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갑상선질환 및 비갑상선질환에서 TSH 측정의 진단적 의의
이가희(Ka Hee Yi),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min) 대한내과학회 1991 대한내과학회지 Vol.40 No.3
N/A The diagnostic value of basal serum TSH measured by ultrasensitive IRMA was evaluated. For hyperthyroidism, we measured serum TSH by IRMA in 499 patients with thyroid diseases and analysed the causes of undetectable TSH levels in 821 serum samples referred for thyroid function test during one month (May, 1988). For euthyroid sick syndrome in nonthyroidal ill- nesses, we measured serum TSH using IRMA in 411 patients hospitalized due to nonthyroida1 illnesses and in 105 randomly selected patients, T3, T3RU, T4, FT4I, FT4 and rT3 were also measured by RIA. The mean of serum TSH level in 178 normal controls was 1.39±0.76 μU/ml(log mean=1.18)and the 99% confidence range(mean±3SD) was 0.19~7.4 μU/ml. the serum TSH levels of 141 patients with Graves disease were below 0.19 μU/ml and those of 136 patients (96.4%) were undetectable. In patients with thyroid diseases other than Graves disease, the serum TSH levels were decreased below 0.19 uU/ml in 6. The diagnostic sensitivity of TSH by IRMA for hyperthyroidism was 100% (141/141), and specificity was 97.8%(271/277). 176 samples (21.4%) out of 821 sera referred for thyroid function test for one month showed undetectable TSH levels. The undetectable TSH lebels were caused by Graves' hyperthyroidism in 127(72%), Graves' disease under treatment (euthyroidism) in 38(22%), thyoxine treatment in 7(3.4%), subacute thyroiditis in 2(1%), and thyroid nodule in 2(1%). Among 411 patients hospitalized due to nonthyroidal illnesses (NTI), 16 patients (3.9%) showed undetectable or low (<0.19μU/ml) TSH levels and 4 patients (0.9%) showed raised (>7.4 μU/ml) TSH levels. 6(3%) of 20 patients with abnormal TSH levels had received steroid therapy which suppress TSH secretion and 1(5%) had received metoclopropamide which antagonize dopaminergic inhibition of TSH secretion. Only 13(3.2%) out of 411 patients showed abnormal TSH levels due to NTI. Results of thyroid function test in randomly selected 105 patients with NTI showed low total T3 levels in 79(75.2%), low total T4 in 31(29.5%), low FT4I in in 11(10.5%), raised FT4 in 17(16.2%), decreased FT4 in 5(4.8%), raised rT3 in 38(36.2%), decreased rT3 in 13(12.4%). In contrast, TSH levels were abnormal only in 6(5.7%), increased in 2(1.9%) and decreased in 4(3.8%) patients with NTI. Therefore basal seum TSH measured by IRMA can represent status of pituitary-thyroid axis both in patients with thyroid diseases, especially hyperthyroidism and nonthyroidal illnesses.
Hui Ka-Yin,Fung James,Cheung Ka-Shing,Mak Lung-Yi,Seto Wai-Kay,Yuen Man-Fung 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.2
Background/Aims: Hepatitis B surface antigen (HBsAg) seroclearance remains uncommon in chronic hepatitis B (CHB) infection. During acute flares of CHB (AFOCHB), alanine aminotransferase elevation reflects a mounting immune response toward viral clearance. We hypothesized that severe AFOCHB is associated with a greater quantitative HBsAg (qHBsAg) decline and HBsAg seroclearance rate. Methods: A total of 75 patients with severe AFOCHB with alanine aminotransferase 10× the upper limit of normal were matched to a control group by age and sex in a 1:2 ratio. qHBsAg levels were measured at the time of flare and annually (for both cases and controls) until the last follow-up. Results: The median follow-up times for patients with severe AFOCHB and controls were 8.8 and 10.5 years, respectively. The cumulative rate of HBsAg seroclearance was higher in the severe AFOCHB group than in the control group (11.8% vs 5.0%, p=0.04) despite the former group having a trend of a higher baseline median qHBsAg (3,127 IU/mL vs 1,178 IU/mL, p=0.076). Compared with the control group, the severe AFOCHB group had a greater annual qHBsAg reduction (–242.4 IU/mL/yr vs –47.3 IU/mL/yr, p=0.002). Increasing age (p=0.049), lower baseline qHBsAg (p=0.002), and severe AFOCHB (p=0.014) were independently associated with HBsAg seroclearance. However, the cumulative rate of hepatocellular carcinoma was significantly higher in the severe AFOCHB group than in the control group (15.8% vs 1.9%, p<0.001). Conclusions: Severe AFOCHB was associated with a greater incidence of HBsAg seroclearance and qHBsAg decline. However, it was associated with a higher incidence of hepatocellular carcinoma.
일차성 점액수종환자에서 차단형 TSH 수용체항체의 유무에 따른 임상상의 차이
이가희(Ka Hee Yi),안종호(Chong Ho Ahn),김원배(Won Bae Kim),정재훈(Jae Hoon Chung),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),송영기(Young Kee Shong) 대한내과학회 1994 대한내과학회지 Vol.47 No.5
N/A Objectives: To elucidate primary myxedema characterized by progressive atrophy of the thyroid gland and primary hypothyroidism is caused by the blocking type TSH receptor antibody and as a end result of Hashimoto's thyroiditis as well. Methods: We measured thyrotropin-binding inhibitory immunoglobulin (TBII) using radioreceptor assay and thyroid-stimuiation blocking antibody (TSBAb) by bioassay using rat thyroid cell line, FRTL-5, in the sera from 84 patients with primary myxedema and from 61 patients with Hashimoto's thyroiditis and compared their clinical characteristics. Results: Among the patients with primary myxedema THII was detected in 39 patients (46%) and TSBAb in 47 patients (64%). In patients with Hashimoto's thyroiditis, TBII was detected only in 3 patients (5%) and TSBAb in 3 patients (8.8%). The prevalences of both TBII and TSBAb were significantly higher in primary myxedema than those in Hashimoto's thyroiditis. TSBAb activity was significantly higher in TRII positive primary myxedema patients when compared with TBII negative and was positively correlated with TBII activity. The activities of both TBII and TSBAb measured in patients with Hashimoto's thyroiditis were much lower than those in primary myxedema. The mean age at the onset of primary myxedema was significantly lower in the patients with TBII. When compared with the patients with Hashimoto's thyroiditis, mean age at the onset of disease was significantly older in the TBII negative primary myxedema patients. But the age of disease onset in TBII positive myxedema was not different from that of Hashimoto's patients. As the patients were younger at the onset of disease, the prevalence of TBII was higher: for the patients under the age of 29, TBII was detected in 76%, for between 30 and 39, 55%, for 40~49, 45%, for 50~59, 16 % and for over 60, 38 %, respectively (ψ²=24.77, df=l, p<0.05). Among the patients with primary myxedema, 24h 1311-thyroid uptake values were significantly lower in patients with TBII compared to those without TBII (1.5±1.1% vs. 4.1±3.9% p<0.05). Conclusion: These results suggest that primary myxedema may be a heterogenous disease: for the development of hypothyroidism, blocking type TSH receptor antibodies play a major role in one group, especially young patients and cell-mediated destructive mechanisms may be important in another group.