Walfish P G, Gottesman I S, Baxter J L
Can Med Assoc J. 1982 Aug 15;127(4):291-4.
Five patients with Graves' ophthalmopathy and no previously documented clinical or laboratory evidence of hyperthyroidism were studied. Their serum levels of thyroxine and triiodothyronine (T3) and their T3 uptake were normal. Although the baseline serum level of thyrotropin (TSH) was normal in two patients, it was increased on the other three, and when TSH releasing hormone (TRH) was administered the T3 response was impaired in three patients and the TSH response was exaggerated in all five. These findings facilitated the diagnosis of subclinical hypothyroidism and distinguished the patients from those with Graves' ophthalmopathy and normal thyroid function or subclinical hyperthyroidism. Thyroid antibodies were detected in the serum of four of the five patients, suggesting the coexistence of chronic autoimmune thyroiditis; this disorder could account in part for the subclinical hypothyroidism, which was even present in the two patients in whom thyroid-stimulating immunoglobulin was found in the serum. These observations indicate the value of a TRH stimulation test in detecting subclinical hypothyroidism in patients with Graves' ophthalmopathy who appear from clinical and routine laboratory studies to have normal thyroid function but could have normal function or subclinical hyperthyroidism.
对5例格雷夫斯眼病患者进行了研究，这些患者既往无甲亢的临床或实验室证据记录。他们的血清甲状腺素和三碘甲状腺原氨酸（T3）水平以及T3摄取均正常。虽然2例患者促甲状腺素（TSH）的基线血清水平正常，但另外3例升高，当给予促甲状腺素释放激素（TRH）时，3例患者的T3反应受损，所有5例患者的TSH反应均增强。这些发现有助于亚临床甲减的诊断，并将这些患者与格雷夫斯眼病且甲状腺功能正常或亚临床甲亢的患者区分开来。5例患者中有4例血清中检测到甲状腺抗体，提示存在慢性自身免疫性甲状腺炎；这种疾病可能部分解释了亚临床甲减，在血清中发现甲状腺刺激免疫球蛋白的2例患者中也存在亚临床甲减。这些观察结果表明，TRH刺激试验对于检测格雷夫斯眼病患者中的亚临床甲减具有价值，这些患者从临床和常规实验室检查来看甲状腺功能正常，但可能是甲状腺功能正常或亚临床甲亢患者。
