Lum S M, Kaptein E M, Nicoloff J T
West J Med. 1983 May;138(5):670-5.
Severe intercurrent nonthyroidal illnesses (diabetic ketoacidosis, myocardial infarction, fulminant hepatitis and bacterial pneumonia) in four thyrotoxic patients were associated with depression of total serum thyroxine (T(4)) and triiodothyronine (T(3)) values into the normal or even subnormal range. A diagnosis of hyperthyroidism was established by a combination of elevated radioactive iodine uptake, absent thyroid-stimulating hormone response to thyrotropin-releasing hormone or an elevated free T(4) by dialysis values. In the two of four cases that had a fatal outcome, there was a progressive decline in total T(4) and total T(3) values. In contrast, the two surviving patients had a progressive increase of total T(3) and total T(4) values into the hyperthyroid range as their underlying illness resolved. As has been seen with severe nonthyroidal illnesses, pronounced depression of total T(3) and total T(4) levels in hyperthyroid patients may also portend a poor prognosis.
4例甲状腺毒症患者并发严重的非甲状腺疾病（糖尿病酮症酸中毒、心肌梗死、暴发性肝炎和细菌性肺炎），血清总甲状腺素（T4）和三碘甲状腺原氨酸（T3）值降至正常甚至低于正常范围。通过放射性碘摄取升高、促甲状腺激素对促甲状腺激素释放激素无反应或透析法测定游离T4升高相结合来确诊甲状腺功能亢进。在4例中有2例死亡，其血清总T4和总T3值呈进行性下降。相反，另外2例存活患者随着基础疾病的好转，血清总T3和总T4值逐渐升高至甲状腺功能亢进范围。正如在严重非甲状腺疾病中所见到的，甲状腺功能亢进患者血清总T3和总T4水平显著降低也可能预示预后不良。
