Ito M, Takamatsu J, Yoshida S, Murakami Y, Sakane S, Kuma K, Ohsawa N
First Department of Medicine, Osaka Medical College, Takatsuki, Japan.
J Clin Endocrinol Metab. 1997 Feb;82(2):616-9. doi: 10.1210/jcem.82.2.3751.
Serum TSH concentrations were determined by both second and third generation assays in three types of thyrotoxicosis associated with subacute thyroiditis, silent thyroiditis, and hyperthyroid Graves' disease at the time of each patient's initial visit to the clinic. Serum TSH concentrations as measured by the second generation assay with an analytical sensitivity of 0.04 mU/L were below the detection limit in every patient. In contrast, serum TSH concentrations as measured by the third generation assay with an analytical sensitivity of 0.009 mU/L were below the detection limit in 18 of 21 (86%) patients with Graves' disease, 18 of 20 (90%) with silent thyroiditis, but only 4 of 18 (22%) with subacute thyroiditis. Changes in serum TSH concentrations were studied in healthy volunteers given daily 75 micrograms of T3; their serum TSH concentrations on the second generation assay fell below the detection limit within 3 days in every subject. However, the TSH concentration measured by the third generation assay remained above the detection limit in 6 of 8 normal subjects even on the 14th day of therapy. The reason for incomplete TSH suppression in most subacute thyroiditis patients may be that these patients had notable neck pain, and their initial visit to the clinic may have occurred earlier after the onset of disease than with patients who have had silent thyroiditis or Graves' disease. Thus, the serum TSH concentration had not decreased sufficiently below the detection limit at the time blood was drawn. The data suggest also that the highly sensitive TSH assay, if the level is above the detection limit, can be used to suppose that the short duration of the initiation of thyrotoxicosis indicates a case of subacute thyroiditis.
在三种类型的甲状腺毒症（与亚急性甲状腺炎、寂静性甲状腺炎和甲状腺功能亢进型格雷夫斯病相关）患者首次到诊所就诊时，采用第二代和第三代检测方法测定血清促甲状腺激素（TSH）浓度。第二代检测方法的分析灵敏度为0.04 mU/L，所测每位患者的血清TSH浓度均低于检测限。相比之下，第三代检测方法的分析灵敏度为0.009 mU/L，21例格雷夫斯病患者中有18例（86%）、20例寂静性甲状腺炎患者中有18例（90%），但亚急性甲状腺炎患者中仅18例中的4例（22%）血清TSH浓度低于检测限。对每日服用75微克T3的健康志愿者的血清TSH浓度变化进行了研究；采用第二代检测方法时，每位受试者的血清TSH浓度在3天内均降至检测限以下。然而，即使在治疗的第14天，采用第三代检测方法测定时，8名正常受试者中有6人的TSH浓度仍高于检测限。大多数亚急性甲状腺炎患者TSH抑制不完全的原因可能是这些患者颈部疼痛明显，他们首次到诊所就诊的时间可能比寂静性甲状腺炎或格雷夫斯病患者发病后更早。因此，在抽血时血清TSH浓度尚未充分降至检测限以下。数据还表明，如果高灵敏度TSH检测水平高于检测限，则可据此推测甲状腺毒症发病时间短表明为亚急性甲状腺炎病例。
