Amino N, Yabu Y, Miki T, Morimoto S, Kumahara Y, Mori H, Iwatani Y, Nishi K, Nakatani K, Miyai K
J Clin Endocrinol Metab. 1981 Jul;53(1):113-6. doi: 10.1210/jcem-53-1-113.
The serum ratios of T3 to T4, and T4-binding globulin (TBG) and calcitonin concentrations were studied in cases of thyrotoxic Graves' disease and destruction-induced thyrotoxicosis. In 272 patients with Graves' disease, 209 of 240 (87%) untreated patients without complications had high T3 to T4 ratios (nanograms per micrograms) of more than 20. Six of 32 (19%) patients with Graves' disease who had complications (15 with pregnancy, 14 with increased TBG, and 3 with conditions associated with a low T3 syndrome) had high T3 to T4 ratios. Eleven of 74 (15%) patients with destruction-induced thyrotoxicosis (24 with subacute thyroiditis, 39 with postpartum transient thyrotoxicosis, and 11 with spontaneous transient thyrotoxicosis) had high T3 to T4 ratios. Patients who had serum T4 levels of more than 30 micrograms/dl and/or T3 levels of more than 800 ng/dl had Graves' disease. There was no significant correlation between the T3 to T4 ratio and activities of thyroid-stimulating immunoglobulins in thyrotoxic patients with Graves' disease who had no complications. The average serum levels of TBG in destruction-induced thyrotoxicosis and thyrotoxic Graves' disease were 20.7 +/- 4.3 micrograms/ml (mean +/- SD; n = 22), and 19.9 +/- 4.0 (n = 41), respectively, which were significantly lower than that in healthy subjects (22.7 +/- 4.4 micrograms/ml; n = 165), but there was no difference between the values in the two groups of thyrotoxicosis patients. The average serum level of calcitonin in destruction-induced thyrotoxicosis patients was 96.7 +/- 66.7 pg/ml (n = 21), which was significantly (P less than 0.05) higher than the values in patients with thyrotoxic Graves' disease (62.0 +/- 44.7 pg/ml; n = 26) and in healthy subjects (63.9 +/- 31.2 pg/ml; n = 29), but the difference in values in the two groups of thyrotoxicosis was not clinically useful because of considerable overlap of individual values. The T3 to T4 ratio is a simple and helpful index for the differentiation of the two types of thyrotoxicosis. A T3 to T4 ratio less than 20 in thyrotoxic patients before therapy is a laboratory signal of destruction-induced thyrotoxicosis or Graves' disease with complications, but final differentiation should be confirmed by measuring radioactive iodine uptake.
对甲状腺毒症性格雷夫斯病和破坏性甲状腺毒症患者的血清T3与T4比值、甲状腺素结合球蛋白（TBG）及降钙素浓度进行了研究。在272例格雷夫斯病患者中，240例未合并并发症的未治疗患者中有209例（87%）的T3与T4比值（纳克/微克）高于20。32例合并并发症的格雷夫斯病患者（15例妊娠、14例TBG升高、3例合并低T3综合征相关疾病）中有6例T3与T4比值升高。74例破坏性甲状腺毒症患者（24例亚急性甲状腺炎、39例产后短暂性甲状腺毒症、11例自发性短暂性甲状腺毒症）中有11例T3与T4比值升高。血清T4水平高于30微克/分升和/或T3水平高于800纳克/分升的患者患有格雷夫斯病。在无并发症的甲状腺毒症性格雷夫斯病患者中，T3与T4比值与促甲状腺素受体抗体活性之间无显著相关性。破坏性甲状腺毒症和甲状腺毒症性格雷夫斯病患者的平均血清TBG水平分别为20.7±4.3微克/毫升（均值±标准差；n = 22）和19.9±4.0（n = 41），均显著低于健康受试者（22.7±4.4微克/毫升；n = 165），但两组甲状腺毒症患者的值无差异。破坏性甲状腺毒症患者的平均血清降钙素水平为96.7±66.7皮克/毫升（n = 21），显著高于甲状腺毒症性格雷夫斯病患者（62.0±44.7皮克/毫升；n = 26）和健康受试者（63.9±31.2皮克/毫升；n = 29）（P＜0.05），但由于个体值有相当大的重叠，两组甲状腺毒症患者的值差异在临床上并无实际意义。T3与T4比值是区分两种类型甲状腺毒症的一个简单且有用的指标。甲状腺毒症患者治疗前T3与T4比值小于20是破坏性甲状腺毒症或合并并发症的格雷夫斯病的实验室信号，但最终的鉴别应通过测量放射性碘摄取来确认。
