Caplan R H, Pagliara A S, Wickus G, Goodlund L S
J Psychiatr Res. 1982;17(3):267-74. doi: 10.1016/0022-3956(82)90005-x.
We calculated a free triiodothyronine (FT3) index on 124 patients who exhibited symptoms and signs of hyperthyroidism and elevations of the free thyroxine (FT4) index on initial screening. A thyrotropin-releasing hormone (TRH) test served as the final arbiter of thyroid function if the clinical presentation was not characteristic of hyperthyroidism or if the FT3 index was not elevated. Forty-one of the 124 patients had normal TRH tests and were thus classified as euthyroid. Of these patients with the so-called euthyroid sick syndrome, 23 had psychiatric disorders. In a separate study, we measured a FT4 index on 100 unselected admissions to the psychiatric ward. Of six patients with elevated FT4 values, only one had hyperthyroidism. We conclude that false positive FT4 index elevations occur commonly in psychiatric patients. The mechanism(s) for the FT4 index elevations remain obscure. Despite some limitations, the TRH test is a valuable diagnostic adjunct for diagnosing hyperthyroidism in the mentally ill patient when other tests and serial observations are inconclusive.
我们对124例表现出甲状腺功能亢进症状和体征且初次筛查时游离甲状腺素（FT4）指数升高的患者计算了游离三碘甲状腺原氨酸（FT3）指数。如果临床表现不具有甲状腺功能亢进的特征或FT3指数未升高，则促甲状腺激素释放激素（TRH）试验作为甲状腺功能的最终判定标准。124例患者中有41例TRH试验结果正常，因此被归类为甲状腺功能正常。在这些患有所谓甲状腺功能正常的病态综合征的患者中，23例患有精神疾病。在另一项研究中，我们对100名未经挑选入住精神科病房的患者测量了FT4指数。在FT4值升高的6例患者中，只有一例患有甲状腺功能亢进。我们得出结论，精神科患者中FT4指数升高的假阳性情况很常见。FT4指数升高的机制仍不清楚。尽管存在一些局限性，但当其他检查和系列观察结果不明确时，TRH试验对于诊断精神病患者甲状腺功能亢进是一种有价值的辅助诊断方法。
