Grün R, Kaffarnik H
Klin Wochenschr. 1985 Aug 16;63(16):752-61. doi: 10.1007/BF01733827.
Basal thyroid hormone levels were measured in 68 women with liver cirrhosis (LC) of different etiology (alcoholic n = 34, posthepatitic B n = 9, PBC n = 5, cryptogenetic n = 18, M. Wilson n = 2). In addition the rise of TSH after 400 micrograms TRH was measured in 23 women with LC and compared with the data obtained from 17 women of a control group. There was no difference of the median T4-concentrations (LC 8.0 micrograms/dl versus 7.2 micrograms/dl) but a significant correlation of T4 to the grade of decompensation of LC. In contrast of T4 there was a marked decrease of T3 in LC-patients (109 ng/dl versus 143 ng/dl) and a rise of reverse T3 (0.21 ng/ml versus 0.13 ng/ml). The decrease of T3 and rise of reverse T3 equally correlated to the severeness of LC. TBG concentrations fell according to the grade of decompensation of LC and T4/TBG-quotient exhibited no difference to the control data (0.51 both). Though basal thyroid hormones and TSH show euthyroidism the significant augmented TSH release after TRH (delta-TSH 7.0 versus 3.2 microU/ml) indicate a status of latent hypothyroidism. In alcoholic cirrhosis the degree of TSH release was much higher than in non alcoholic cirrhosis. Estradiol and estrone levels correlated significantly negatively to T4, T3, estrone negatively to TBG and positively to reverse T3 but not to TSH and TSH release. Otherwise TSH release correlated positively to estradiol. The thyroid status in women with liver cirrhosis does not differ from the thyroid hormone profile found in men with cirrhosis.
对68例不同病因的肝硬化(LC)女性患者(酒精性肝硬化34例,乙型肝炎后肝硬化9例,原发性胆汁性肝硬化5例,隐源性肝硬化18例,威尔逊病2例)测定了基础甲状腺激素水平。此外,对23例肝硬化女性患者测定了400微克促甲状腺激素释放激素(TRH)后促甲状腺激素(TSH)的升高情况,并与17例对照组女性的数据进行了比较。LC患者的T4中位数浓度(8.0微克/分升对7.2微克/分升)无差异,但T4与LC失代偿程度显著相关。与T4相反,LC患者的T3显著降低(109纳克/分升对143纳克/分升),而反T3升高(0.21纳克/毫升对0.13纳克/毫升)。T3降低和反T3升高均与LC的严重程度相关。甲状腺素结合球蛋白(TBG)浓度随LC失代偿程度下降,T4/TBG比值与对照数据无差异(均为0.51)。尽管基础甲状腺激素和TSH显示甲状腺功能正常,但TRH后TSH释放显著增加(△TSH为7.0对3.2微单位/毫升)表明存在潜在甲状腺功能减退状态。在酒精性肝硬化中,TSH释放程度远高于非酒精性肝硬化。雌二醇和雌酮水平与T4、T3显著负相关,雌酮与TBG负相关,与反T3正相关,但与TSH及TSH释放无关。此外,TSH释放与雌二醇正相关。肝硬化女性的甲状腺状态与肝硬化男性的甲状腺激素谱无差异。