过氧化物酶缺陷型激素合成障碍性甲状腺肿的核医学特征

Features of Nuclear Medicine for TPO Defect Hormonogenic Obstruction Goiter

用放射免疫法测定过氧化物酶缺陷型激素合成障碍性甲状腺肿病人血清TT3,TT4,FT3,FT4,TGAb,TMAb,用高敏感免疫放射法测定TSH,并进行碘过氨酸钾释放实验和^(99m)锝甲状腺静态显像,实验显示:该类病人血清甲状腺素水平降低,TSH水平升高,TGAb呈阴性反应;碘过氯酸钾释放试验呈阳性反应;核素显像显示甲状腺均匀性肿大,摄取^(99m)锝功能增加,结果表明:该类病人甲状腺细胞合成甲状腺素的关键酶—过氧化物酶活性低下,使进入甲状腺细胞的碘离子氧化为碘分子的过程受到抑制,该酶活性降低使甲状腺素水平降低,反馈性刺激垂体TSH分泌增加,在TSH刺激下,甲状腺增生肿大,摄取^(131)碘和^(99m)锝功能增加,SPECT静态显像甲状腺放射性分布浓聚,与桥本甲状腺炎鉴别诊断,测定血清甲状腺自身抗体TGAb。

We assessed the diagnostic features in nuclear medicine lab on patients with TPO defect hormono-genic obstruction goiter by means of RIA and FUMA for determination of serum TT3,TT4, FT3, FT4, TSH.TCAb. TMAh.KCIO4131I release test and SPECT thyroid imaging were also taken on the patients. Results showed that the level of serum thyroxin in the patients was lower and TSH was higher than normal. Serum TGAb and TMAb were negative. The KCIO4131I release test was positive. Thyroid SPECT imaging showsed that mass of thyroid wasswollen and radiation was welldistributed. The abilities of 99mTc uptake were increased. The results of the study indicated that the lack of TPO might block the synthesis of thyroxin and led to TSH level to nse irorn feedback, which stimulated cell to grow,increased the abilities of 131I and 99mTc and caused goiter.It is important to determine TGAb and TMAb in the differential diagnosis of Hashimoto's thyroiditis.