Hyperthyroxinemia in patients receiving thyroid replacement therapy.
Hyperthyroxinemia in patients receiving thyroid replacement therapy.
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接受甲状腺替代治疗的患者出现高甲状腺素血症。
DOI：
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发表时间：
1989
影响因子：
--
通讯作者：
C. Niewoehner
中科院分区：
文献类型：
--
作者：
F. Grund;C. Niewoehner
11 名有甲状腺功能减退病史、患有高甲状腺素血症和游离甲状腺素指数升高但左旋甲状腺素替代后血清三碘甲状腺原氨酸浓度正常的患者每三个月减少一次左旋甲状腺素剂量，直至游离甲状腺素指数降至正常范围。所有患者的临床甲状腺始终功能正常。促甲状腺素对促甲状腺素释放激素的反应也随之正常化，表明轻微的甲状腺功能亢进得到了纠正。平均甲状腺素剂量从 161 微克/天（2.06 微克/公斤）降至 120 微克/天（1.51 微克/公斤）。 11 名患者中有 8 名的静息心率下降（P 小于 0.02）。 11 名患者中有 8 名左心室射血分数下降，但下降幅度并不具有统计学意义。考虑到垂体、心脏和骨组织对即使是少量过量的甲状腺素随着时间的推移也会产生敏感性，因此即使在接受左旋甲状腺素替代治疗、临床上甲状腺功能正常且血清三碘甲状腺原氨酸浓度在正常范围内的患者中，也应该纠正与游离甲状腺素指数升高相关的高甲状腺素血症。
Eleven patients, with a history of hypothyroidism, who had hyperthyroxinemia and an elevated free thyroxine index but normal serum triiodothyronine concentrations on levothyroxine replacement underwent levothyroxine dose reduction at three-month intervals until the free thyroxine index fell into the normal range. All were clinically euthyroid throughout. Normalization of the thyrotropin response to thyrotropin-releasing hormone occurred concomitantly, indicating correction of subtle hyperthyroidism. The mean thyroxine dose decreased from 161 micrograms/d (2.06 micrograms/kg) to 120 micrograms/d (1.51 micrograms/kg). The resting heart rate fell in eight of 11 patients (P less than .02). The left ventricular ejection fraction decreased in eight of 11 patients, although the decrease was not statistically significant. Considering the sensitivity of pituitary, cardiac, and bone tissue to even a small excess of thyroxine over time, hyperthyroxinemia associated with an elevated free thyroxine index should be corrected even in patients taking levothyroxine replacement who are clinically euthyroid and whose serum triiodothyronine concentrations are within normal limits.
L-甲状腺素长期抑制垂体-甲状腺轴可能导致亚临床甲状腺功能亢进和骨密度降低。
DOI：
10.1016/0002-9343(87)90219-1
发表时间：
1987
期刊：
The American journal of medicine
影响因子：
--
作者：
Ross,DS;Neer,RM;Ridgway,EC;Daniels,GH
通讯作者：
Daniels,GH