Kaplan M M, Larsen P R, Crantz F R, Dzau V J, Rossing T H, Haddow J E
Am J Med. 1982 Jan;72(1):9-16. doi: 10.1016/0002-9343(82)90565-4.
We measured serum total and free thyroxine (T4) and triiodothyronine (T3) concentrations, free T4 and T3 indexes, thyroid-stimulating hormone (TSH), thyroxine-binding globulin (TBG) and thyroxine-binding prealbumin (TBPA) concentrations in 98 patients hospitalized for acute medical illnesses. The free thyroxine index (FT4I) or TSH level was abnormal in 16 percent, but only 3 percent had thyroid disease. Serum fre T4 measurements by equilibrium dialysis were abnormal in 25 percent, but no additional patients who initially had abnormal concentrations of serum free T4 were subsequently proved to have thyroid disease. Patients with supranormal serum free T4 concentrations (21 percent) ahd higher serum T4, lower serum T3, and higher serum reverse T3 (rT3) concentrations than other patients, but the measured changes in serum T4, TBG and TBPA levels could only partly account for the magnitude of the free T4 elevation. In these acutely ill patients, an accurate diagnosis of thyroid disease could be achieved by determination of FT4I and TSH level and a history of medication usage. We conclude that other tests are rarely necessary for this purpose in a patient population such as this.
我们测定了98例因急性内科疾病住院患者的血清总甲状腺素（T4）、游离甲状腺素（T4）、总三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（T3）浓度、游离T4和T3指数、促甲状腺激素（TSH）、甲状腺素结合球蛋白（TBG）和甲状腺素结合前白蛋白（TBPA）浓度。16%的患者游离甲状腺素指数（FT4I）或TSH水平异常，但只有3%的患者患有甲状腺疾病。通过平衡透析测定的血清游离T4在25%的患者中异常，但最初血清游离T4浓度异常的患者中，没有其他患者随后被证实患有甲状腺疾病。血清游离T4浓度超常的患者（21%）比其他患者具有更高的血清T4、更低的血清T3和更高的血清反三碘甲状腺原氨酸（rT3）浓度，但血清T4、TBG和TBPA水平的测定变化只能部分解释游离T4升高的幅度。在这些急性病患者中，通过测定FT4I和TSH水平以及用药史可实现甲状腺疾病的准确诊断。我们得出结论，在此类患者群体中，为此目的很少需要进行其他检查。
