Bartalena L, Martino E, Brandi L S, Falcone M, Pacchiarotti A, Ricci C, Bogazzi F, Grasso L, Mammoli C, Pinchera A
Istituto di Endocrinologia, University of Pisa, Italy.
J Clin Endocrinol Metab. 1990 Jan;70(1):293-6. doi: 10.1210/jcem-70-1-293.
The effects of surgery on TSH secretion, with particular regard to the nocturnal TSH surge, were evaluated in 10 consecutive patients followed for 6 days after surgery. Surgical trauma was associated in all patients with significant decreases in serum total and free T3 and a significant increase in serum rT3 levels, with no variations in serum total and free T4 concentrations. A marked increase in serum cortisol levels was observed, with higher values at night than in the morning. Serum cortisol levels and circadian rhythm normalized on the fifth day. Serum TSH values in the morning significantly decreased on the first day after surgery and returned to normal on the second day. Serum TSH values at night (2400-0200 h) were higher than in the morning preoperatively, but the nocturnal surge was abolished from days 1-5 after surgery and was restored only on the sixth day. Thus, surgery was associated with a prolonged loss of the nocturnal serum TSH surge. This effect on TSH secretion was more marked than predictable on the basis of serum TSH measurements in the morning alone. An inverse relationship was found between serum cortisol and serum TSH values at night, suggesting that the excessive endogenous cortisol secretion might play a role in the derangement of TSH secretion.
对10例连续患者在术后随访6天，评估手术对促甲状腺激素（TSH）分泌的影响，尤其关注夜间TSH激增情况。所有患者的手术创伤均伴有血清总T3和游离T3显著降低以及血清反T3（rT3）水平显著升高，而血清总T4和游离T4浓度无变化。观察到血清皮质醇水平显著升高，夜间值高于早晨。血清皮质醇水平及其昼夜节律在术后第5天恢复正常。术后第1天早晨血清TSH值显著降低，第2天恢复正常。术前夜间（24:00 - 02:00）血清TSH值高于早晨，但术后第1 - 5天夜间激增消失，仅在第6天恢复。因此，手术与夜间血清TSH激增的长期丧失有关。这种对TSH分泌的影响比仅根据早晨血清TSH测量所预测的更为明显。发现夜间血清皮质醇与血清TSH值之间呈负相关，提示内源性皮质醇分泌过多可能在TSH分泌紊乱中起作用。
