Weiss R E, Stein M A, Trommer B, Refetoff S
Department of Medicine, University of Chicago, Illinois 60637.
J Pediatr. 1993 Oct;123(4):539-45. doi: 10.1016/s0022-3476(05)80947-3.
Attention-deficit hyperactivity disorder (ADHD) is thought to have a biologic basis, but the precise cause is unknown. It is one of the neurodevelopmental abnormalities frequently observed in children with generalized resistance to thyroid hormone (GRTH), suggesting that thyroid abnormalities may be related to ADHD. We report a prospective screening study for thyroid abnormalities in 277 children with ADHD by measurement of serum levels of total thyroxine, free thyroxine index, and thyrotropin. Fourteen children with ADHD had thyroid function test abnormalities: six had a normal free thyroxine index and elevated thyroxine level (group 1); three had a high free thyroxine index and a normal thyrotropin level (group 2); and five had a low free thyroxine index with a normal thyrotropin level (group 3). GRTH could not be demonstrated in a detailed study of four of the subjects in whom it was suspected (groups 1 and 2). Although the prevalence of ADHD in subjects with GRTH has been reported to be 46%, the overall prevalence of GRTH must be less than 1:2500 because we failed to detect GRTH in the 277 children with ADHD studied. We conclude that the prevalence of thyroid abnormalities is higher (5.4%) in children with ADHD than in the normal population (< 1%).
注意缺陷多动障碍（ADHD）被认为有生物学基础，但确切病因尚不清楚。它是在全身性甲状腺激素抵抗（GRTH）儿童中经常观察到的神经发育异常之一，这表明甲状腺异常可能与ADHD有关。我们通过测量血清总甲状腺素、游离甲状腺素指数和促甲状腺激素水平，对277名ADHD儿童进行了甲状腺异常的前瞻性筛查研究。14名ADHD儿童甲状腺功能测试异常：6名游离甲状腺素指数正常但甲状腺素水平升高（第1组）；3名游离甲状腺素指数高且促甲状腺激素水平正常（第2组）；5名游离甲状腺素指数低且促甲状腺激素水平正常（第3组）。在对4名疑似患有GRTH的受试者（第1组和第2组）进行的详细研究中未证实存在GRTH。尽管据报道GRTH患者中ADHD的患病率为46%，但由于我们在研究的277名ADHD儿童中未检测到GRTH，GRTH的总体患病率肯定低于1:2500。我们得出结论，ADHD儿童中甲状腺异常的患病率（5.4%）高于正常人群（<1%）。
