Stockigt J R, Essex W B, West R H, Murray R M, Breidahl H D
J Clin Endocrinol Metab. 1976 Nov;43(5):1094-100. doi: 10.1210/jcem-43-5-1094.
A 34-year-old woman with longstanding untreated thyroprivic hypothyroidism and pituitary enlargement is reported here in whom visual failure coincided with thyroid hormone replacement. Visual fields were normal after 30 years untreated hypothyroidism, but severe concentric field constriction developed during the first 6 months of therapy and was relieved by hypophysectomy. Plasma TSH and prolactin remained elevated during 10 months replacement therapy, but both were suppressed by preoperative hyperreplacement with T3 and T4. The paradoxical pressure symptoms suggest imbalance between pituitary TSH content and TSH release during treatment with thyroid hormone; a finding previously reported in animal studies. This sequence suggests that patients with known pituitary enlargement secondary to thyroid hypofunction should be observed for pressure symptoms during thyroid hormone treatment.
本文报道了一名34岁女性，患有长期未经治疗的甲状腺功能减退性垂体功能减退症且垂体增大，其视力减退与甲状腺激素替代治疗同时出现。在30年未经治疗的甲状腺功能减退症期间视野正常，但在治疗的前6个月出现了严重的同心性视野缩小，垂体切除术后视野缩小得到缓解。在10个月的替代治疗期间，血浆促甲状腺激素（TSH）和催乳素仍升高，但术前用T3和T4进行过度替代治疗可使其降低。这种矛盾的压迫症状提示在甲状腺激素治疗期间垂体TSH含量与TSH释放之间存在失衡；这一发现先前在动物研究中已有报道。这一系列情况表明，已知继发于甲状腺功能减退的垂体增大的患者在甲状腺激素治疗期间应观察是否有压迫症状。
