Kokei S, Inoue T, Iino S
Nihon Naibunpi Gakkai Zasshi. 1986 Nov 20;62(11):1231-43. doi: 10.1507/endocrine1927.62.11_1231.
The change in the levels of free thyroid hormones and the pathophysiology of the hypothalamo-pituitary-thyroid axis of patients with nonthyroidal illness (NTI) have not been clearly elucidated so far. Therefore, it was thought of interest to investigate this problem by determining free thyroid hormones and TSH in serum and the response of TSH to TRH in these patients. The subjects employed in this study were 71 cases with hemodialysis, 40 cases with diabetes mellitus, 24 cases with liver cirrhosis, 12 cases with various cancers, 10 cases with anorexia nervosa and 110 normal subjects as controls. The serum total protein, albumin, free T4, free T3, TSH and other parameters of thyroid function were determined, and the TRH test was performed on about 10 patients of each group. Serum TSH was not only determined by a conventional assay system, but with a highly sensitive method, and the data were compared with one another. It was found that the serum free T3 levels were significantly low in all the groups investigated, but the serum free T4 levels were significantly low only in the groups with hemodialysis, decompensated liver cirrhosis, cancers and anorexia nervosa. No significant lowering of serum free T4 was observed in the patients with diabetes mellitus, acute hepatitis and compensated liver cirrhosis. However, serum TSH levels tended to be higher in all the groups studied, though they were not significant. The response of TSH to TRH was low or delayed in about 20-50% of patients with hemodialysis, diabetes mellitus, liver cirrhosis, cancers and anorexia nervosa. It was observed that the serum rT3 concentration was significantly high in the patients with diabetes mellitus and anorexia nervosa but significantly low in the patients on hemodialysis. In the rest of the groups, there were found many cases who showed high levels of serum rT3 although they were not statistically significant. These results indicate that low concentrations of serum free T3 observed in the majority of the patients with severe NTI were, at least in part, due to the decrease in the peripheral conversion of T4 to T3 and the lowered sensitivity of the anterior pituitary to thyroid hormones and TRH.
非甲状腺疾病（NTI）患者游离甲状腺激素水平的变化以及下丘脑 - 垂体 - 甲状腺轴的病理生理学至今尚未完全阐明。因此，通过测定这些患者血清中的游离甲状腺激素和促甲状腺激素（TSH）以及TSH对促甲状腺激素释放激素（TRH）的反应来研究这个问题被认为是有意义的。本研究采用的对象为71例血液透析患者、40例糖尿病患者、24例肝硬化患者、12例各种癌症患者、10例神经性厌食症患者以及110名正常受试者作为对照。测定了血清总蛋白、白蛋白、游离T4、游离T3、TSH以及其他甲状腺功能参数，并对每组约10例患者进行了TRH试验。血清TSH不仅通过传统检测系统测定，还采用了高灵敏度方法，对数据进行了相互比较。结果发现，在所研究的所有组中血清游离T3水平均显著降低，但仅在血液透析组、失代偿期肝硬化组、癌症组和神经性厌食症组中血清游离T4水平显著降低。在糖尿病患者、急性肝炎患者和代偿期肝硬化患者中未观察到血清游离T4有显著降低。然而，尽管不显著，但在所研究的所有组中血清TSH水平均有升高趋势。在血液透析、糖尿病、肝硬化、癌症和神经性厌食症患者中，约20% - 50%的患者TSH对TRH的反应较低或延迟。观察到糖尿病患者和神经性厌食症患者血清反T3（rT3）浓度显著升高，而血液透析患者血清rT3浓度显著降低。在其他组中，发现许多患者血清rT3水平较高，尽管无统计学意义。这些结果表明，在大多数严重NTI患者中观察到的血清游离T3浓度降低，至少部分是由于T4向T3的外周转化率降低以及垂体前叶对甲状腺激素和TRH的敏感性降低所致。
