Effect of Hyperglycemia-Related Acute Metabolic Disturbance on Thyroid Function Parameters in Adults.
Effect of Hyperglycemia-Related Acute Metabolic Disturbance on Thyroid Function Parameters in Adults.
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DOI：
10.3389/fendo.2022.869869
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发表时间：
2022
影响因子：
5.2
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中科院分区：
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非甲状腺疾病（NTI）是由于非甲状腺疾病导致下丘脑-垂体-甲状腺系统和甲状腺激素代谢异常的疾病。虽然NTI已被报道发生在儿童高血糖紧急情况下，很少有成人病例的研究。在这项研究中，我们研究了成人高血糖患者NTI的频率及其触发因素。因糖尿病酮症（DK）、糖尿病酮症酸中毒（DKA）或高血糖高渗综合征（HHS）住院的成人糖尿病患者纳入本研究。与DK组相比，DKA和HHS组的入院血糖、阴离子间隙、血清渗透压、肌酐和尿素氮较高，pH和eGFR较低。DKA、HHS和DK组NTI的发生率分别为80%、70%和50%，高血糖治疗后促甲状腺激素（TSH）和游离甲状腺素3（FT 3）显著改善。多元回归分析显示，FT 3水平下降与3-羟基丁酸和白蛋白显著相关。与高血糖相关的急性代谢衰竭往往与治疗开始时NTI的高发生率和低FT 3水平相关。本研究中的数据清楚地表明，在患有急性代谢疾病（如DKA、HHS和DK）的受试者中经常观察到一过性NTI。此外，我们应该记住，对于因DKA、HHS和DK而患有NTI的受试者，没有必要进行甲状腺激素替代治疗，尤其是在未观察到明显的甲状腺功能减退症症状时。
Non-thyroidal illness (NTI) is a condition in which the hypothalamic-pituitary-thyroid system and thyroid hormone metabolism are abnormal due to non-thyroidal diseases. Although NTI has been reported to occur in hyperglycemic emergencies in children, there have been few studies in adult cases. In this study, we examined adult patients with hyperglycemia regarding the frequency of NTI and its triggers. Adult diabetic patients who were hospitalized for diabetic ketosis (DK), diabetic ketoacidosis (DKA), or hyperglycemic hyperosmolarity syndrome (HHS) were included in the study. Compared with the DK group, the DKA and HHS groups had higher admission blood glucose, Anion Gap, serum osmolality, creatinine, and urea nitrogen, and lower pH and eGFR. The frequency of NTI in the DKA, HHS, and DK groups was 80%, 70%, and 50%, respectively, and thyroid stimulating hormone (TSH) and free thyroxine 3 (FT3) were significantly improved after treatment for hyperglycemia. Multiple regression analysis showed a significant correlation between the decrease in FT3 level and 3-hydroxybutyrate and albumin. Acute metabolic failure associated with hyperglycemia tends to be associated with a high rate of NTI and low FT3 levels at the start of treatment. The data in this study clearly shows that transient NTI is frequently observed in subjects with acute metabolic disorders such as DKA, HHS and DK. In addition, we should bear in mind that thyroid hormone replacement therapy is not necessary in subjects with NTI due to DKA, HHS and DK, especially when overt symptoms of hypothyroidism are not observed.