Bartalena L, Placidi G F, Martino E, Falcone M, Pellegrini L, Dell'Osso L, Pacchiarotti A, Pinchera A
Instituto di Endocrinologia, University of Pisa, Italy.
J Clin Endocrinol Metab. 1990 Sep;71(3):650-5. doi: 10.1210/jcem-71-3-650.
TSH secretion, with particular regard to the nocturnal surge of the hormone, was evaluated in 15 women (age range, 35-66 yr; mean, 50 yr) with untreated major endogenous depression and 15 healthy women (age range, 32-67 yr; mean, 53 yr) using an ultrasensitive assay. Mean morning (0830 h) TSH values did not differ in the 2 groups (1.3 +/- 02 mU/L in depressives and 1.4 +/- 0.1 mU/L in controls), whereas mean nighttime (2400-0200 h) values were significantly reduced in depressives (1.5 +/- 0.3 vs. 3.1 +/- 0.3 mU/L; P less than 0.0005). At variance with the control group, morning and nighttime TSH values did not differ in the depressives. The nocturnal serum TSH surge was abolished in 14 of 15 depressed patients. The mean peak TSH value after TRH was slightly yet significantly lower in the depressives. Patients with subnormal (less than 0.4 mU/L) TSH values in the morning had a serum TSH increase after TRH less than 2 mU/L in 5 of 6 cases and a lack of the nocturnal TSH surge in 6 of 6. Among the 9 patients with normal TSH values in the morning, the nocturnal serum TSH surge was lost in 8 of 9, whereas the response to TRH was normal in all. The depressives, at variance with other reports, showed significantly lower values of total and free thyroid hormones. Mean serum sex hormone-binding globulin (SHBG) and ferritin were also significantly reduced. In conclusion, major endogenous depression is associated with a major impairment of TSH secretion, which baseline TSH measurements in the morning and the evaluation of the TSH response to TRH may not reveal. In this regard, the loss of the nocturnal serum TSH rise would appear to be a more sensitive indicator of hypothalamus-pituitary-thyroid axis alterations in depressives than the TRH test, which is commonly used in the evaluation of these patients. The lack of the nocturnal TSH surge may be responsible for the reduced thyroid hormone secretion and supports the case for some degree of central hypothyroidism in endogenous depression.
采用超敏检测法，对15名未经治疗的重度内源性抑郁症女性患者（年龄范围35 - 66岁，平均50岁）和15名健康女性（年龄范围32 - 67岁，平均53岁）的促甲状腺激素（TSH）分泌情况，尤其是该激素的夜间分泌高峰进行了评估。两组患者的早晨（08:30）TSH平均水平无差异（抑郁症患者为1.3±0.2 mU/L，对照组为1.4±0.1 mU/L），而抑郁症患者的夜间（24:00 - 02:00）平均水平显著降低（1.5±0.3对比3.1±0.3 mU/L；P < 0.0005）。与对照组不同，抑郁症患者的早晨和夜间TSH水平无差异。15例抑郁症患者中有14例夜间血清TSH分泌高峰消失。抑郁症患者促甲状腺激素释放激素（TRH）刺激后TSH的平均峰值略低但有显著差异。早晨TSH水平低于正常（< 0.4 mU/L）的患者中，6例中有5例TRH刺激后血清TSH升高不足2 mU/L，且6例均无夜间TSH分泌高峰。在早晨TSH水平正常的9例患者中，9例中有8例夜间血清TSH分泌高峰消失，而所有患者对TRH的反应均正常。与其他报道不同，抑郁症患者的总甲状腺激素和游离甲状腺激素水平显著降低。血清性激素结合球蛋白（SHBG）和铁蛋白的平均水平也显著降低。总之，重度内源性抑郁症与TSH分泌的严重受损有关，早晨的基础TSH测量值以及TSH对TRH反应的评估可能无法揭示这种情况。在这方面，夜间血清TSH升高的消失似乎是抑郁症患者下丘脑 - 垂体 - 甲状腺轴改变的一个比TRH试验更敏感的指标，TRH试验常用于评估这些患者。夜间TSH分泌高峰的缺失可能是甲状腺激素分泌减少的原因，并支持内源性抑郁症存在一定程度中枢性甲状腺功能减退的观点。
