Carpi A, Iervasi G, Nicolini A, Del Corso L, Levanti C, Zucchelli G C, Bianchi R
Metabolism. 1982 May;31(5):417-20. doi: 10.1016/0026-0495(82)90227-x.
Serum concentrations of TSH, TT4, TT3 and rT3 were monitored for one month after excision of ten autonomous thyroid adenomas which had suppressed TSH secretion. Basal serum TSH levels start to increase between 30 hr and 20 days after surgery reaching normal and steady levels by the 24 day. Serum TT3 concentrations rapidly decrease in the first 20 hr to values near the lower limit of the normal range. Thereafter TT3 levels change little until pituitary TSH secretion recovers. Serum TT4 levels also fall, but much more slowly than TT3. Rising TSH levels stimulate residual extranodular thyroid tissue secretion of both TT3 and TT4. However, serum TT3 levels rise more rapidly than TT4 levels. Preoperative serum concentrations of both TT4 and TT3 are related directly to the time required until the beginning of the postoperative rise in TSH levels, and inversely with the maximal postoperative serum TSH concentration achieved. Throughout the study period, for all patients, serum TSH concentrations were inversely related to serum TT4 concentrations. These data suggest that, although the time required until the onset of recovery of TSH secretion is directly related to preoperative levels of TT4 and TT3, the regulation of postoperative TSH levels is dependent upon serum TT4 levels. Also, the serum TT3 levels constant at the lower limit of the normal range before recovery of TSH secretion, and the preferential rise in serum TT3 concentrations associated with rising TSH secretion, may prevent or abbreviate temporary postoperative hypothyroidism.
对切除了抑制促甲状腺激素（TSH）分泌的10个自主性甲状腺腺瘤的患者，在术后1个月内监测血清TSH、总甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）和反三碘甲状腺原氨酸（rT3）的浓度。基础血清TSH水平在术后30小时至20天开始升高，到第24天时达到正常稳定水平。血清TT3浓度在最初20小时内迅速下降至接近正常范围下限的值。此后，直到垂体TSH分泌恢复，TT3水平变化不大。血清TT4水平也下降，但比TT3慢得多。升高的TSH水平刺激残留的甲状腺结节外组织分泌TT3和TT4。然而，血清TT3水平比TT4水平升高得更快。术前TT4和TT3的血清浓度与术后TSH水平开始升高所需的时间直接相关，与术后达到的最大血清TSH浓度呈负相关。在整个研究期间，对所有患者而言，血清TSH浓度与血清TT4浓度呈负相关。这些数据表明，虽然TSH分泌恢复开始所需的时间与术前TT4和TT3水平直接相关，但术后TSH水平的调节取决于血清TT4水平。此外，在TSH分泌恢复之前血清TT3水平恒定在正常范围下限，以及与TSH分泌增加相关的血清TT3浓度优先升高，可能预防或缩短术后短暂性甲状腺功能减退。
