TSH suppression in the management of autonomously functioning thyroid lesions.
TSH suppression in the management of autonomously functioning thyroid lesions.
复制标题
TSH 抑制治疗自主功能性甲状腺病变。
DOI：
10.1007/bf01655242
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发表时间：
1986
影响因子：
2.6
通讯作者：
Nayfeh,SN
中科院分区：
文献类型：
--
作者：
ThomasJr,CG;Tawil,M;Berman,MI;Nayfeh,SN
孤立性自主功能性甲状腺病变（AFTL）是离散的功能亢进结节，其生长和功能似乎不依赖于促甲状腺激素（TSH）。虽然他们逐渐增加的大小和功能多年来，他们很少进展到产生甲状腺功能亢进症。这篇文章提出了这样一个论点，即这种“自限性特征”与它们的生长和功能受到TSH水平的调节有关。对6例自主功能性甲状腺病变的甲状腺膜进行了检查。获得非线性Scatchard图，其中功能亢进性甲状腺病变显示高亲和力、低容量TSH受体组分。这些药物的结合能力范围为7至600 fmol/mg蛋白质（在TSH水平被抑制的患者中），在甲状腺功能正常的患者中为1，450。所有病变均表现出基础腺苷酸环化酶活性，其被牛TSH刺激2-3倍。回顾病变的自然史，发现病变的大小和功能随时间逐渐增大。在接受甲状腺激素作为抑制治疗的9例患者中，观察了4-14年，4例病变部分消退，5例未进展。当这种结节在其发育过程的早期被识别时，这种由TSH水平调节AFTL的生长和功能的概念具有治疗意义。此时，TSH抑制可能会抑制结节大小和甲状腺激素分泌的增加。
Solitary autonomously functioning thyroid lesions (AFTL) are discrete hyperfunctioning nodules whose growth and function do not appear to be dependent on thyroid‐stimulating hormone (TSH). Although they gradually increase in size and function over years, rarely do they progress to produce hyperthyroidism. This article presents the thesis that this “self‐limiting feature” is related to their growth and function being modulated by levels of TSH. Thyroid membranes from autonomously functioning thyroid lesions were examined in 6 patients. A nonlinear Scatchard plot was obtained with the hyperfunctioning thyroid lesion demonstrating high‐affinity, low‐capacity TSH receptor components. These exhibited a binding capacity ranging from 7 to 600 fmol/mg protein in patients with suppressed TSH levels to 1,450 in a euthyroid patient. All lesions exhibited basal adenylate cyclase activity which was stimulated 2–3‐fold by Bovine TSH. A review of the natural history of the lesion demonstrates a decremental increase in size and function with time. In 9 patients receiving thyroid hormone as suppressive therapy observed over a period of 4–14 years, the lesions partially regressed in 4 and did not progress in 5. This concept of growth and function of AFTL being modulated by TSH levels has therapeutic implications when such nodules are identified early in the course of their development. At this time, TSH suppression may be inhibitory to increase in nodule size and secretion of thyroid hormones.