transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2018-5-3-28-35transmed-435Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYСоотношение свободных тиреоидных гормонов в сыворотке крови больных амиодарон-индуцированным тиреотоксикозом 1 и 2 типовFree thyroid hormons ration in patients with amiodaron-induced thyrotoxicosis type 1 and type 2УлуповаЕ. О.UlupovaE. O.

Улупова Евгения Олеговна - клинический ординатор НИИ Эндокринологии.

Ул. Пархоменко, д. 15 лит. Б, СанктПетербург, 194156

Evgeniya O. Ulupova - postgraduate student.

Parkhomenko str. 15-B, Saint Petersburg, 194156

БогдановаГ. А.BogdanovaG. A.

Богданова Галина Александровна - врач УЗИ.

Ул. Пархоменко, д. 15 лит. Б, СанктПетербург, 194156

Galina A. Bogdanova - MD, doctor of ultrasound diagnostics.

Parkhomenko str. 15-B, Saint Petersburg, 194156

КароноваТ. Л.KaronovaT. L.

Каронова Татьяна Леонидовна - доктор медицинских наук, заведующая НИЛ Клинической эндокринологии НИИ Эндокринологии.

Ул. Пархоменко, д. 15 лит. Б, СанктПетербург, 194156

Tatiana L. Karonova - MD, PhD, Associate Professor, head of the Clinical Endocrinology laboratory.

Parkhomenko str. 15-B, Saint Petersburg, 194156

ГриневаЕ. Н.GrinevaE. N.

Гринева Елена Николаевна - доктор медицинских наук, профессор, директор НИИ Эндокринологии.

Ул. Пархоменко, д. 15 лит. Б, СанктПетербург, 194156

Elena N. Grineva, MD PhD, Professor, Director of Endocrinology Institute.

Parkhomenko str. 15-B, Saint Petersburg, 194156

grineva_e@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research CentreRussian Federation201801102018532835Copyright © Улупова Е.О., Богданова Г.А., Каронова Т.Л., Гринева Е.Н., 20182018Улупова Е.О., Богданова Г.А., Каронова Т.Л., Гринева Е.Н.Ulupova E.O., Bogdanova G.A., Karonova T.L., Grineva E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/435

Дифференциальный диагноз между амиодарон-индуцированным тиреотоксикозом 1 типа (АмИТ1) и 2 типа (АмИТ2) является серьезной клинической проблемой. Существующие сегодня диагностические тесты часто оказываются неспособными дифференцировать эти два типа тиреотоксического синдрома. В ряде исследований было обнаружено, что уровень Т4 и соотношение тироидных гормонов больных деструктивным тиреоидитом и болезнью Грейвса существенно отличаются. Так сывороточная концентрация Т4, была значимо выше, а соотношение Т3/T4 ниже у больных с деструктивным тиреоидом по сравнению с этими показателями при болезни Грейвса. Поскольку известно, что AмИТ1 развивается у пациентов с латентной болезнью Грейвса, а AмИT2 является деструктивным тиреоидитом, целью нашего исследования было оценить уровень свТ4 в сыворотке и соотношение св.T4/св.T3 при AмИT1 и AмИT2 в качестве дополнительного диагностического теста для дифференциальной диагностики этих типов тиреотоксикоза.

В исследование включили 45 пациентов с тиреотоксикозом (33 с AмИT1 и 12 AмИT2). Диагноз тиротоксикоза (AмИT1 или AмИT2) был установлен на основе клинических данных, результатов цветного допплеровского сканирования (ЦД), наличия аутоантител к ТТГ–рец., а также эффекта от лечения. Не было выявлено различий в уровнях свТ3 у пациентов с АмИТ1 и АмИТ2, тогда как значения свТ4 (36,2 ± 19,1 и 17,8 ± 3,7 пмоль/л соответственно, p = 0,002) и соотношение св.T4 /св.T3 (6,1 ± 5,7 и 2,7 ± 0,8 соответственно, p = 0,048) были значительно выше у пациентов с АмИТ2, чем у пациентов с АмИТ1. Более того, 75% пациентов с AмИT1 имели значение соотношения св.T4 /св.T3 <3,10, тогда как у 75% пациентов с АмИТ2 этот показатель был более 3,65. Значение соотношения св.T4/св.T3 может быть использовано в качестве дополнительного теста в дифференциальной диагностике AмИT1 и AмИT2.

Differentiation between amiodarone-induced thyrotoxicosis type 1 (AmIT1) and type 2 (AmIT2) is a diagnostic challenge. The current diagnostic tests are often unable to differentiate these two types of thyrotoxic syndrome. Several studies had shown that the serum T4 level and T3/T4 ratio are significantly different in patients with destructive thyroiditis, and those with Graves` disease. These studies showed that the serum T4 concentration is significantly higher, and the T3/T4 ratio is significantly lower in patients with destructive forms of thyroiditis compared to their values  in Graves’ disease. Since AmIT1 is known to develop in patients with latent Graves` disease, and AmIT2 is a destructive thyroiditis, the purpose of our study was to evaluate the serum FТ4 level and FT4/FT3 ratio in AmIT1 and AmIT2 as an additional diagnostic test for differentiating these types of thyrotoxicosis. 45 patients with thyrotoxicosis (33 with AmIT1 and 12 AmIT2) were included in the study. The diagnosis of thyrotoxicosis type (AmIT1 or AmIT2) was established on the basis of clinical data, color flow Doppler sonography (CFDS), the presence of TSH receptor autoantibody in patients with AmIT1, as well as the effect of treatment. There was no difference in FT3 levels in patients with AmIT1 and AmIT2, while the FT4 values were significantly higher in patients with AmIT2 (36,2±19,1 mmol/L) than in those with AmIT1 (17,8±3,7 mmol/L, p= 0,002). Also, a difference in the FT4/FT3 ratio was found between AmIT1 (2,7±0,8) and AmIT2 (6,1±5,7, p=0,048). Moreover, 75% of patients with AmIT1 had FT4/FT3ratio < 3,10, while 75% of patients with AmIT2 had FT4/FT3 ratio > 3,65. The FT4/FT3 ratio can be used as an additional test in the differential diagnosis AmIT1 and AmIT2.

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The authors declare that there are no conflicts of interest present.