The hypothalamic-pituitary-thyroid axis in critical illness
The hypothalamic-pituitary-thyroid axis in critical illness
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DOI：
10.1053/beem.2001.0163
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发表时间：
2001-12-01
影响因子：
7.4
通讯作者：
Wiersinga, WM
中科院分区：
文献类型：
--
作者：
Fliers, E;Alkemade, A;Wiersinga, WM
在严重疾病中，下丘脑-垂体-甲状腺轴会发生深刻的变化。观察到的甲状腺激素和促甲状腺素（TSH）血清浓度的下降与负反馈循环不相容，表明下丘脑-垂体-甲状腺轴的设定点调节发生了重大变化。尸检研究显示，血清 T3 水平降低的患者下丘脑室旁核中促甲状腺素释放激素的表达降低，这也支持了这一点。在危重疾病中，血清 T3 甚至可能检测不到，但不会导致血清 TSH 浓度升高。目前尚不清楚这是否反映了机体对疾病的适应，或者是否反映了导致组织水平甲状腺功能减退的潜在有害状况。因此，需要对危重患者进行随机临床试验，以调查他们是否可以从甲状腺激素浓度正常化中受益。最近对这些患者进行的涉及下丘脑肽给药的临床研究开辟了实现这一目标的新方法。
In severe illness' profound changes occur in the hypothalamic-pituitary-thyroid axis. The observed decrease in serum concentration of both thyroid hormones and thyrotropin (TSH) are not compatible with a negative feedback loop and suggest a major change in setpoint regulation of the hypothalamic-pituitary-thyroid axis. This is supported by post mortem studies showing a decreased expression of thyrotropin-releasing hormone in the hypothalamic paraventricular nucleus of patients with a decreased serum T3 level. In critical illness, serum T3 may even become undetectable without giving rise to an elevated concentration of serum TSH. It is currently not clearly established whether this reflects an adaptation of the organism to illness or instead a potentially harmful condition leading to hypothyroidism at tissue level. There is thus a need for randomized clinical trials in critically ill patients to investigate whether they may benefit from a normalization of thyroid hormone concentration. Recent clinical studies in these patients involving the administration of hypothalamic peptides open up new ways of achieving this.