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Re -discuss T3 hyperthyroidism: Ap for a typical case
Written article | Zhang Tai Sheng
Recently, in other disciplines participating in the author, a case of inspiring patients with hyperthyroidism (hyperthyroidism) patients:
Case Express
This is a 50 -year -old man, because" Repeated chest tightness for half a year, and send another 1 week " Check in Internal Medicine, there are symptoms of sweat and hand tremor , accompanied by In the case of hormone abnormalities , please consult our department for consultation (Figure 1-2):
Results
Figure 2 The result of thyroid antibody
Thyroid ultrasound: 1. The solid nodule of the left and right liquid liquids, C-Tirads 3 (& LT; 2%); 2. The thyroid enlargement, and the blood transport is slightly abundant.
Examination: The thyroid I swelling, smelling and a little vascular noise, thyroid no tenderness and tenderness.No abnormal eye.
In clinical observation, the patients trio -iodine -shaped picanine (TT3) and the level of free trimetonicine (FT3) are abnormal, accompanied by the pemoniasis hormone (TSH).Significantly low. Compared with hyperthyroidism in the traditional concept, the patients hormone level described herein shows certain differences (see Table 1).
Table 1 T3 Over-hyperthyroidism Comparison with Traditional Hyperthyroidism [1,3]
*TT4: Total thyroxine measurement FT4: free thyroxine
Based on the current case, you need to re -examine and understand this special type of hyperthyroidism -T3 super hyperthyroidism.
Learn for T3 superior nail hyperthyroidism
Under normal circumstances, T4 in thyroid hormones occupies absoluteThe dominant position is as high as 98%, while T3 is relatively small, accounting for only 2%.Although in the blood circulation, 25%of T4 will be converted into T3, the concentration of T3 in the blood is still much lower than that of T4, only one -twenty of T4 [2].
Among patients who are diagnosed as hyperthyroidism for the first time, the level of T3 and T4 of patients is usually found to increase, and TSH decreases.After the treatment of anti -thyroid drugs, thyroid synthesis is suppressed, while the number and activity of inhibitory lymphocytes is improved, which gradually reduces the titration of the receptor antibody and the T4 synthesis is reduced.Generally, about 8 weeks, the level of T3 and T4 gradually returns to normal.
However, in recent years, some patients with hyperthyroidism have been found in the entire treatment process, despite standardized treatment, T3 and T4 remain at a high level [3].In clinical clinic, some patients were diagnosed with hyperthyroidism, and the test results of thyroid hormone showed that the level of T3 hormone was significantly higher, while the TSH level decreased accordingly.
This is mainly t3, and the hyperthyroidism with TSH is called: T3 super hyperthyroidism.
pathogenesis:
The most common cause of hyperthyroidism is permeable toxic thyroid (GD, GRAVES disease).Followed by more toxicity, (TMNG) toxic thyroid glandoma (TA).Non -hyperthyroidism is mainly: subacute thyroiditis, bridge thyroiditis, etc. [4].
T3 super -type GD mechanism has these characteristics:
1) In thyroid, type 1 and 2The activity of type 5 dehydase (D1 and D2) is enhanced, where the conversion of D2 to T4 to T3 is more significant.Among the patients with Graves, the expression of D2 gene is over four times the level of general Graves disease patients;
2) The continuous rise of TRAB, TPOAB, TGAB and other antibody activation ringsThe promoter dependent on adenosine (CAMP) (CAMP) promotes the proliferation of thyroid filter cell cells, leading to infiltration of thyroid tissue, lymphocytes, etc., and enhancing the conversion process of T4 to T3;
3) The mice that are knocked through the gene are inhibited, but the level 1 and 2 5 dehydram enzyme genes are inhibited, but the level of plasma T3 remains normal.
This result indicates that D1 and D2 enzymes are not necessary factor that maintains the normal level of T3. It is speculated that there are other channels to adjust the T3 level [5].
Although the GD patients in the case only occur in FT3 and TT3, TSH decreases.But it has obviously have the clinical characteristics of GD.So what should be treated for patients with this case?
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References:
[1] Chinese Medical Society, Grassroots Diagnosis and Treatment Guidelines (2019 edition) [J], 2019,18 (12): 1118-1128
] Dong Lian.FT3 t FT4 ､ TSH and T3 ､ T4 joint test evaluation of the clinical significance of thyroid function [J]. Heilongjiang Pharmaceutical, 2023,36 (03): 701-704.
[3] Wang Naizun, Liu Hong, Yang Hanwen.t3 superior hyperthyroidism [J]. Journal of Guangxi Medical College, 1991, (04): 356-357
[4] The Endocrinology Branch of the Chinese Medical Association, the guidelines for the diagnosis and treatment of thyroid poison in China and other reasons [J], Chinese endocrine metabolism magazine, 2022,38 (8): 700-748
[5] Wang Dan, Yang Yuzhi, etc., T3 superior Graves disease effect and prognosis related factors [j], Chinese grass-roots medicine, 2012 12th issue 1802-1803
[6] Sui Jia, T3 hyperthyroidism nursing experience [J], Chinese health strip, March 10th, No. 12, No. 12
[7] Xu Chunqi, Lu Xiuying, Sun Deyong, et al. Taking two ankle pain ､ Emotional disorders as the first symptoms of the first symptoms.35IA8AEM "> Editor in charge: Kobayashi*" The medical community "strives to publish the content of the content and reliable content, but not promise the accuracy of the content;It will be checked separately when adopting or using this as a basis for decision -making.
