Selection and analysis of cases with atypical responses in the pituitary-thyroid axis from a large thyroid database.

从大型甲状腺数据库中选择和分析垂体-甲状腺轴非典型反应的病例。

基本信息

批准号：
02671068
负责人：
ICHIHARA Kiyoshi
金额：
$ 1.34万
依托单位：
Osaka University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1990
资助国家：
日本
起止时间：
1990 至 1991
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-02671068/
关键词：
thyrotropin free thyroxin epitope analysis computer analysis immunoassay immuno assay thyroxin bioassay

项目摘要

The relation between TSH and free T4 index (FT41) was analyzed from a large laboratory database in order to select cases showing atypical responses in the pituitary thyroid axis, characterized by high TSH despite high FT41. From among 7700 data, 67 cases with such inappropriate secretion of TSH were singled out and their clinical features and serial changes in the hormone levels were examined. Twenty-seven cases among them were children with cretinism under constant replacement therapy. Another four cases were those who underwent total thyroidectomy for thyroid cancer. The level of TSH remained high despite sufficient replacement therapy. In both groups of patients, the level of TSH, however, fluctuated inversely with variations of FT41 in response to the changing replacement dosage, thus, suggesting the presense of intact negative-feedback mechanism but with a skewed set point.In another serie of study, the relation between TSH and free T4 (FT4) were examined and identical groups of patients were found. In addition, three patients with Hashimoto's thyroiditis were found, who had no apparent reasons for the inappropriate secretion of TSH. Biochemical analyses of those cases were carried out, inclusing gel chromatography, a test for immunoreactivity for serially diluted samples, a search for autoantibodies against TSH or T4. None of them were positive.Recently, there have been many reports of changes in glycation patterns of TSH molecule resulting in altered bioactivity. Therefore, further study is required to identifiy such a change in the glycation pattern in our cases. Anyway, our approach to search for atypical cases is so efficient that it will facilitate discoveries of novel disorders involving the pituitary-thyroid axis.

从大型实验室数据库中分析 TSH 和游离 T4 指数 (FT41) 之间的关系，以选择垂体甲状腺轴显示非典型反应的病例，其特征是尽管 FT41 高，但 TSH 仍较高。从7700份资料中，筛选出67例TSH分泌异常的病例，检查其临床特征和激素水平的系列变化。其中27例为持续替代治疗的克汀病儿童。另外四例是因甲状腺癌而接受甲状腺全切除术的患者。尽管有足够的替代治疗，TSH 水平仍然很高。然而，在两组患者中，TSH 水平随着 FT41 的变化而波动，以响应替代剂量的变化，因此，表明存在完整的负反馈机制，但设定点存在偏差。，检查了 TSH 和游离 T4 (FT4) 之间的关系，发现了相同的患者组。此外，还发现了3名桥本甲状腺炎患者，但没有明显原因导致TSH分泌异常。对这些病例进行了生化分析，包括凝胶色谱、连续稀释样品的免疫反应性测试、针对 TSH 或 T4 自身抗体的搜索。没有一个呈阳性。最近，有许多关于 TSH 分子糖化模式变化导致生物活性改变的报道。因此，需要进一步研究来确定我们病例中糖化模式的这种变化。不管怎样，我们寻找非典型病例的方法非常有效，将有助于发现涉及垂体-甲状腺轴的新型疾病。