Vardarli I, Vardarli I, Schmidt R, Paschke R, Schaaf L, Scholte-Sautter B, Teuber J, Feldmann U, Usadel K H
II. Medizinische Klinik, Klinikum Mannheim der Universität Heidelberg.
Klin Wochenschr. 1989 May 15;67(10):543-50. doi: 10.1007/BF01719781.
In euthyroidism the circadian rhythm and pulsatility of TSH is well known. With regard to hyperthyroidism only very preliminary data were described. In this study we investigated the secretion pattern of the pituitary-thyroid axis hormones during 24 h in latent and overt hyperthyroidism and in euthyroidism with regard to common and different properties. Blood was obtained for 24 h at 10-min intervals. In euthyroidism we found intraindividually three overlapping patterns of TSH, which are different in amplitude and frequency and can be found interindividually, too. These patterns are equal to the circadian rhythm, pulsatile secretion and lastly to the methodic rustle. The circadian rhythm in latent hyperthyroidism is distinctly suppressed and in overt hyperthyroidism totally. Whereas in latent hyperthyroidism pulsatile secretion is extant, in overt hyperthyroidism the TSH pulses are absent. To record the patients' TSH circadian rhythm with only three blood samples, we defined the TSH-Triplex. In young as well as in elderly healthy volunteers it demonstrated significantly higher TSH levels at midnight (at 24:00 h) than it did at 4 p.m. and 8 a.m. The present study shows a significantly different TSH pattern in latent hyperthyroidism compared to euthyroidism. It should be discussed whether latent hyperthyroidism could be defined as hyperthyroidism stage I. On the other hand, latent hyperthyroidism could be an illness with its own cause, different from hyperthyroidism. Our data suggest that the laboratory findings of latent hyperthyroidism in each age are non-physiological. However, the cause for this disorder is unclear until now; hence further investigations are necessary.
在甲状腺功能正常状态下，促甲状腺激素（TSH）的昼夜节律和脉冲性是众所周知的。关于甲状腺功能亢进症，仅有非常初步的数据被描述。在本研究中，我们针对隐匿性和显性甲状腺功能亢进症以及甲状腺功能正常状态下垂体 - 甲状腺轴激素在24小时内的分泌模式，研究了其共同和不同的特性。每隔10分钟采集一次血液，持续24小时。在甲状腺功能正常状态下，我们发现个体内存在三种重叠的TSH模式，它们在幅度和频率上有所不同，并且在个体间也能发现。这些模式分别等同于昼夜节律、脉冲式分泌以及最后是方法性噪声。隐匿性甲状腺功能亢进症中的昼夜节律明显受到抑制，而在显性甲状腺功能亢进症中则完全被抑制。虽然在隐匿性甲状腺功能亢进症中脉冲式分泌仍然存在，但在显性甲状腺功能亢进症中TSH脉冲消失。为了仅通过三个血样记录患者的TSH昼夜节律，我们定义了TSH三联征。在年轻和老年健康志愿者中，它显示午夜（24:00时）的TSH水平显著高于下午4点和上午8点。本研究表明，与甲状腺功能正常状态相比，隐匿性甲状腺功能亢进症中的TSH模式存在显著差异。应该讨论隐匿性甲状腺功能亢进症是否可以被定义为甲状腺功能亢进症的I期。另一方面，隐匿性甲状腺功能亢进症可能是一种有其自身病因的疾病，与甲状腺功能亢进症不同。我们的数据表明，各年龄段隐匿性甲状腺功能亢进症的实验室检查结果均是非生理性的。然而，直到现在这种疾病的病因仍不清楚；因此有必要进行进一步的研究。
