Karga Helen J, Papapetrou Peter D, Karpathios Sakellaris E, Papandroulaki Fotini E, Tsompos Constantinos N, Papaioannou Garyphallia P, Aloumanis Kyriakos P, Papaioannou Panayotis L
Second Division of Endocrinology and the Departmentof Obstetrics and Gynecology, Alexandra Hospital, Athens, Grece.
Metabolism. 2003 Oct;52(10):1307-12. doi: 10.1016/s0026-0495(03)00198-7.
It is controversial whether the administration of thyroid hormone to patients with nonthyroidal illness has any beneficial effect. Two groups of patients undergoing abdominal hysterectomy under the same general anesthesia were studied. Group A consisted of 15 women taking chronically l-thyroxine therapy (1.8 mug/kg daily), and group B (control) consisted of 16 apparently healthy euthyroid women taking placebo. Thyroid hormones, cortisol, and interleukin (IL)-6 were measured 1 day before and 1, 2, 3, and 6 days after surgery. Total triiodothyronine (TT(3)) decreased to a significantly greater degree (P <.05) and for a longer period of time in group B than in group A. The significant increase of reverse T(3) (rT(3)) noted early in group B failed to reach the baseline levels until the end of the study, whereas in group A, rT(3) returned to the preoperative values by day 2. Both groups had similar free thyroxine (FT(4)) at baseline. FT(4) increased significantly at day 1 and remained significantly elevated throughout the postoperative period in group B only. Serum TT(4), thyroid-stimulating hormone (TSH), and cortisol did not change significantly in either group. In all patients, IL-6 increased significantly to a peak value at day 1, showing a slow decrease thereafter. A stronger negative correlation was found between T(3) and IL-6 in group B than in group A (r = -.66, P <.0001 v r = -.38, P <.001, respectively) and a strong positive correlation was observed between rT(3) and IL-6 in group B only (r =.57, P <.001). The long-term treatment with T(4) seems to attenuate the decrease of serum T(3), which occurs during the development of nonthyroidal illness postoperatively. The elevation of IL-6 accounted for a greater proportion of the variations of the T(3) and rT(3) in the control group B than in the T(4)-treated group A.
对于非甲状腺疾病患者使用甲状腺激素治疗是否有任何有益效果存在争议。研究了两组在相同全身麻醉下接受腹部子宫切除术的患者。A组由15名长期接受左旋甲状腺素治疗（每日1.8μg/kg）的女性组成，B组（对照组）由16名服用安慰剂的明显健康的甲状腺功能正常女性组成。在手术前1天以及手术后1、2、3和6天测量甲状腺激素、皮质醇和白细胞介素（IL）-6。与A组相比，B组总三碘甲状腺原氨酸（TT(3)）下降程度更显著（P<.05）且持续时间更长。B组早期出现的反式T(3)（rT(3)）显著升高直到研究结束才恢复到基线水平，而在A组，rT(3)在第2天就恢复到术前值。两组在基线时游离甲状腺素（FT(4)）相似。仅B组的FT(4)在第1天显著升高并在术后整个期间保持显著升高。两组血清TT(4)、促甲状腺激素（TSH）和皮质醇均无显著变化。所有患者中，IL-6在第1天显著升高至峰值，此后缓慢下降。B组中T(3)与IL-6之间的负相关性比A组更强（分别为r = -.66，P<.0001对r = -.38，P<.001），且仅在B组中观察到rT(3)与IL-6之间有强正相关性（r =.57，P<.001）。长期T(4)治疗似乎减弱了术后非甲状腺疾病发展过程中出现的血清T(3)下降。与T(4)治疗的A组相比，对照组B中IL-6升高在T(3)和rT(3)变化中所占比例更大。
