Brajkovich I E, Mashiter K, Joplin G F, Cassar J
Metabolism. 1983 Aug;32(8):745-7. doi: 10.1016/0026-0495(83)90101-4.
Forty-five patients with primary hypothyroidism were studied during the first 4 to 36 months of replacement therapy with thyroxine. All became clinically euthyroid (23 patients while taking 0.1 mg/d, 14 patients while taking 0.15 mg/d, 7 patients while taking 0.2 mg/d, and 1 patient while taking 0.25 mg/d) over a period of three to six months. The patients were then divided for data analysis into two groups. Group I had normal serum T3 levels, normal (or elevated) serum T4 levels, and normal serum TSH levels. Group II had normal serum T3 levels, normal (or elevated) serum T4 levels, but high serum TSH levels. Group II was subdivided further into a group of 13 patients (group IIa) whose dose of thyroxine was deliberately increased until the serum TSH level was normalized; five of these patients became clinically and biochemically hyperthyroid. Group IIb consisted of eight patients with normal serum T3 and T4 levels and high serum TSH levels who were followed up without attempting to normalize their serum TSH levels. None became thyrotoxic, and their serum TSH levels showed little change. These findings suggest that serum TSH levels alone are not adequate to assess the required dose of thyroxine replacement therapy.
45例原发性甲状腺功能减退患者在接受甲状腺素替代治疗的最初4至36个月期间接受了研究。在三到六个月的时间里，所有患者的临床甲状腺功能均恢复正常（23例患者服用0.1mg/d，14例患者服用0.15mg/d，7例患者服用0.2mg/d，1例患者服用0.25mg/d）。然后将患者分为两组进行数据分析。第一组患者血清T3水平正常，血清T4水平正常（或升高），血清TSH水平正常。第二组患者血清T3水平正常，血清T4水平正常（或升高），但血清TSH水平较高。第二组进一步细分为13例患者（IIa组），其甲状腺素剂量被故意增加直至血清TSH水平恢复正常；其中5例患者出现临床和生化甲状腺功能亢进。IIb组由8例血清T3和T4水平正常但血清TSH水平较高的患者组成，对其进行随访，未试图使其血清TSH水平恢复正常。无一例发生甲状腺毒症，其血清TSH水平变化很小。这些发现表明，仅血清TSH水平不足以评估甲状腺素替代治疗所需的剂量。
