Mendel C M, Cavalieri R R
J Clin Endocrinol Metab. 1984 Jun;58(6):1117-24. doi: 10.1210/jcem-58-6-1117.
Red blood cell T4 concentrations (RBC T4) were measured in 15 normal subjects, 13 patients with hypo- or hyperthyroidism, and 10 patients with elevated or decreased serum thyroid hormone binding. In each case, RBC T4 was compared with the serum concentration of free T4 measured by equilibrium dialysis ( FT4D ). RBC T4 correlated significantly with FT4D in these subjects (r = 0.90; P less than 0.001). The normal range for RBC T4 was 0.27-0.83 ng/ml. RBC T4 was below the normal range in all 8 patients with hypothyroidism and above the normal range in all 5 patients with hyperthyroidism. It was within the normal range in all 4 subjects with absent or low T4-binding globulin (TBG) and in 5 of the 6 subjects with elevated TBG or familial dysalbuminemic hyperthyroxinemia. The sixth subject (increased TBG) had elevated RBC T4 and FT4D . RBC T4 was similarly measured in 10 patients with severe nonthyroid illness (NTI), 5 of whom had decreased serum concentrations of total T4. RBC T4 was normal in 8 of these patients, elevated in 1, and decreased in 1; in comparison, FT4D was normal in 4, elevated in 5, and decreased in 1. Eight patients receiving continuous iv infusions of heparin were also studied because of previously described similarities in the in vitro thyroid tests of heparin-treated and euthyroid sick patients. FT4D was elevated in 7 of the heparin-treated patients, whereas RBC T4 was elevated in only 2. Furthermore, for any given value of FT4D , RBC T4 was lower in heparin-treated patients than in normal subjects, indicating the presence of an inhibitor of cellular T4 binding in these patients. This putative inhibitor, demonstrated by an elevated FT4D to RBC T4 ratio, was present in 6 of the 8 heparin-treated patients and in 5 of the 10 patients with NTI. The findings of this study support the hypothesis that an inhibitor of cellular T4 binding is present in the serum of some patients with NTI and in most heparin-treated individuals.
对15名正常受试者、13名甲状腺功能减退或亢进患者以及10名血清甲状腺激素结合升高或降低的患者进行了红细胞T4浓度（RBC T4）测定。在每种情况下，将RBC T4与通过平衡透析测定的游离T4血清浓度（FT4D）进行比较。在这些受试者中，RBC T4与FT4D显著相关（r = 0.90；P < 0.001）。RBC T4的正常范围为0.27 - 0.83 ng/ml。所有8名甲状腺功能减退患者的RBC T4均低于正常范围，所有5名甲状腺功能亢进患者的RBC T4均高于正常范围。所有4名甲状腺素结合球蛋白（TBG）缺乏或降低的受试者以及6名TBG升高或家族性异常白蛋白血症性甲状腺素血症患者中的5名，其RBC T4均在正常范围内。第六名受试者（TBG升高）的RBC T4和FT4D升高。对10名患有严重非甲状腺疾病（NTI）的患者进行了类似的RBC T4测定，其中5名患者的血清总T4浓度降低。这些患者中8名的RBC T4正常，1名升高，1名降低；相比之下，4名患者的FT4D正常，5名升高，1名降低。还对8名接受肝素持续静脉输注的患者进行了研究，因为先前描述了肝素治疗患者和甲状腺功能正常的患病患者在体外甲状腺测试中的相似性。7名接受肝素治疗的患者的FT4D升高，而只有2名患者的RBC T4升高。此外，对于任何给定的FT4D值，肝素治疗患者的RBC T4低于正常受试者，表明这些患者存在细胞T4结合抑制剂。通过升高的FT4D与RBC T4比值证明，这种假定的抑制剂存在于8名接受肝素治疗的患者中的6名以及10名NTI患者中的5名。本研究结果支持以下假设：某些NTI患者的血清以及大多数接受肝素治疗的个体中存在细胞T4结合抑制剂。
