Somppi Taija Liisa
Amplia Clinic, Medical Center, Tampere, Finland.
Front Immunol. 2017 Aug 7;8:919. doi: 10.3389/fimmu.2017.00919. eCollection 2017.
Long-term exposure to dampness microbiota induces multi-organ morbidity. One of the symptoms related to this disorder is non-thyroidal illness syndrome (NTIS). A retrospective study was carried out in nine patients with a history of mold exposure, experiencing chronic fatigue, cognitive disorder, and different kinds of hypothyroid symptoms despite provision of levothyroxine (3,5,3',5'-tetraiodothyronine, LT4) monotherapy. Exposure to volatile organic compounds present in water-damaged buildings including metabolic products of toxigenic fungi and mold-derived inflammatory agents can lead to a deficiency or imbalance of many hormones, such as active T3 hormone. Since the 1970s, the synthetic prohormone, levothyroxine (LT4), has been the most commonly prescribed thyroid hormone in replacement monotherapy. It has been presumed that the peripheral conversion of T4 (3,5,3',5'-tetraiodothyronine) into T3 (3,5,3'-triiodothyronine) is sufficient to satisfy the overall tissue requirements. However, evidence is presented that this not the case for all patients, especially those exposed to indoor air molds. This retrospective study describes the successful treatment of nine patients in whom NTIS was treated with T3-based thyroid hormone. The treatment was based on careful interview, clinical monitoring, and laboratory analysis of serum free T3 (FT3), reverse T3 (rT3) and thyroid-stimulating hormone, free T4, cortisol, and dehydroepiandrosterone (DHEA) values. The ratio of FT3/rT3 was calculated. In addition, some patients received adrenal support with hydrocortisone and DHEA. All patients received nutritional supplementation and dietary instructions. During the therapy, all nine patients reported improvements in all of the symptom groups. Those who had residual symptoms during T3-based therapy remained exposed to indoor air molds in their work places. Four patients were unable to work and had been on disability leave for a long time during LT4 monotherapy. However, during the T3-based and supportive therapy, all patients returned to work in so-called "healthy" buildings. The importance of avoiding mycotoxin exposure the diet is underlined as DIO2 genetic polymorphism and dysfunction of DIO2 play an important role in the development of symptoms that can be treated successfully with T3 therapy.
长期暴露于潮湿环境中的微生物群体会引发多器官疾病。与这种疾病相关的症状之一是非甲状腺疾病综合征（NTIS）。对9名有霉菌接触史的患者进行了一项回顾性研究，这些患者尽管接受了左甲状腺素（3,5,3',5'-四碘甲状腺原氨酸，LT4）单一疗法，但仍患有慢性疲劳、认知障碍和各种甲状腺功能减退症状。接触受水损坏建筑物中存在的挥发性有机化合物，包括产毒真菌的代谢产物和霉菌衍生的炎症介质，可导致多种激素缺乏或失衡，如活性T3激素。自20世纪70年代以来，合成前体激素左甲状腺素（LT4）一直是替代单一疗法中最常用的甲状腺激素。据推测，T4（3,5,3',5'-四碘甲状腺原氨酸）向T3（3,5,3'-三碘甲状腺原氨酸）的外周转化足以满足整体组织需求。然而，有证据表明并非所有患者都是如此，尤其是那些接触室内空气霉菌的患者。这项回顾性研究描述了9例NTIS患者采用基于T3的甲状腺激素成功治疗的情况。治疗基于仔细的问诊、临床监测以及对血清游离T3（FT3）、反T3（rT3）、促甲状腺激素、游离T4、皮质醇和脱氢表雄酮（DHEA）值的实验室分析。计算FT3/rT3的比值。此外，一些患者接受了氢化可的松和DHEA的肾上腺支持治疗。所有患者都接受了营养补充和饮食指导。在治疗期间，所有9名患者报告所有症状组均有改善。那些在基于T3的治疗期间仍有残留症状的患者在工作场所仍暴露于室内空气霉菌中。4名患者在LT4单一疗法期间无法工作并长期请病假。然而，在基于T3的支持性治疗期间，所有患者都回到了所谓“健康”的建筑物中工作。强调了在饮食中避免接触霉菌毒素的重要性，因为DIO2基因多态性和DIO2功能障碍在可通过T3疗法成功治疗的症状发展中起重要作用。
