选择性垂体甲状腺激素抵抗所致TSH甲亢一例的治疗观察

本文报告１例选择性垂体对甲状腺激素抵抗所致ＴＳＨ甲亢。用ＰＴＵ治疗１３个月后，血清ＦＴ＿３、ＦＴ＿４水平持续高于正常，血清ＴＳＨ值波动于２６～６０ｍＵ／Ｌ之间，ＴＲＨ兴奋试验呈过度反应。改用溴隐亭治疗６个月后，血清基础ＴＳＨ及ＴＳＨ对ＴＲＨ反应均恢复正常，血清ＴＴ＿３、ＴＴ＿４水平也随之逐渐下降至正常，甲亢症状控制。Ｄ－Ｔ＿４治疗１１天，血清基础ＴＳＨ值保持正常，对ＴＲＨ无反应，而血清ＦＴ＿４、ＴＴ＿４水平回升至高于正常范围，甲亢复发。我们的观察说明，溴隐亭治疗这类甲亢有效，副作用小，可长期使用。

HYPERTHYROIDISM DUE TO SELECTIVE PITUITARY RESISTANCE TO THYROID HORMONE A CASE REPORT

Acase of hypcrthyroidism caused by selective resistance of pituitary to thyroid hormone was reported.Although the patientwas treated with PTU for 13 months,the levels of serum FT_3 and FT_1 were still consistently higher than normal,the serum TSHconcentration varied from 26mU/L to 60mU/L. TRH stimulating test showed hyperreaction. After treatment with bromocriptinefor 6 months, both the basic TSH Ievel and the TRH stimulating test returned to normal,the levels of serum TT_4 and FT_4 also de-creased to normal range. The symptoms of hyperthyrodism were controlled. After treatment with D-T_4 for 11 days,the level ofserum TSH was in normal range, and the result of TRH stimulating test was negative, however,the levels of serum TT_3 and FT_4rose above normal range again and hyperthyroidism relapsed.Our observation suggests that bromocriptine is effective with verysIight side-effects,so it can be used for treating this type of hyperthyroidism for a long period.