Romijn J A, Wiersinga W M
Department of Intensive Care, University of Amsterdam, The Netherlands.
J Clin Endocrinol Metab. 1990 Jan;70(1):35-42. doi: 10.1210/jcem-70-1-35.
To evaluate the regulation of TSH secretion in nonthyroidal illness (NTI) we studied the nocturnal TSH surge in 11 healthy controls and 26 NTI patients; none of the patients was on medication known to interfere with TSH secretion. The presence of a nocturnal TSH surge was defined as a mean nighttime TSH (the mean of 5 samples taken hourly from 0000-0400 h) significantly greater than the mean daytime TSH (the mean of 5 samples taken from 1500-1900 h). A nocturnal TSH surge was present in 11 of 26 NTI patients and in 11 of 11 controls (P less than 0.01). Both the absolute (0.3 +/- 0.1 vs. 1.0 +/- 0.2 mU/L; P less than 0.01) and relative (11 +/- 6% vs. 71 +/- 12%; P less than 0.001) nocturnal TSH surges were lower in NTI patients than in controls. NTI patients had lower plasma T3 (1.11 +/- 0.08 vs. 1.84 +/- 0.11 nmol/L; P less than 0.001) and higher plasma rT3 (0.81 +/- 0.24 vs. 0.23 +/- 0.01 nmol/L; P less than 0.001) concentrations than controls, but T4, FT4, and TSH values were similar in both groups. No differences were found between the 15 NTI patients without nocturnal TSH surge and the 11 patients with a nocturnal TSH surge in sex distribution, age, caloric intake, or plasma T4 and T3, but hospital mortality was slightly, although not significantly, higher in those with an absent nocturnal TSH surge. An absent nocturnal TSH surge occurred in 2 of 2 patients with a low TSH (less than 0.4 mU/L), in 11 of 20 patients with a normal TSH (0.4-4.0 mU/L), and in 2 of 4 patients with a high TSH (greater than 4.0 mU/L). Pituitary TSH responsiveness to TRH was similar in patients with or without a nocturnal TSH surge. We conclude that NTI is frequently associated with a decreased nocturnal TSH surge. This phenomenon is not related to ambient plasma T4, T3, or TSH concentrations or pituitary TSH responsiveness to TRH. A decreased nocturnal TSH surge appears to be one of the features of the sick euthyroid syndrome and is probably related to hypothalamic dysregulation.
为评估非甲状腺疾病（NTI）中促甲状腺激素（TSH）分泌的调节情况，我们研究了11名健康对照者和26名NTI患者的夜间TSH激增情况；这些患者均未服用已知会干扰TSH分泌的药物。夜间TSH激增的存在定义为夜间平均TSH（从00:00至04:00每小时采集5个样本的均值）显著高于白天平均TSH（从15:00至19:00采集5个样本的均值）。26名NTI患者中有11名出现夜间TSH激增，11名对照者中也有11名出现（P<0.01）。NTI患者的夜间TSH激增的绝对值（0.3±0.1 vs. 1.0±0.2 mU/L；P<0.01）和相对值（11±6% vs. 71±12%；P<0.001）均低于对照者。NTI患者的血浆三碘甲状腺原氨酸（T3）浓度较低（1.11±0.08 vs. 1.84±0.11 nmol/L；P<0.001），而血浆反三碘甲状腺原氨酸（rT3）浓度较高（0.81±0.24 vs. 0.23±0.01 nmol/L；P<0.001），但两组的甲状腺素（T4）、游离甲状腺素（FT4）和TSH值相似。在15名无夜间TSH激增的NTI患者和11名有夜间TSH激增的患者之间，在性别分布、年龄、热量摄入或血浆T4和T3方面未发现差异，但无夜间TSH激增者的医院死亡率略高，虽无统计学意义。2名促甲状腺激素水平低（<0.4 mU/L）的患者中有2名无夜间TSH激增，20名促甲状腺激素水平正常（0.4 - 4.0 mU/L）的患者中有11名无夜间TSH激增，4名促甲状腺激素水平高（>4.0 mU/L）的患者中有2名无夜间TSH激增。有或无夜间TSH激增的患者垂体TSH对促甲状腺激素释放激素（TRH）的反应相似。我们得出结论，NTI常与夜间TSH激增减少有关。这种现象与周围血浆T4、T3或TSH浓度或垂体TSH对TRH的反应无关。夜间TSH激增减少似乎是低甲状腺素病态综合征的特征之一，可能与下丘脑调节异常有关。
