Ann Intern Med. 1981 Sep;95(3):339-51. doi: 10.7326/0003-4819-95-3-339.
Recent studies have provided major new insights into the syndromes of inappropriate secretion of thyroid-stimulating hormone (TSH), a heterogeneous group of disorders in which patients show inappropriately elevated levels of serum immunoactive TSH in the presence of elevated free thyroid hormone levels. Certain of these patients appear to have a non-neoplastic disorder associated with variable degrees of pituitary and peripheral resistance to the action of thyroid hormone, whereas others harbor a tumor of pituitary thyrotropic cells. Measurement of free serum alpha subunit has proved valuable in differentiating these disorders, showing normal alpha concentration and alpha-to-TSH ratios in the non-neoplastic and highly elevated values in the neoplastic disorders. All these syndromes appear unrelated to Graves' disease because thyroid-binding and thyroid-stimulating antibodies are usually absent. Some of these patients also have abnormal metabolism of thyroid hormones. Although the pathogenesis of these syndromes remains to be elucidated, increased recognition and study of these patients should provide fundamental insights into the regulation of TSH secretion as well as the action of thyroid hormone.
最近的研究对促甲状腺激素（TSH）分泌异常综合征提供了重要的新见解，这是一组异质性疾病，患者在游离甲状腺激素水平升高的情况下血清免疫活性TSH水平却异常升高。其中一些患者似乎患有与不同程度的垂体和外周甲状腺激素作用抵抗相关的非肿瘤性疾病，而另一些患者则患有垂体促甲状腺细胞肿瘤。血清游离α亚基的测定已被证明在区分这些疾病方面很有价值，在非肿瘤性疾病中显示α浓度和α与TSH的比值正常，而在肿瘤性疾病中则显著升高。所有这些综合征似乎都与格雷夫斯病无关，因为通常不存在甲状腺结合抗体和甲状腺刺激抗体。这些患者中的一些人还存在甲状腺激素代谢异常。尽管这些综合征的发病机制仍有待阐明，但对这些患者的更多认识和研究应能为TSH分泌的调节以及甲状腺激素的作用提供基本见解。
