Hurley J R, Becker D V
Semin Nucl Med. 1981 Apr;11(2):149-60. doi: 10.1016/s0001-2998(81)80043-8.
In the past, T3 suppression testing was often required to confirm the presence of autonomous thyroid function in patients with borderline clinical and laboratory findings suggestive of hyperthyroidism or in euthyroid patients with the stigmata of Graves' disease. Similarly, TSH stimulation testing was used to document the presence of "low thyroid reserve" in patients with borderline clinical and laboratory findings suggestive of hypothyroidism. The current availability of radioimmunoassays for triiodothyronine (T3) and thyrotorpin (TSH) plus the ability to evalate pituitary responsiveness by performing a TRH stimulation test permits a definitive diagnosis to be made in the majority of borderline situations without recourse to the more cumbersome suppression and stimulation tests. Suppression and stimulation thyroid scanning retain a unique position in the evaluation of localized areas in increased uptake of radionuclide (hot nodules), especially in patients who are euthyroid. Proof that such nodules are autonomously functioning thyroid adenomas (AFTN) greatly decreases the possibility that they represent malignant thyroid tumors. Suppression and stimulation scanning have a more limited role in the evaluation of patients with hyperthyroidism arising in a multinodular goiter, where TSH stimulation scanning may help to differentiate between toxic multinodular goiter and Graves' disease arising in a preexisting goiter.
过去，对于临床和实验室检查结果处于临界状态、提示甲状腺功能亢进的患者，或患有格雷夫斯病体征的甲状腺功能正常患者，往往需要进行T3抑制试验以确认自主性甲状腺功能的存在。同样，TSH刺激试验用于在临床和实验室检查结果处于临界状态、提示甲状腺功能减退的患者中证明“甲状腺储备功能低下”的存在。目前可获得三碘甲状腺原氨酸（T3）和促甲状腺激素（TSH）的放射免疫测定法，加上通过进行TRH刺激试验评估垂体反应性的能力，使得在大多数临界情况下无需借助更繁琐的抑制和刺激试验即可做出明确诊断。甲状腺抑制和刺激扫描在评估放射性核素摄取增加的局部区域（热结节），特别是甲状腺功能正常的患者中，仍占有独特地位。证明此类结节是自主性功能性甲状腺腺瘤（AFTN），可大大降低其代表甲状腺恶性肿瘤的可能性。甲状腺抑制和刺激扫描在评估多结节性甲状腺肿引起的甲状腺功能亢进患者时作用较为有限，TSH刺激扫描可能有助于鉴别毒性多结节性甲状腺肿和原有甲状腺肿基础上发生的格雷夫斯病。
