Schilling J U, Zimmermann T, Albrecht S, Zwipp H, Saeger H D
Klinik für Viszeral-, Thorax- und Gefässchirurgie, Universitätsklinikums, TU Dresden.
Med Klin (Munich). 1999 Oct 15;94 Suppl 3:66-9. doi: 10.1007/BF03042196.
Many nonthyroidal illnesses, such as major trauma, severe burn injury, sepsis or immune deficiency are associated with a reduced T3 concentration without increased serum TSH secretion. The pathopysiologic meaning of this phenomenon was controversely discussed since its investigation 20 years ago. The identification of the Type I 5-iodthyronine-deiodinase as a selenoenzyme brought many new aspects into this discussion.
To investigate the correlation of T3 blood levels and the selenium concentrations in consideration of the severity of the nonthyroidal illness 20 patients with major trauma where included in this study. In all these patients frequently T3, T4, fT3, fT4, TSH, Se (whole blood), Se (plasma) and Glasgow-Coma-Scale (GCS), APACHE II and MOF-Score where measured until the 28th day of illness.
Five patients (20%) died during the study until the 8th day of measurement. Survivors and nonsurvivors initial showed a low T3 and fT3 level in serum. While the T3 serum concentrations of nonsurvivors remained on a low level the thyronine concentrations of survivors distinctly increased. The measured thyroid hormone concentrations were significantly correlated with MOF-score, APACHE II and inversely with GCS. There was no significant correlation between low T3/fT3 blood levels and low selenium concentrations in all observed patients.
The selenium deficiency in all patients with major trauma seems to be not the single cause of the low T3 syndrome. The distinctly suppression of TSH could be caused by the action of various cytokines such as IL-6 and TNF-alpha. Further investigations should improve the effectivity of substitution of selenium and/or thyroid hormones in the therapy of patients with severe nonthyroidal illness.
许多非甲状腺疾病，如严重创伤、重度烧伤、败血症或免疫缺陷，都与血清三碘甲状腺原氨酸（T3）浓度降低有关，而血清促甲状腺激素（TSH）分泌并未增加。自20年前对这一现象进行研究以来，其病理生理意义一直存在争议。I型5-碘甲状腺原氨酸脱碘酶被鉴定为一种含硒酶，为这一讨论带来了许多新的方面。
为了研究在考虑非甲状腺疾病严重程度的情况下T3血水平与硒浓度之间的相关性，本研究纳入了20例严重创伤患者。在所有这些患者中，在疾病的第28天之前，经常检测T3、T4、游离T3（fT3）、游离T4（fT4）、TSH、全血硒、血浆硒以及格拉斯哥昏迷评分（GCS）、急性生理与慢性健康状况评分系统II（APACHE II）和多器官功能障碍评分（MOF评分）。
在研究期间直至测量的第8天，有5例患者（20%）死亡。幸存者和非幸存者最初血清中的T3和fT3水平较低。非幸存者的T3血清浓度维持在低水平，而幸存者的甲状腺素浓度明显升高。所测甲状腺激素浓度与MOF评分、APACHE II显著相关，与GCS呈负相关。在所有观察的患者中，低T3/fT3血水平与低硒浓度之间无显著相关性。
所有严重创伤患者的硒缺乏似乎不是低T3综合征的唯一原因。TSH的明显抑制可能是由多种细胞因子如白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的作用引起的。进一步的研究应提高硒和/或甲状腺激素替代疗法对严重非甲状腺疾病患者治疗的有效性。
