Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 01583, USA.
Curr Opin Endocrinol Diabetes Obes. 2013 Oct;20(5):478-84. doi: 10.1097/01.med.0000433069.09294.e8.
The current state of the pathophysiology, diagnosis, and therapeutic implications of the nonthyroidal illness syndrome is reviewed.
Previous studies attributed the development of the nonthyroidal illness syndrome to alterations in three main areas of thyroid hormone metabolism: deiodinase activity, thyroid-stimulating hormone secretion, and hormone binding to serum proteins. New studies suggest that alterations in thyroid hormone transport into tissues and alterations of the nuclear thyroid hormone receptors may also play a role. Therapy of the nonthyroidal illness syndrome remains a controversial topic.
Multiple factors lead to the development of the nonthyroidal illness syndrome, including alterations in type 1 and 3 deiodinase activity, thyrotropin-releasing hormone and thyroid-stimulating hormone secretion, hormone binding to plasma proteins, thyroid hormone transporter expression and activity, and the thyroid hormone nuclear receptor complex. These data show that acute and chronic illness affect all aspects of thyroid hormone metabolism and action. Some of these changes are physiologic and some are pharmacologic. The mediators of these alterations are still largely unclear. There continues to be no indication for thyroid hormone therapy in the vast majority of patients with the nonthyroidal illness syndrome, although interesting data suggest a possible role for treating a small subset of patients.
本文回顾了非甲状腺疾病综合征的病理生理学、诊断和治疗意义的现状。
先前的研究将非甲状腺疾病综合征的发展归因于甲状腺激素代谢的三个主要领域的变化：脱碘酶活性、促甲状腺激素分泌和激素与血清蛋白的结合。新的研究表明，甲状腺激素向组织内转运的改变以及核甲状腺激素受体的改变也可能起作用。非甲状腺疾病综合征的治疗仍然是一个有争议的话题。
多种因素导致非甲状腺疾病综合征的发生，包括 1 型和 3 型脱碘酶活性、促甲状腺激素释放激素和促甲状腺激素分泌、激素与血浆蛋白结合、甲状腺激素转运体的表达和活性以及甲状腺激素核受体复合物的改变。这些数据表明，急性和慢性疾病会影响甲状腺激素代谢和作用的各个方面。其中一些变化是生理性的，一些是药理学的。这些改变的介质在很大程度上仍不清楚。尽管有趣的数据表明，对一小部分患者可能有治疗作用，但绝大多数非甲状腺疾病综合征患者仍不需要甲状腺激素治疗。
