Ohyama T, Nakai A, Nagasaka A, Aono T, Masunaga R, Nakagawa H, Kataoka K, Ohtani S, Shinoda S, Iwase K
Nihon Naibunpi Gakkai Zasshi. 1987 Jan 20;63(1):19-25. doi: 10.1507/endocrine1927.63.1_19.
It has been reported that there is a decrease in the serum concentration of thyroid hormones in non-thyroidal illness. In the present study we made serial measurements of serum concentration of thyroid hormones [triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), reverse triiodothyronine (rT3)], thyroid stimulating hormone (TSH) and thyroxine binding globulin (TBG) in 10 patients with acute myocardial infarction (AMI, Grade I, according to the classification of Killip & Forrester) during 14 days after onset. In the early phase of AMI, serum T3, T4, FT3 and FT4 levels decreased while rT3 increased. TSH and TBG levels, however, were unchanged. In the patients with a high peak creatine phosphokinase activity (greater than or equal to 400 mU/ml), the decrease in thyroid hormone and increase in serum rT3 levels were greater than in patients with a low peak value (less than 400 mU/ml), suggesting a correlation between severity of AMI and changes in serum thyroid hormone levels. Especially, serum FT3 levels fell below the lower limit of controls within 14 days, with the lowest levels and the rT3 peak on the third day after onset. These data suggest that in AMI peripheral conversion of T4 favours rT3 production and that low levels of serum FT3 and T3 protect the infarcted heart muscle against thyroid hormone action.
据报道，在非甲状腺疾病中血清甲状腺激素浓度会降低。在本研究中，我们对10例急性心肌梗死患者（根据Killip和Forrester分类为I级）发病后14天内的血清甲状腺激素[三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、反三碘甲状腺原氨酸（rT3）]、促甲状腺激素（TSH）和甲状腺素结合球蛋白（TBG）进行了连续测量。在急性心肌梗死的早期，血清T3、T4、FT3和FT4水平降低，而rT3升高。然而，TSH和TBG水平未发生变化。肌酸磷酸激酶活性峰值较高（大于或等于400 mU/ml）的患者，甲状腺激素的降低和血清rT3水平的升高比峰值较低（小于400 mU/ml）的患者更明显，这表明急性心肌梗死的严重程度与血清甲状腺激素水平的变化之间存在相关性。特别是，血清FT3水平在14天内降至对照组下限以下，在发病后第三天达到最低水平和rT3峰值。这些数据表明，在急性心肌梗死中，T4的外周转化有利于rT3的产生，血清FT3和T3水平较低可保护梗死心肌免受甲状腺激素作用。
