治疗一年后能耐受更高剂量的口服T4。两名患者的血清T4/T3比值极低,在这方面与另外六名T3甲状腺毒症患者和41名“传统”T3/T4甲亢患者有显著差异。得出的结论是,对于因外周T4向T3过度转化导致的T3甲状腺毒症患者,抗甲状腺药物治疗期间的替代治疗应采用极低剂量的甲状腺素或每日分次服用的三碘甲状腺原氨酸。在这种情况下,血清T3水平是控制治疗最可靠的生化指标,血清T4水平无关紧要。