Powner D J, Hendrich A, Lagler R G, Ng R H, Madden R L
Department of Medicine, Indiana University School of Medicine, Indianapolis.
Crit Care Med. 1990 Jul;18(7):702-8. doi: 10.1097/00003246-199007000-00004.
Thirty neurologically impaired (Glasgow Coma Score less than 7) patients were evaluated to determine if changes in serum levels of thyroid hormone, cortisol, insulin, or lactate suggest that replacement therapy is needed before removal of organs for donation. Serum levels of free thyroxine (fT4), thyroid-stimulating hormone (TSH), reverse T3 (rT3), cortisol, insulin, and lactate were monitored in 16 patients before and after brain death and in 14 additional patients who were similarly compromised but did not become brain dead. Low fT3, normal fT4, and normal or high rT3 as found in most patients were consistent with a variant of the euthyroid sick syndrome although TSH was elevated in some patients. Cortisol, insulin, and lactate levels were also normal or high. No correlation was found between low thyroid hormones and elevated lactate or the amount of vasopressor needed to sustain BP. No significant changes occurred in hormone or lactate levels after brain death. The explanation for an elevated lactate remains unclear but we do not believe this single finding justifies the diagnosis of a hypothyroid state in these patients or the administration of thyroid hormone to brain dead organ donors.
对30例神经功能受损（格拉斯哥昏迷评分低于7分）的患者进行评估，以确定甲状腺激素、皮质醇、胰岛素或乳酸盐的血清水平变化是否表明在为器官捐献而摘除器官之前需要进行替代治疗。在16例患者脑死亡前后监测其血清游离甲状腺素（fT4）、促甲状腺激素（TSH）、反三碘甲状腺原氨酸（rT3）、皮质醇、胰岛素和乳酸盐水平，并对另外14例同样病情但未发生脑死亡的患者进行监测。大多数患者出现的低fT3、正常fT4以及正常或高rT3与甲状腺功能正常的病态综合征的一种变体相符，尽管部分患者的TSH升高。皮质醇、胰岛素和乳酸盐水平也正常或升高。未发现甲状腺激素水平低与乳酸盐升高或维持血压所需血管升压药的用量之间存在相关性。脑死亡后激素或乳酸盐水平未发生显著变化。乳酸盐升高的原因尚不清楚，但我们认为这一单一发现不足以诊断这些患者为甲状腺功能减退状态，也不足以给脑死亡的器官捐献者使用甲状腺激素。
