Golden M P, Kaplan S A, Lippe B M, Lee W N
Pediatrics. 1977 May;59(5):762-7.
One hundred simultaneous determinations of serum T4 and T3 were performed during the course of treatment of 23 children and adolescents with Graves' disease. Five patients were previously untreated and six were experiencing relapse after treatment was discontinued. During relapse, increased T3 concentration is frequently present when serum T4 concentration is normal and T3 measurement is therefore more reliable for early detection of relapse. During therapy with thionamides, T4 measurement alone is often misleading in assessing adequacy of control achieved by therapy. Commonly, patients who clinically have hyperthyroidism have serum T4 concentrations within the normal range but continue to have elevated T3 concentrations (T3 toxicosis). Similarly, T4 can be suppressed into the hypothyroid range in the clinically euthyroid patient with either a normal or high T3 concentration. In these patients, determination of serum T3 often prevents premature reduction of thionamide dosage. When T4 and T3 concentrations do not clearly demonstrate presence or absence of hypothyroidism, measurement of serum thyroid stimulating hormone can be of value.
在对23例患有格雷夫斯病的儿童和青少年进行治疗的过程中，同时进行了100次血清T4和T3测定。5例患者此前未接受过治疗，6例在治疗中断后出现复发。在复发期间，当血清T4浓度正常时，T3浓度常常升高，因此T3测定对于复发的早期检测更为可靠。在使用硫代酰胺类药物治疗期间，仅测定T4在评估治疗所达到的控制是否充分时常常会产生误导。通常，临床上患有甲状腺功能亢进症的患者血清T4浓度在正常范围内，但T3浓度持续升高（T3中毒）。同样，在临床上甲状腺功能正常但T3浓度正常或升高的患者中，T4可能会被抑制到甲状腺功能减退范围内。在这些患者中，测定血清T3常常可防止过早减少硫代酰胺类药物的剂量。当T4和T3浓度不能明确显示甲状腺功能减退的存在或不存在时，测定血清促甲状腺激素可能会有帮助。
