Hidaka Y, Nishi I, Tamaki H, Takeoka K, Tada H, Mitsuda N, Amino N
Department of Laboratory Medicine, Osaka University Medical School, Japan.
Thyroid. 1994 Fall;4(3):275-8. doi: 10.1089/thy.1994.4.275.
Destruction-induced thyrotoxicosis and Graves' thyrotoxicosis must be differentiated, since they are treated differently. To find a useful marker, we examined serial changes in serum thyroglobulin (Tg) concentrations in 20 patients with postpartum thyroid disease (9, euthyroid Hashimoto's disease; 11, Graves' disease in remission in early pregnancy). Serum Tg was measured by a new multisite immunoradiometric assay that allows little influence of anti-Tg autoantibodies. Eight women developed destruction-induced thyrotoxicosis 1 to 4 months postpartum, 6 had relapse of Graves' thyrotoxicosis 2 to 4 months postpartum, and 6 remained euthyroid. In destruction-induced thyrotoxicosis, serum Tg 2 months before the onset was 13.3 +/- 11.4 micrograms/L, then clearly increased 1 month before (34.5 +/- 31.9 micrograms/L) and was even higher at the onset of thyrotoxicosis (116.5 +/- 137.1 micrograms/L). In contrast, serum Tg increased only at the onset in Graves' thyrotoxicosis (from 25.9 +/- 25.2 micrograms/L 1 month before to 76.1 +/- 75.3 micrograms/L at the onset, p < 0.05). There was no difference in serum Tg level at the onset between the two disorders. However, when data were expressed as the percent increase from the level one month before, and the cut-off value were taken at 150%, all 7 patients above the cut-off developed destruction-induced thyrotoxicosis, and 6 of 7 below had recurrent Graves' thyrotoxicosis. Thus, serial measurement of serum Tg is useful for the differentiation of destruction-induced thyrotoxicosis from Graves' thyrotoxicosis after delivery.
必须区分破坏诱导型甲状腺毒症和格雷夫斯甲状腺毒症，因为它们的治疗方法不同。为了找到一个有用的标志物，我们检测了20例产后甲状腺疾病患者（9例甲状腺功能正常的桥本氏病；11例妊娠早期缓解期的格雷夫斯病）血清甲状腺球蛋白（Tg）浓度的系列变化。采用一种新的多位点免疫放射分析方法测定血清Tg，该方法受抗Tg自身抗体的影响很小。8名女性在产后1至4个月发生破坏诱导型甲状腺毒症，6名在产后2至4个月格雷夫斯甲状腺毒症复发，6名仍保持甲状腺功能正常。在破坏诱导型甲状腺毒症中，发病前2个月血清Tg为13.3±11.4μg/L，然后在发病前1个月明显升高（34.5±31.9μg/L），在甲状腺毒症发作时甚至更高（116.5±137.1μg/L）。相比之下，格雷夫斯甲状腺毒症仅在发病时血清Tg升高（从发病前1个月的25.9±25.2μg/L升至发病时的76.1±75.3μg/L，p<0.05）。两种疾病发病时血清Tg水平无差异。然而，当数据表示为较前1个月水平的升高百分比，且临界值取为150%时，所有高于临界值的7例患者发生破坏诱导型甲状腺毒症，7例低于临界值的患者中有6例复发格雷夫斯甲状腺毒症。因此，连续测定血清Tg有助于区分产后破坏诱导型甲状腺毒症和格雷夫斯甲状腺毒症。
