Batman Training and Research Hospital, Batman, Turkey.
Ankara Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey.
Endocrine. 2023 Dec;82(3):580-585. doi: 10.1007/s12020-023-03446-z. Epub 2023 Jul 25.
Thyroid-stimulating hormone (TSH) has a pulsatile and circadian rhythm in healthy individuals. We aimed to evaluate the diurnal changes of free thyroid hormones and serum TSH levels in patients with end-stage renal failure (ESRF) whose thyroidal functions are at normal ranges.
Thirty hemodialysis patients with chronic renal failure and without a known thyroidal disease who are over 18 and 35 healthy individuals were included. The serum TSH, free T3, and free T4 levels were examined among the patient and control group which were taken at 8:00 a.m., 4:00 p.m., and 0:00 a.m.
Twenty-two (73.3%) patients were male, and the mean age of the patient group was 64 (sd = 14.45 years). Seventeen (48.6%) of the control group were female, and the mean age was 31.9 (sd = 6.4 years). Serum free T3 levels, measured at three different time points (8:00 a.m., 4:00 p.m., and 0:00 a.m.), were significantly lower in the patient group than in the control group and serum free T4 levels were measured at three different time points (8:00 am, 4:00 p.m., and 0:00 a.m.) were significantly higher in the patient group than in the control group. Serum TSH levels were higher in the patient group than in the control group at 08:00, and were lower at 24:00 (p < 0.001). The nocturnal increase of serum TSH level under 0.525 suggested diurnal rhythm disruption with 83% sensitivity and 87% specificity.
The nocturnal serum TSH increase is not seen in ESRF patients who did not have a thyroid disease. We think that not observing a nocturnal TSH increase could be an early indication of the sick euthyroid syndrome.
健康个体的促甲状腺激素（TSH）具有脉冲和昼夜节律。我们旨在评估甲状腺功能正常的终末期肾衰竭（ESRF）患者游离甲状腺激素和血清 TSH 水平的昼夜变化。
纳入 30 名患有慢性肾衰竭且无已知甲状腺疾病的血液透析患者，年龄均在 18 岁以上，另外纳入 35 名健康个体作为对照组。分别在患者组和对照组中于上午 8:00、下午 4:00 和凌晨 0:00 检测血清 TSH、游离 T3 和游离 T4 水平。
22 名（73.3%）患者为男性，患者组的平均年龄为 64（标准差=14.45 岁）。对照组中 17 名（48.6%）为女性，平均年龄为 31.9（标准差=6.4 岁）。患者组在三个不同时间点（上午 8:00、下午 4:00 和凌晨 0:00）测量的血清游离 T3 水平明显低于对照组，而患者组在三个不同时间点（上午 8:00、下午 4:00 和凌晨 0:00）测量的血清游离 T4 水平明显高于对照组。上午 8:00 时患者组的血清 TSH 水平高于对照组，而 24:00 时则低于对照组（p<0.001）。血清 TSH 水平在 0.525 以下的夜间增加提示昼夜节律中断，其敏感性为 83%，特异性为 87%。
患有甲状腺疾病的 ESRF 患者没有观察到夜间血清 TSH 增加。我们认为，未观察到夜间 TSH 增加可能是病态甲状腺功能正常综合征的早期表现。
