Takamatsu J, Miki K, Isaji H, Kitazawa A, Furukawa K, Fujiwara M, Kuma K, Mozai T
Endocrinol Jpn. 1984 Aug;31(4):435-41. doi: 10.1507/endocrj1954.31.435.
We describe a 29-year-old male with thyroid hormone resistance. He was first seen because of a goiter, and was considered to have hyperthyroid Graves' disease. Despite subtotal thyroidectomy followed by radioiodine therapy, serum thyroxine levels were elevated with high serum TSH levels. Baseline thyroid function showed serum thyroxine of 16.6 micrograms/dl, free thyroxine of 4.60 ng/dl, triiodothyronine of 197 ng/dl, and TSH of 34 microU/ml. Triiodothyronine administration by gradually increased doses of 75, 150, 225, 300, and 375 micrograms/d over a 25-day period resulted in gradual reduction of serum TSH and T4 levels, but serum TSH still responded to TRH even during this period. The basal metabolic rate was--14% and showed a minimal rise even with large doses of triiodothyronine. The results led to the diagnosis of generalized thyroid hormone resistance including the pituitary gland. Increased pulse rate, finger tremor and emotional lability in the patient suggest that the severity of peripheral refractoriness to the hormone may vary from tissue to tissue. In addition, a reduced thyroidal responsiveness to TSH as a consequence of inappropriate radioiodine therapy was observed in this patient.
我们描述了一名患有甲状腺激素抵抗的29岁男性。他因甲状腺肿大首次就诊，当时被认为患有甲状腺功能亢进的格雷夫斯病。尽管进行了甲状腺次全切除术并随后接受了放射性碘治疗，但血清甲状腺素水平仍升高，同时血清促甲状腺激素（TSH）水平也很高。基础甲状腺功能显示血清甲状腺素为16.6微克/分升，游离甲状腺素为4.60纳克/分升，三碘甲状腺原氨酸为197纳克/分升，TSH为34微国际单位/毫升。在25天内逐渐增加三碘甲状腺原氨酸剂量至75、150、225、300和375微克/天，导致血清TSH和T4水平逐渐降低，但在此期间血清TSH仍对促甲状腺激素释放激素（TRH）有反应。基础代谢率为-14%，即使使用大剂量三碘甲状腺原氨酸，基础代谢率也仅有轻微升高。这些结果导致诊断为包括垂体在内的全身性甲状腺激素抵抗。患者脉搏加快、手指震颤和情绪不稳定表明，外周组织对该激素的抵抗程度可能因组织而异。此外，在该患者中观察到，由于不适当的放射性碘治疗，甲状腺对TSH的反应性降低。
