Suppression of thyrotropin in the low-thyroxine state of severe nonthyroidal illness.
Suppression of thyrotropin in the low-thyroxine state of severe nonthyroidal illness.
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在严重非甲状腺疾病的低甲状腺素状态下抑制促甲状腺素。
DOI：
10.1056/nejm198502283120904
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Santos,GW
中科院分区：
文献类型：
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作者：
Wehmann,RE;Gregerman,RI;Burns,WH;Saral,R;Santos,GW
在一项前瞻性研究中，我们评估了促甲状腺激素在与严重疾病相关的低甲状腺素状态发展中的作用。对35例造血系统恶性肿瘤和再生障碍性贫血患者进行了骨髓移植治疗前后血清促甲状腺激素和甲状腺激素水平的动态观察。在19例患者中，甲状腺素在骨髓移植后急剧下降，并与17例受试患者血清促甲状腺激素的减少有关，通常低于正常范围。这些患者的血清三碘甲状腺原氨酸水平、游离甲状腺素指数和游离甲状腺素水平也下降。在恢复的患者中，临床改善伴随着促甲状腺激素和甲状腺激素浓度恢复到治疗前的范围。这些和相关的研究结果表明，低甲状腺素状态的严重疾病是几个事件的结果，其中之一是失败的正常负反馈控制的垂体-甲状腺轴由于疾病相关的，减少分泌促甲状腺激素。认为这些患者是“甲状腺功能正常”的观点必须受到质疑，但在这些情况下甲状腺替代治疗的可能价值仍有待确定。（N Engl J Med 1985; 312：546-52.）
In a prospective study, we assessed the role of thyrotropin in the development of the low-thyroxine state that is associated with severe illness. We measured the serum thyrotropin and thyroid hormone concentrations longitudinally in 35 patients with hematopoietic cancer or aplastic anemia who were treated by bone-marrow transplantation. In 19 patients thyroxine declined sharply after bone-marrow transplantation and was associated with a reduction of the serum thyrotropin in the 17 patients tested, often to levels below the normal range. The serum triiodothyronine level, free thyroxine index, and free thyroxine level also declined in these patients. In the patients who recovered, clinical improvement was accompanied by the return of thyrotropin and thyroid hormone concentrations to their pretreatment ranges. These and related findings suggest that the low-thyroxine state of severe illness is the result of several events, one of which is failure of the normal negative-feedback control of the pituitary–thyroid axis due to illness-associated, decreased secretion of thyrotropin. The notion that such patients are "euthyroid" must be questioned, but the possible value of thyroid hormone–replacement therapy in these circumstances remains to be determined. (N Engl J Med 1985; 312: 546–52.)