Spanheimer R G, Bar R S, Hayford J C
Arch Intern Med. 1982 Jul;142(7):1283-6. doi: 10.1001/archinte.142.7.1283.
We have identified the condition of thyrotropin (thyroid-stimulating hormone [TSH])-induced hyperthyroidism secondary to selective pituitary insensitivity to thyroid hormone in three patients. Each patient was clinically hyperthyroid, with elevated serum levels of thyroxine (T4) and triiodothyronine (T3) and detectable levels of serum TSH before therapy. After therapy each patient had notably elevated TSH levels at a time that peripheral levels of thyroid hormones were in the hyperthyroid range. Before and after therapy, serum levels of TSH were suppressed by therapy with liothyronine sodium and were stimulated by protirelin (thyrotropin-releasing hormone) both before and after liothyronine and dexamethasone treatment. Dexamethasone therapy decreased the levels of TSH, protirelin-stimulated TSH, and circulating T4 and T3. Serum levels of glycoprotein alpha-subunit were 0.6 to 2.4 ng/ml, values considerably lower than found in patients with TSH-secreting pituitary tumors. We suggest that the frequency of TSH-induced hyperthyroidism secondary to pituitary insensitivity to thyroid hormone may be higher than presently indicated in the medical literature.
我们已在三名患者中确诊了促甲状腺激素（甲状腺刺激激素[TSH]）诱导的甲状腺功能亢进症，其继发于垂体对甲状腺激素的选择性不敏感。每位患者临床上均表现为甲状腺功能亢进，治疗前血清甲状腺素（T4）和三碘甲状腺原氨酸（T3）水平升高，且血清TSH水平可检测到。治疗后，每位患者的TSH水平显著升高，而此时外周甲状腺激素水平处于甲状腺功能亢进范围内。治疗前后，血清TSH水平在接受左甲状腺素钠治疗时受到抑制，在左甲状腺素和地塞米松治疗前后均受到促甲状腺素释放激素（TRH）刺激。地塞米松治疗降低了TSH、TRH刺激的TSH以及循环T4和T3的水平。糖蛋白α亚基的血清水平为0.6至2.4 ng/ml，该值远低于分泌TSH的垂体瘤患者。我们认为，继发于垂体对甲状腺激素不敏感的TSH诱导的甲状腺功能亢进症的发生率可能高于目前医学文献中所指出的。
