TRH stimulation test in patients with repeatedly elevated TSH and normal FT4

Q4 Medicine
P. Rosário
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引用次数: 0

Abstract

Subclinical hypothyroidism (SCH) is defined by elevated thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4). We aimed to evaluate the thyrotropin-releasing hormone (TRH) stimulation test in patients with repeatedly elevated TSH (up to 10 mIU/l) and normal FT4, but without apparent thyroid disease. Women with TSH > 4.5 and ≤ 10 mIU/l (in two measurements) and normal FT4 were selected. Women with a known non-thyroid cause of TSH elevation, those treated with anti-thyroid drugs, amiodarone, lithium, and those with a history of thyroidectomy, neck radiotherapy and 131 I treatment were excluded. Seventy women had negative antithyroperoxidase antibodies. Ultrasonography revealed a eutopic thyroid, usual echogenicity, and a volume ≤ 15 ml, and they underwent the TRH stimulation test during initial evaluation. After stimulation with TRH, TSH > 30 mIU/l was observed in 38 women (expected response), while 32 women had TSH < 20 mIU/l (inadequate response). Age, basal TSH or thyroid volume did not differ between both groups, but FT4 concentrations were significantly lower in the first group. Follow-up was available for 66/70 women. Seven women developed a need for levothyroxine, all of them in the group with an adequate response to TRH [7/36 (19.4%) versus 0/30]. The results suggest that some cases of TSH elevation (even persistent) do not represent the early stage of thyroid insufficiency.
反复升高TSH和FT4正常患者的TRH刺激试验
亚临床甲状腺功能减退症(SCH)的定义是促甲状腺激素(TSH)升高,游离甲状腺素(FT4)正常。我们的目的是评估反复升高TSH(高达10 mIU/l)和FT4正常但没有明显甲状腺疾病的患者的促甲状腺激素释放激素(TRH)刺激试验。选择TSH > 4.5和≤10 mIU/l(两次测量),FT4正常的女性。已知非甲状腺原因导致TSH升高的女性,接受过抗甲状腺药物、胺碘酮、锂治疗的女性,以及有甲状腺切除术、颈部放疗和131 I治疗史的女性均被排除在外。70名妇女抗甲状腺过氧化物酶抗体阴性。超声示甲状腺异位,回声正常,体积≤15ml,初诊时行TRH刺激试验。经TRH刺激后,38名女性TSH bb0 30 mIU/l(预期反应),32名女性TSH < 20 mIU/l(反应不足)。年龄、基础TSH或甲状腺体积在两组之间没有差异,但FT4浓度在第一组明显较低。70名妇女中有66名可随访。7名妇女需要左甲状腺素,她们都在TRH反应足够的组中[7/36(19.4%)对0/30]。结果表明,一些TSH升高的病例(甚至持续)并不代表甲状腺功能不全的早期阶段。
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来源期刊
Jornal Brasileiro de Patologia e Medicina Laboratorial
Jornal Brasileiro de Patologia e Medicina Laboratorial Health Professions-Medical Laboratory Technology
CiteScore
1.30
自引率
0.00%
发文量
0
审稿时长
20 weeks
期刊介绍: The Jornal Brasileiro de Patologia e Medicina Laboratorial (Brazilian Journal of Pathology and Laboratory Medicine), a continuation of Jornal Brasileiro de Patologia (Brazilian Journal of Pathology), and published quarterly (March, June, September and December) is directed towards the publication of scientific articles that contribute to the development of the area of Laboratory Medicine (Clinical Pathology, Pathology, Cytopathology). It accepts the following categories of articles: original articles, review articles, case reports, short communications, updating articles, letters to editors and reviews.
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