Amino N, Miyai K, Yamamoto T, Kuro R, Tanaka F
J Clin Endocrinol Metab. 1977 Jan;44(1):130-6. doi: 10.1210/jcem-44-1-130.
Four patients with Graves' disease whose hyperthyroidism was in remission following antithyroid therapy were studied without any treatment during and after pregnancy. In the 8-9th month of pregnancy, they were in a euthyroid state with serum levels of thyroxine (T4) of 18.9, 11.9, 11.2 and 14.5 mug/100 ml, triiodothyronine (T3) of 273, 190, 162 and 244 ng/100 ml and T3 resin sponge uptake (RT3U) of 22, 14, 19 and 16% respectively (normal pregnant range: T4, 7.0-15.0, T3 140-250, RT3U 15-25). At 1-3 months after delivery, hyperthyroidism recurred, as manifested by T4 levels of 17.2, 14.5, 16.7 and 21.7 mug/100 ml, T3 levels of 320, 225, 390 and 464 ng/100 ml and RT3U levels of 34, 34, 43, and 41% respectively (normal non-pregnant range: T4 5.0-12.0, T3 90-190, RT3U 24-37). The recurrence of hyperthyroidism was also demonstrated by serial measurements of serum free T4 and free T3. The thyroid function of all four patients returned spontaneously to the normal range at 4-6 months after delivery. One patient developed hypothyroidism for a short period before regaining the euthyroid state. The titers of serum anti-thyroid microsomal antibodies and levels of serum immunoglobulins decreased during pregnancy and increased transitorily at the time of hyperthyroidism after delivery. Similarly, increases in the levels of thyroid hormones, anti-thyroid antibodies and immunoglobulins were observed transitorily following spontaneous abortion after 4 months' pregnancy in one case. We suggest that the transient recurrence of hyperthyroidism in Graves' disease may be induced by immunological changes after delivery.
对4例接受抗甲状腺治疗后甲亢已缓解的格雷夫斯病患者在孕期及产后未进行任何治疗的情况下进行了研究。在妊娠8 - 9个月时，她们处于甲状腺功能正常状态，血清甲状腺素（T4）水平分别为18.9、11.9、11.2和14.5μg/100ml，三碘甲状腺原氨酸（T3）水平分别为273、190、162和244ng/100ml，T3树脂海绵摄取率（RT3U）分别为22%、14%、19%和16%（正常妊娠范围：T4 7.0 - 15.0，T3 140 - 250，RT3U 15 - 25）。产后1 - 3个月，甲亢复发，表现为T4水平分别为17.2、14.5、16.7和21.7μg/100ml，T3水平分别为320、225、390和464ng/100ml，RT3U水平分别为34%、34%、43%和41%（正常非妊娠范围：T4 5.0 - 12.0，T3 90 - 190，RT3U 24 - 37）。血清游离T4和游离T3的系列测量也证实了甲亢的复发。所有4例患者的甲状腺功能在产后4 - 6个月自发恢复到正常范围。1例患者在恢复到甲状腺功能正常状态之前有短时间的甲状腺功能减退。血清抗甲状腺微粒体抗体滴度和血清免疫球蛋白水平在孕期降低，产后甲亢时短暂升高。同样，1例妊娠4个月后自然流产后，甲状腺激素、抗甲状腺抗体和免疫球蛋白水平也短暂升高。我们认为，格雷夫斯病甲亢的短暂复发可能是由产后免疫变化引起的。
