Studies on the TRH Test on the Patients with Graves' Disease During the Treatment with Antithyroid Drug

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  • ENOMOTO Kazuko
    The First Department of Medicine, Toho University School of Medicine
  • INOUE Kazuko
    The First Department of Medicine, Toho University School of Medicine
  • ENOMOTO Hitoshi
    The First Department of Medicine, Toho University School of Medicine

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Other Title
  • バセドウ病の治療経過に伴うTRHテストに関する研究
  • バセドウビョウ ノ チリョウ ケイカ ニ トモナウ TRH テスト ニカンスル

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Abstract

A study was performed to observe serum TSH response following TRH injection (TRH test) in 79 cases of Graves' disease (male 23, female 56, aged 16-70 years old), before and during treatment by antithyroid drug, in a total of 244 occasions. Treatment was mostly the daily administration of methyl-mercaptoimidazole (MMI), and in one case of propylthiouracil (PTU). TRH test was conducted by i.v. administration of 500 μg synthetic TRH, and subsequent 6 blood drawing until 2 hours. Serum TSH was measured by radioimmunoassay in each serum, and serum T4, T3, RT3U and cholesterol were measured in the serum before TRH injection. In some cases, the results of TRH test were compared with those of T3 131I thyroidal uptake suppression test, using the 131I uptake values at 20 min. and 24 hours.<BR>Results were obtained as follows : <BR>1) Some cases showed positive TRH test at the early stage of treatment when the patients were in eumetabolic states, while many patients showed no TSH response in spite of their long maintenance at eumetabolic states.<BR>2) When both serum T4 and T3 were high, all cases showed no response of TSH. When serum T4 alone was high, all cases except one case showed no response; whereas when serum T3 alone was high, 5 cases showed normal response. When both serum T4 and T3 were below normal, 2 cases showed no response. When serum T4 alone was low, all cases showed response; whereas when serum T3 alone was low, 6 cases showed no response. Thus, there was no positive correlation between TSH reactivity and serum concentrations of thyroid hormones.<BR>3) No correlation was observed between TSH reactivity and the period after the onset of hyperthyroidism.<BR>4) In 57 cases of Graves' disease, who were under treatment and in eumetabolic states, a comparison was made between TSH reactivity and the results of T3 suppression test. In T3 suppressed group, 19 showed response, and 3 showed no response; where as in T3 non-suppressed group, 18 showed response and 17 showed no response. In the group of T3 non-suppression as well as in the group of T3 non-suppression plus TRH no response, there was a significant elevation of serum T3 compared with the control group.<BR>5) TRH test does not appear to be an appropriate test as a predictive method to know the permanent remission of Graves' disease.

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