Resistance to thyrotropin.

Resistance to thyrotropin.
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对甲状腺激素的抗性。

DOI:
10.1016/j.beem.2017.03.004
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发表时间:
2017-03
期刊:
Best practice & research. Clinical endocrinology & metabolism
影响因子:
--
通讯作者:
Refetoff S
Refetoff S
中科院分区:
其他
文献类型:
--
作者:
Grasberger H;Refetoff S

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促甲状腺激素抵抗(RTSH)广义上定义为由于遗传缺陷导致甲状腺滤泡细胞对具有生物活性的TSH刺激的敏感性降低。受影响的个体在没有甲状腺肿的情况下血清TSH升高,其严重程度从非甲状腺性孤立性促甲状腺素血症到严重的先天性甲状腺功能减退伴甲状腺发育不全不等。从概念上讲,导致RTSH的缺陷损害TSH介导的作用的两个方面,即甲状腺激素合成和腺体生长。这些包括编码TSH受体和PAX 8转录因子的基因中的失活突变。第三种常见的病因已被遗传定位在15号染色体上的一个位点,但其潜在的病理生理学尚未阐明。本文综述了目前定义的非综合征性RTSH的原因,其鉴别诊断(自身免疫性;部分碘有机化缺陷;综合征形式的RTSH)和RTSH患者的临床方法的影响。
Resistance to thyrotropin (RTSH) is broadly defined as reduced sensitivity of thyroid follicle cells to stimulation by biologically active TSH due to genetic defects. Affected individuals have elevated serum TSH in the absence of goiter, with the severity ranging from nongoitrous isolated hyperthyrotropinemia to severe congenital hypothyroidism with thyroid hypoplasia. Conceptually, defects leading to RTSH impair both aspects of TSH-mediated action, namely thyroid hormone synthesis and gland growth. These include inactivating mutations in the genes encoding the TSH receptor and the PAX8 transcription factor. A common third cause has been genetically mapped to a locus on chromosome 15, but the underlying pathophysiology has not yet been elucidated. This review provides a succinct overview of currently defined causes of nonsyndromic RTSH, their differential diagnoses (autoimmune; partial iodine organification defects; syndromic forms of RTSH) and implications for the clinical approach to patients with RTSH.
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