滋养细胞疾患对甲状腺功能变化影响的初步观察

INFLUENCE OF TROPHBLASTIC DISEASES UPON THYROID FUNCTION A PRELIMINARY INVESTICATION

本组对112例滋养细胞肿瘤患者、47例正常孕妇、15例育龄妇女测定了TT_3、TT_4、^(125)I-T_3吸收比值。证实葡萄胎患者确有甲功增强现象,其TT_3、TT_4值与育龄妇女组相比,均有高度显著差异.112例中,1例恶性葡萄胎(以下简称恶葡)、1例绒毛膜上皮癌(以下简称绒癌)有甲亢临床表现,为脉洪及心动过速,且有心电图改变,但无眼球突出及震颤。文献一般认为滋养细胞肿瘤患者甲亢现象是由hCG刺激引起的,hCG作用于细胞膜上磷酸腺苷环化酶,通过第二信使CAMP促进甲状腺素的生成和分泌,但也有人认为甲亢不是由hCG引起的。本组材料发现hCG升高与甲功增强有一定相关性,但不能解释hCG滴度很高而无甲功增加的病例。

Blood T_4, T_3^(125)I-T_3, and TSH were determined in a series of 112 cases of trophoblastic diseases, with 47 normal pregant womer and 15 women of reproductive age as controls. The differences in blood T_3and T_4levels were highly significant between patients and women of reproductive age (P<0.01). Clinical manifestations of hyperthyroidism, such as bounding pulse, tachycardia, and abnormal EGG were demonstrated in one case of invasive mole and one casc of choriocarcinoma, however, no exophthalmos and fine trermors were observed. The symptons disappared rapidly after chemotherapy. In the past, Some studies claimed that hCG is capable to stimulate the adenylate cydase in human thyroid cell membrane, via the second messenger-cAMP, to facilitate thyroxin synthesis and secreting. The authors investigation also suggests that there is some positive correlations between elevation of hCG and hyperthroidism. However, the enigma of absence of hyperthyroidic manifestations in paticnts with high hCG levels still remains an obscurity.