Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming.
Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming.
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DOI：
10.3389/fendo.2017.00163
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发表时间：
2017
影响因子：
5.2
通讯作者：
Dietrich JW
中科院分区：
文献类型：
--
作者：
Chatzitomaris A;Hoermann R;Midgley JE;Hering S;Urban A;Dietrich B;Abood A;Klein HH;Dietrich JW
下丘脑-垂体-甲状腺反馈控制是一个动态的、自适应的系统。在代表1型变稳态的疾病和能量剥夺的情况下，应激反应操作以改变其设定点和外周传递参数。相比之下，2型非稳态负荷，通常有效的心理社会压力，怀孕，代谢综合征，适应寒冷，产生一个几乎相反的表型预测可塑性。非甲状腺疾病综合征（NTIS）或危重病、肿瘤、尿毒症和饥饿（TACITUS）中的甲状腺别稳态，通常在住院患者中观察到，显示了历史上研究充分的甲状腺别稳态反应模式。其特征是总甲状腺激素和游离甲状腺激素浓度降低，促甲状腺激素（TSH）水平变化，从降低（严重病例）到正常甚至升高（主要在恢复期）TSH浓度。可以区分急性期和慢性期（消耗综合征）。这两种类型在分子机制和预后方面有所不同。甲状腺激素代谢对危重疾病的急性适应可能对机体有益，而与慢性疾病相关的更为复杂的分子改变经常导致非稳态超负荷。后者与不良结局相关，与基础疾病无关。甲状腺稳态的适应性反应延伸到胎儿期、体重增加或减轻、体温调节、体育锻炼和精神疾病期间甲状腺激素浓度的改变。各种形式的甲状腺异位给甲状腺疾病的鉴别诊断带来了严重的问题。这篇综述文章提供了一个概述的生理机制，以及主要的诊断和治疗的影响下，甲状腺异位的各种发展和应变条件。
The hypothalamus–pituitary–thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. The non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumors, uremia, and starvation (TACITUS), commonly observed in hospitalized patients, displays a historically well-studied pattern of allostatic thyroid response. This is characterized by decreased total and free thyroid hormone concentrations and varying levels of thyroid-stimulating hormone (TSH) ranging from decreased (in severe cases) to normal or even elevated (mainly in the recovery phase) TSH concentrations. An acute versus chronic stage (wasting syndrome) of TACITUS can be discerned. The two types differ in molecular mechanisms and prognosis. The acute adaptation of thyroid hormone metabolism to critical illness may prove beneficial to the organism, whereas the far more complex molecular alterations associated with chronic illness frequently lead to allostatic overload. The latter is associated with poor outcome, independently of the underlying disease. Adaptive responses of thyroid homeostasis extend to alterations in thyroid hormone concentrations during fetal life, periods of weight gain or loss, thermoregulation, physical exercise, and psychiatric diseases. The various forms of thyroid allostasis pose serious problems in differential diagnosis of thyroid disease. This review article provides an overview of physiological mechanisms as well as major diagnostic and therapeutic implications of thyroid allostasis under a variety of developmental and straining conditions.
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