Wolf E, Eisenstein A B
Endocrinology. 1981 Jun;108(6):2109-13. doi: 10.1210/endo-108-6-2109.
Decreased glucose tolerance in hyperthyroidism has been long recognized; however, the mechanism(s) responsible for altered carbohydrate metabolism have not been elucidated. Studies of insulin secretion in hyperthyroidism have been reported by several investigators; however, the results are not conclusive since hormone secretion has been reported as increased, normal, or decreased. Few investigations of glucagon secretion in hyperthyroidism have been described; thus, the role of the alpha cell hormone in the glucose intolerance associated with thyrotoxicosis has not been established. To clarify these matters, experimental hyperthyroidism was induced in male rats by injecting T4 ip for 9 days. On the 10th day, blood was collected from the portal vein for measurement of insulin and glucagon. Animals injected with T4 (500 microgram/kg . day) became clearly thyrotoxic as evidenced by elevated plasma T4 and T3 and diminished weight gain. Rats receiving 750 micrograms T4/kg demonstrated marked enhancement of pancreatic insulin and glucagon release as evidence by elevated portal vein hormone values. Plasma insulin and glucagon in T4-treated rats were substantially elevated regardless of whether the animals were fed or were fasted for 20 h before blood samples were obtained. Insulin and glucagon in vena cava blood were far lower than in the portal vein in both control and hyperthyroid rats, and there was no significant difference between the two groups. We believe that portal vein hormone concentrations more accurately reflect insulin and glucagon secretion than do peripheral blood levels because the hormones and partially degraded in the liver. It is postulated that elevated T4 stimulates the alpha cell to release excess amounts of glucagon, which enhances hepatic glucose output. The possible increase in hepatic glucose output plus insulin resistance, which is characteristic of hyperthyroidism, may account for a secondary rise in insulin release.
甲状腺功能亢进症患者葡萄糖耐量降低早已为人所知;然而,导致碳水化合物代谢改变的机制尚未阐明。几位研究者报告了对甲状腺功能亢进症患者胰岛素分泌的研究;然而,结果并不确凿,因为激素分泌有增加、正常或减少的报告。关于甲状腺功能亢进症患者胰高血糖素分泌的研究描述很少;因此,α细胞激素在甲状腺毒症相关的葡萄糖不耐受中的作用尚未确定。为了阐明这些问题,通过腹腔注射T4 9天诱导雄性大鼠实验性甲状腺功能亢进。在第10天,从门静脉采集血液以测量胰岛素和胰高血糖素。注射T4(500微克/千克·天)的动物明显出现甲状腺毒症,表现为血浆T4和T3升高以及体重增加减少。接受750微克T4/千克的大鼠门静脉激素值升高,表明胰腺胰岛素和胰高血糖素释放显著增强。无论动物在采血前是喂食还是禁食20小时,T4处理大鼠的血浆胰岛素和胰高血糖素均显著升高。在对照大鼠和甲状腺功能亢进大鼠中,腔静脉血中的胰岛素和胰高血糖素远低于门静脉血中的水平,两组之间无显著差异。我们认为,门静脉激素浓度比外周血水平更准确地反映胰岛素和胰高血糖素的分泌,因为这些激素在肝脏中会部分降解。据推测,升高的T4刺激α细胞释放过量的胰高血糖素,从而增加肝脏葡萄糖输出。肝脏葡萄糖输出可能增加,加上甲状腺功能亢进症特有的胰岛素抵抗,可能导致胰岛素释放继发性增加。