Führer Dagmar, Brix Klaudia, Biebermann Heike
Department of Endocrinology and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Department of Life Sciences and Chemistry, Jacobs University Bremen, Bremen, Germany.
Eur Thyroid J. 2015 Sep;4(Suppl 1):1-8. doi: 10.1159/000431318. Epub 2015 May 27.
Thyroid hormones (TH) are of crucial importance for the physiological function of almost all organs. In cases of abnormal TH signaling, pathophysiological consequences may arise. The routine assessment of a healthy or diseased thyroid function state is currently based on the determination of serum concentrations of thyroid-stimulating hormone (TSH), and the TH T3 and T4. However, the definition of a 'normal' TSH range and similarly 'normal' T3 and T4 concentrations remains the subject of debate in different countries worldwide and has important implications on patient treatment in clinics. Not surprisingly, a significant number of patients whose thyroid function tests are biochemically determined to be within the normal range complain of impaired well-being. The reasons for this are so far not fully understood, but it has been recognized that thyroid function status needs to be 'individualized' and extended beyond simple TSH measurement. Thus, more precise and reliable parameters are required in order to optimally define the healthy thyroid status of an individual, and as a perspective to employ these in clinical routine. With the recent identification of new key players in TH action, a more accurate assessment of a patient's thyroid status may in the future become possible. Recently described distinct TH derivatives and metabolites, TH transporters, nongenomic TH effects (either through membrane-bound or cytosolic signaling), and classical nuclear TH action allow for insights into molecular and cellular preconditions of a healthy thyroid state. This will be a prerequisite to improve management of thyroid dysfunction, and additionally to prevent and target TH-related nonthyroid disease.
甲状腺激素（TH）对几乎所有器官的生理功能都至关重要。在TH信号异常的情况下，可能会出现病理生理后果。目前，对健康或患病甲状腺功能状态的常规评估基于甲状腺刺激激素（TSH）以及TH T3和T4的血清浓度测定。然而，“正常”TSH范围以及类似的“正常”T3和T4浓度的定义在全球不同国家仍然是一个有争议的话题，并且对临床患者治疗具有重要影响。毫不奇怪，大量甲状腺功能测试生化结果显示在正常范围内的患者抱怨健康状况受损。其原因目前尚未完全了解，但人们已经认识到甲状腺功能状态需要“个体化”，并且不能仅仅局限于简单的TSH测量。因此，需要更精确和可靠的参数来最佳地定义个体的健康甲状腺状态，并将其应用于临床常规。随着最近TH作用中新关键因素的发现，未来对患者甲状腺状态进行更准确的评估可能成为现实。最近描述的不同TH衍生物和代谢物、TH转运体、非基因组TH效应（通过膜结合或胞质信号传导）以及经典的核TH作用，有助于深入了解健康甲状腺状态的分子和细胞前提条件。这将是改善甲状腺功能障碍管理以及预防和针对TH相关非甲状腺疾病的先决条件。
