三种甲状腺制剂治疗原发甲状腺机能低减症对血清甲状腺激素的影响

本文报告不同剂量的三种甲状腺制剂,对原发甲状腺机能低减症患者血清甲状腺激素(T_4,T_3与rT_3)与促甲状腺激素(TSH)水平的影响。甲状腺制剂替代治疗时,血清T_3与TSH变化比T_4与rT_3敏感,血清T_4与T_3都可直接抑制垂体TSH的分泌,但T_4与TSH关系比T_3更为密切。三种甲状腺制剂发挥同等生物效应的剂量关系为:100μg甲状腺素片≈30～40μg三碘甲腺原氨酸片≈40～60mg干燥甲状腺片。在判断药物过量时,血清T_4值要优于T_3。甲状腺制剂宜在睡前服。

The Effect of Three Kinds of Thyroid Hormone Preparations on Serum Thyroid Hormone and TSH in Primary Hypothyroidism

Thirty-eight cases of primary hypothyroidism were treated prospectively with three kinds of thyroid hormone preparations, including Levothyroxine, L-triiodothyronine and dry thyroid preparation. A protocol of different dosages with same biologic effects was followed: 100 micrograms Levothyroxine approximately 40-60 mg dry thyroid preparation approximately 30-40 micrograms L-triiodothyronine. During drug replacement treatment, the change serum T3 and TSH is more sensitive than that of serum T4 and reverse T3. Both of serum T3 and T4 can directly inhibit the secretion of pituitary TSH, but serum T4 is more closely related to TSH than is T3. In judging the overdose, the level of serum T4 is a superior indicator to the level of T3. The best time to take thyroid hormone preparations is at bedtime.