[The hypophyseal TSH reserve in surgical patients with bland goiter and recurrent goiter].
Serum-T4, -T3, FTI, basal TSH and TRH-induced TSH response were measured in 80 patients with simple nontoxic goiter and in 24 patients with nontoxic recurrent goiter in a surgical unit. 55 of the 80 patients with simple goiter and 11 patients with recurrent goiter had normal individual TSH values. Mean FTI and serum T3 were not statistically different from age and sex related normal values, except serum-T3, which was above normal in elderly goiter patients. The incidence of elevated TSH reserve (preclinical hypothyroidism) was significantly higher (p less than 0.0005) in recurrent than in simple goiter (10 of 24 vs. 8 of 80 patients). Simple goiter aptients with preclinical hypothyroidism had a lower-than-normal mean serum T4 level, whereas mean serum T4 and T3 concentrations were higher than normal in preclinically hypothyroid recurrent goiter patients. In these subjects raised TSH values and goitrogenesis possibly may be related to lower sensitivity of the pituitary to thyroid hormones. 17 simple goiter patients and 3 recurrent goiter patients with normal circulating serum T4 and T3 levels showed no response to TSH to TRH. This suprising finding is related to preclinical hyperthyroidism on the basis of autonomously functioning thyroid compartments. In 12 tested patients TRH responsiveness recovered following goiter resection. The mean T3 response to TRH in goiter patients with normal or elevated TSH reserve was subnormal. This indicates that thyroid reserve is potentially decreased even in goiter patients whose thyroid function was, on the evidence of normal TSH values, actually appropriate.
D000328:Adult; D000368:Aged; D005260:Female; D006042:Goiter / Q000503:physiopathology*; D006801:Humans; D007037:Hypothyroidism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013972:Thyrotropin / Q000378:metabolism*; D013973:Thyrotropin-Releasing Hormone / Q000032:analysis; D014284:Triiodothyronine / Q000032:analysis
D014284:Triiodothyronine; D013973:Thyrotropin-Releasing Hormone; D013972:Thyrotropin
Die hypophysäre TSH-Reserve in einem chirurgischen Krankengut von blander Struma und Rezidivstruma