Elevation of serum free triiodothyronine, total triiodothyronine, thyroxine-binding globulin, and total thyroxine levels in combat-related posttraumatic stress disorder.
Elevation of serum free triiodothyronine, total triiodothyronine, thyroxine-binding globulin, and total thyroxine levels in combat-related posttraumatic stress disorder.
复制标题
战斗相关的创伤后应激障碍中血清游离三碘甲状腺原氨酸、总三碘甲状腺原氨酸、甲状腺素结合球蛋白和总甲状腺素水平的升高。
DOI：
10.1001/archpsyc.1994.03950080041006
复制
发表时间：
1994
影响因子：
--
通讯作者：
Dennis S. Charney
中科院分区：
文献类型：
--
作者：
John W. Mason;S. Southwick;Rachel Yehuda;Sheila Wang;S. Riney;Douglas Bremner;D. Johnson;Hadar Lubin;Dudley Blake;Gang Zhou;Fred D. Gusman;Dennis S. Charney
背景
本研究旨在评估与战斗有关的创伤后应激障碍（PTSD）中甲状腺功能的中枢和外周方面，其特定目的是为先前在飞行员工作中观察到的血清游离甲状腺素（T4）和总T4水平之间的不平衡找到一种机制解释。
方法
共有96名男性战斗退伍军人被DSM-III-R诊断为PTSD（72名来自康涅狄格州西黑文退伍军人事务医疗中心，24名来自加利福尼亚州门洛帕克退伍军人事务医疗中心），并与24名男性对照组进行了比较。通过放射免疫测定法分析一份或多份血清样本的总T4、游离T4、总三碘甲状腺原氨酸（T3）、游离T3、T4结合球蛋白和促甲状腺激素水平。
结果
PTSD患者中总T4水平中度升高而游离T4水平无升高的初步观察结果得到证实，提示以下假设：（1）可能存在通过脱碘向T3的游离T4外周转化增加或（2）可能存在继发于T4结合球蛋白水平升高的T4结合增加。我们的研究结果支持这两种假设。PTSD组的总T3和游离T3水平均显著且持续升高，T3/T4比值也升高，支持T3转换增加的假说。PTSD组也显示出T4结合球蛋白水平的显著和持续增加，支持结合增加的假设。PTSD组和对照组的促甲状腺激素水平没有差异。
结论
这些研究结果表明，在战斗相关的PTSD中，甲状腺改变的模式不寻常，其特征是总T3，游离T3和T4结合球蛋白水平显著升高，与已确定的内分泌疾病不同，如经典甲状腺功能亢进症，T3甲状腺毒症或慢性T4结合球蛋白升高。
BACKGROUND
This study was designed to assess both central and peripheral aspects of thyroid function in combat-related posttraumatic stress disorder (PTSD), with the particular purpose of finding a mechanistic explanation for an imbalance between serum levels of free thyroxine (T4) and total T4 previously observed in pilot work.
METHODS
A total of 96 male combat veterans with PTSD diagnosed by DSM-III-R (72 from the West Haven, Conn, Veterans Affairs Medical Center and 24 from the Menlo Park, Calif, Veterans Affairs Medical Center) were compared with 24 male control subjects. One or more serum samples were analyzed by radioimmunoassays for levels of total T4, free T4, total triiodothyronine (T3), free T3, T4-binding globulin, and thyrotropin.
RESULTS
The pilot observation of moderately elevated total T4 levels with no elevation in free T4 levels in patients with PTSD was confirmed, suggesting the hypotheses that (1) there may be an increased peripheral conversion of free T4 by deiodination to T3 or (2) there may be an increased binding of T4 secondary to elevated T4-binding globulin levels. Our findings support both hypotheses. The PTSD groups all showed a marked and sustained elevation in levels of both total T3 and free T3, as well as elevated T3/T4 ratios, supporting the increased T3 conversion hypothesis. The PTSD groups also showed a marked and sustained increase in T4-binding globulin levels, supporting the increased binding hypothesis. Thyrotropin levels did not differ between PTSD and control groups.
CONCLUSIONS
These findings demonstrate an unusual pattern of thyroid alterations, featuring substantial elevations in total T3, free T3, and T4-binding globulin levels, in combat-related PTSD that differs from established endocrinopathies, such as classic hyperthyroidism, T3 thyrotoxicosis, or chronic T4-binding globulin elevation.
DOI：
--
发表时间：
1989
期刊：
The Journal of clinical psychiatry
影响因子：
--
作者：
C. Nemeroff
通讯作者：
C. Nemeroff