Ladenson P W, Goldenheim P D, Ridgway E C
Thyroid Unit, Massachusetts General Hospital, Boston.
Am J Med. 1988 May;84(5):877-83. doi: 10.1016/0002-9343(88)90066-6.
To define the prevalence of impaired ventilatory responses in hypothyroidism, clinical and chemical parameters predicting their presence, and the potential for their acute reversal, ventilatory responses to hypercapnia and hypoxia were studied in 38 hypothyroid patients before treatment, and after short-term (seven days) and long-term (12 to 24 weeks) thyroid hormone therapy. Before treatment, hypercapnic ventilatory responses were blunted in 10 of 29 patients (34 percent), whereas hypoxic ventilatory responses were abnormal in eight of 30 patients (27 percent). Hypothyroid women and patients with marked pretreatment elevation of the serum thyrotropin concentration (greater than 90 mU/liter) were significantly more likely to have impaired ventilatory responses. In patients with an abnormal pretreatment response, parenteral thyroid hormone therapy (25 to 50 micrograms of L-triiodothyronine or 100 micrograms of L-thyroxine per day for seven days) significantly enhanced hypercapnic (0.75 +/- 0.06 to 1.19 +/- 0.16 liters/minute/mm Hg, p less than 0.05) and hypoxic (93 +/- 12 to 176 +/- 31 liters.mm Hg/minute, p less than 0.05) ventilatory responsiveness acutely. In seven of nine patients with abnormal pretreatment hypercapnic responses, and six of eight patients with abnormal hypoxic responses, normal ventilatory responsiveness was restored after one week of therapy. It is concluded that: (1) a subset of hypothyroid patients have blunted ventilatory responses to hypercapnia and/or hypoxia; (2) hypothyroid women and patients with a serum thyrotropin greater than 90 mU/liter more often manifest this abnormality; and (3) thyroid hormone therapy for one week reverses impaired ventilatory responses in hypothyroidism.
为明确甲状腺功能减退症患者通气反应受损的患病率、预测其存在的临床和化学参数以及急性逆转的可能性，我们对38例甲状腺功能减退症患者在治疗前、短期（7天）和长期（12至24周）甲状腺激素治疗后对高碳酸血症和低氧血症的通气反应进行了研究。治疗前，29例患者中有10例（34%）的高碳酸通气反应减弱，而30例患者中有8例（27%）的低氧通气反应异常。甲状腺功能减退的女性以及血清促甲状腺素浓度预处理时显著升高（大于90 mU/升）的患者通气反应受损的可能性明显更高。在预处理反应异常的患者中，胃肠外甲状腺激素治疗（每天25至50微克的左旋三碘甲状腺原氨酸或100微克的左旋甲状腺素，共7天）可显著急性增强高碳酸（从0.75±0.06升至1.19±0.16升/分钟/毫米汞柱，p<0.05）和低氧（从93±12升至176±31升·毫米汞柱/分钟，p<0.05）通气反应性。在9例预处理高碳酸反应异常的患者中有7例，8例预处理低氧反应异常的患者中有6例，在治疗1周后通气反应恢复正常。结论如下：（1）一部分甲状腺功能减退症患者对高碳酸血症和/或低氧血症的通气反应减弱；（2）甲状腺功能减退的女性以及血清促甲状腺素大于90 mU/升的患者更常表现出这种异常；（3）甲状腺激素治疗1周可逆转甲状腺功能减退症患者受损的通气反应。
