Hood S, Vaughan-Jackson J D, Farid N R
J Clin Endocrinol Metab. 1976 Dec;43(6):1360-4. doi: 10.1210/jcem-43-6-1360.
Serum thytropin (TSH) in a 45-year-old woman suffering from Hashimoto's thyroiditis and hypothyroidism rose over a period of 8 months from 23 to 98 muU/ml while on 0.15 mg of thyroxine daily. A significant pituitary tumor was excluded and the response of other anterior pituitary hormones to provocative stimuli were normal. The TSH response to thyrotropin releasing hormone (TRH) carried out after a year of therapy and while on 0.15 mg T4 was exaggerated and required 100 mug of triiodothyronine (T3) daily in addition to the thyroxine replacement to suppress it. After the completion of the T3 suppression test and while on 0.2 mg thyroxine, serum TSH rose from less than 0.5 to 27 muU/ml when seen last. It is postulated that in this patient there exists a partial selective resistance of the thyrotrophs to T4 and that the paradoxical increase in serum TSH associated with thyroxine therapy results from T4 dependent increase in the synthesis and secretion of endogenous TRH. Other possibilities include an as yet undetected pituitary microadenoma or a pituitary defect in the deiodination of T4.
一名45岁患有桥本甲状腺炎和甲状腺功能减退症的女性，在每日服用0.15毫克甲状腺素的情况下，血清促甲状腺激素（TSH）在8个月内从23升至98微单位/毫升。排除了明显的垂体肿瘤，且其他垂体前叶激素对刺激的反应正常。在治疗一年且服用0.15毫克T4期间，对促甲状腺激素释放激素（TRH）的TSH反应增强，除了补充甲状腺素外，还需要每日服用100微克三碘甲状腺原氨酸（T3）来抑制它。在完成T3抑制试验且服用0.2毫克甲状腺素时，最后一次检查发现血清TSH从低于0.5升至27微单位/毫升。据推测，该患者存在促甲状腺细胞对T4的部分选择性抵抗，且甲状腺素治疗相关的血清TSH矛盾性升高是由于内源性TRH合成和分泌的T4依赖性增加所致。其他可能性包括尚未检测到的垂体微腺瘤或T4脱碘的垂体缺陷。
