Roca R P, Blackman M R, Ackerley M B, Harman S M, Gregerman R I
Department of Psychiatry, Francis Scott Key Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224.
Endocr Res. 1990;16(4):415-47. doi: 10.1080/07435809009107116.
Acute psychiatric illness may be accompanied by transient hyperthyroxinemia. The mechanism of this phenomenon was examined by determining the role of thyrotropin (TSH) in the genesis of this state. Serial measurements of TSH, thyroxine (T4), free T4 index (FT4I), triiodothyronine (T3), and free T3 index (FT3I) were performed in 45 acutely hospitalized patients with major psychiatric disorders. Twenty-two (49%) patients exhibited significant elevations (greater than or equal to 2 SD above mean value of controls) of one or more thyroid hormone (or index) levels. Among depressed patients with elevated FT4I, TSH was higher (p less than .05) on the day of the peak FT4I than on the day of the FT4I nadir. There were significant positive correlations between psychiatric symptom severity and levels of FT4I among both depressed (p less than .01) and schizophrenic (p less than .025) patients. These data show that elevations of T4, FT4I, T3, and FT3I are common among psychiatric inpatients, especially early in their hospitalization, and that levels of thyroid hormones are correlated with severity of psychiatric symptomatology. TSH is higher early in the acute phase of illness and is not suppressed in the face of elevated thyroid hormone levels, a finding that distinguishes this phenomenon from ordinary hyperthyroidism. Elevations of peripheral thyroid hormone levels, particularly among depressed patients, may result from a centrally-mediated hypersecretion of TSH.
急性精神疾病可能伴有短暂性高甲状腺素血症。通过确定促甲状腺激素（TSH）在这种状态发生过程中的作用，对这一现象的机制进行了研究。对45例因重度精神障碍而急性住院的患者进行了TSH、甲状腺素（T4）、游离T4指数（FT4I）、三碘甲状腺原氨酸（T3）和游离T3指数（FT3I）的系列测量。22例（49%）患者出现一种或多种甲状腺激素（或指数）水平显著升高（高于对照组平均值2个标准差或更高）。在FT4I升高的抑郁症患者中，TSH在FT4I峰值日高于FT4I最低点日（p<0.05）。在抑郁症患者（p<0.01）和精神分裂症患者（p<0.025）中，精神症状严重程度与FT4I水平之间均存在显著正相关。这些数据表明，T4、FT4I、T3和FT3I升高在精神科住院患者中很常见，尤其是在住院早期，而且甲状腺激素水平与精神症状的严重程度相关。TSH在疾病急性期早期较高，且在甲状腺激素水平升高时未被抑制，这一发现将这种现象与普通甲亢区分开来。外周甲状腺激素水平升高，尤其是在抑郁症患者中，可能是由TSH的中枢介导性分泌过多所致。
