Differentiating Graves' disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine.
Differentiating Graves' disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine.
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DOI：
10.1016/j.amsu.2016.07.024
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发表时间：
2016-09
期刊：
影响因子：
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通讯作者：
Bhasipol A
中科院分区：
文献类型：
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作者：
Sriphrapradang C;Bhasipol A
游离甲状腺激素的测量，而不是总的形式，在目前的实践中更常用。我们的目的是评价血清游离三碘甲状腺原氨酸（FT 3，pg/mL）与游离甲状腺素（FT 4，ng/dL）的比值在鉴别Graves病与亚急性甲状腺炎中的作用。回顾性分析了年龄>15岁的甲亢患者的病历，这些患者在开始治疗前首次诊断为甲亢时测量了FT 3、FT 4和促甲状腺激素。从所有诊所收集数据，不限于内分泌诊所。孕妇除外。共招募了548例患者（468例Graves病，40例亚急性甲状腺炎和40例毒性腺瘤/多结节性甲状腺肿）。平均年龄为43.9 ± 15.4岁。大多数是女性434（79.2%），甲状腺肿出现在55.3%。T3和T4中毒的患病率分别为5.6%和6.6%。Graves病患者的平均FT 3/FT 4比值为4.62 ± 2（10−2 pg/ng），亚急性甲状腺炎患者为2.73 ± 0.5。FT 3/FT 4比值诊断Graves病的ROC曲线下面积为0.83（95%CI，0.76-0.91）。以该比值>4.4为界值，敏感性为47.2%，特异性为92.8%。FT 3/FT 4比值>4.4（10−2 pg/ng）可能有助于区分甲状腺毒症的病因。甲状腺毒症的理想治疗应针对其病因。血清总三碘甲状腺原氨酸（T3）：甲状腺素（T4）比值（ng/ug）>20提示Graves病。在目前的实践中，游离甲状腺激素的测量更常用。血清游离T3/游离T4比值>4.4（10−2 pg/ng）可能有助于鉴别甲状腺毒症的病因。
The measurement of free thyroid hormone, instead of the total form, is more commonly used in current practice. We aimed to evaluate the usefulness of the ratio of serum free triiodothyronine (FT3, pg/mL) to free thyroxine (FT4, ng/dL) for differentiating Graves' disease from subacute thyroiditis. Medical records of thyrotoxic patients aged >15 years who had measurement of FT3, FT4 and thyrotropin on the first diagnosis of thyrotoxicosis before initiating treatment were retrospectively reviewed. Data were collected from all clinics, and were not limited to the endocrine clinic. Pregnant women were excluded. A total of 548 patients (468 with Graves' disease, 40 with subacute thyroiditis and 40 with toxic adenoma/multinodular goiter) were recruited. Mean age was 43.9 ± 15.4 years. Most were female 434 (79.2%), and goiter was present in 55.3%. Prevalence of T3-toxicosis and T4-toxicosis were 5.6% and 6.6%, respectively. Mean FT3/FT4 ratios were 4.62 ± 2 (10−2 pg/ng) in patients with Graves' disease and 2.73 ± 0.5 in subacute thyroiditis. The area under the ROC curve of the FT3/FT4 ratio for diagnosis of Graves' disease was 0.83 (95%CI, 0.76–0.91). Cutoff level of this ratio >4.4 offered sensitivity of 47.2% and specificity of 92.8%. FT3/FT4 ratio of >4.4 (10−2 pg/ng) may help in differentiating the cause of thyrotoxicosis. The ideal treatment of thyrotoxicosis should be directed at its etiology. Serum total triiodothyronine (T3): thyroxine (T4) ratio (ng/ug) of >20 suggests Graves' disease. In the current practice, the measurement of free thyroid hormone is more commonly used. Serum free T3/free T4 ratio of >4.4 (10−2 pg/ng) may help in differentiating the cause of thyrotoxicosis.