バセドウ病および破壊性甲状腺中毒症におけるT<SUB>3</SUB>/T<SUB>4</SUB>比およびT<SUB>3</SUB>/rT<SUB>3</SUB>比の評価

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タイトル別名
  • Serum Ratios of Triiodothyronine to Thyroxine and Reverse-triiodothyronine in Graves' Disease and Destruction-induced Thyrotoxicosis
  • バセドウ病および破壊性甲状腺中毒症におけるT3/T4比およびT3/rT3比の評価
  • バセドウビョウ オヨビ ハカイセイ コウジョウセン チュウドクショウ ニ オケ

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In order to determine the frequency of thyroxine (T4) toxicosis and study the possibility of usefulness for differentiation between thyrotoxic Graves' disease and destructioninduced thyrotoxicosis, the serum concentrations of T4, triiodothyronine (T3), reverse T3 (rT3), and T4-binding globulin (TBG) and the values of T3-uptake and radioactive iodine uptake (RAIU) were measured, and free, T4 index (FT4I), free T3 index (FT3I) and serum ratios of T3 to T4 (T3 /T4 ratio) and T3 to rT3 (T3 /rT3 ratio) were calculated in 92 untreated patients with thyrotoxic Graves' diseas (16 with other systemic illnesses and 4 who were pregnant) and 14 patients with destruction-induced thyrotoxicosis (4 with subacute thyroiditis, 8 with postpartum transient thyrotoxicosis, 1 with silent thyroiditis and 1 with chronic thyroiditis with subacute aggravation). The serum concentrations of T4 and T3 and the values of FT4 I, FT3 I, T3/T4 ratio and T3 /rT3 ratio were significantly lower in Graves' patients complicated with other systemic illnesses than those in Graves' patients without any complication. The serum concentrations of T4, T3, rT3 and TBG and the values of FT4 I, FT3 I, T3 /T4 ratio, T3 /rT3 ratio and RAIU in elderly (over the age of 61 years) patients with Graves' disease without any complication were not significantly different from those in young (under 60) patients with Graves' disease without any complication. Although the serum concentration of TBG was significantly higher and the T3/T4 ratio was significantly lower in pregnant Graves' patients than those in Graves' patients without any complication, there was no significant difference in the T3 /rT3 ratio between the two groups. The T3 /T4 ratio was significantly lower in patients with subacute thyroiditis and postpartum transient thyrotoxicosis than that in Graves' patients without any complication, but there were no significant differences in the serum concentration of TBG and T3 /rT3 ratio between the two groups. Fourteen of 72 (19.4%) Graves' patients without any complication, 13 of 16 (81.2%) Graves' patients with complications, 3 of 4 (75.0%) patients with subacute thyroiditis and 4 of 8 (50.0%) patients with postpartum transient thyrotoxicosis had a low T3 /T4 ratio (ng/μg) of less than 20. On the other hand, 4 of 72 (5.6%) Graves' patients without any complication and 13 of 16 (81.2%) Graves' patients with complications had a low T3/rT3 ratio (ng/μg) of less than 2.5. There were no pregnant Graves' patients and no patients with destructioninduced thyrotoxicosis who had a low T3 /rT3 ratio less than 2.5. T4 toxicosis was observed in 9 of 16 Graves' patients with complications and one patient with silent thyroiditis.<BR>T4 toxicosis may be found in the presence of other non-thyroidal illnesses in Graves' patients. The T3 /T4 ratio together with the T3 /rT3 ratio is a simple and useful index for the differentiation of the two types of thyrotoxicosis, but final differentiation should be comfirmed by RAIU.

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