Baumgartner A, Rommelspacher H, Otto M, Schmidt L G, Kürten I, Gräf K J, Campos-Barros A, Platz W
Department of Psychiatry, Klinikum Rudolf Virchow, Berlin, Germany.
Alcohol Clin Exp Res. 1994 Apr;18(2):284-94. doi: 10.1111/j.1530-0277.1994.tb00016.x.
Thyroxine (T4), free T4 (fT4), triiodothyronine (T3), free T3 (fT3), reverse T3 (rT3), thyrotropin (TSH), thyroxine binding globulin (TBG), and T3 uptake were measured in 14 chronic alcoholics during withdrawal and after 21 days of abstinence. Results were compared with those of 16 healthy volunteers. During withdrawal, the fT4 and fT3 concentrations were subnormal, whereas the respective protein-bound fractions were normal. T4, T3, and TBG increased during the abstinence period, T3 and TBG being significantly higher than in normals at the second measuring time. T3 uptake values fell, but remained well within the normal range at both measuring times. During abstinence, the fT3 levels remained significantly lower than in healthy subjects. rT3 concentrations decreased, but not significantly. The TSH values were normal throughout. These results showed numerous abnormalities in the hypothalamic-pituitary-thyroid axis in alcoholics, the reasons for which are as yet unclear. The following possible interpretations are suggested: 1. The abnormally low serum fT3 and fT4 levels during withdrawal might reflect an increase in tissue uptake. 2. The increases in T4--and partly those in T3--during abstinence seem to reflect increased binding by TBG, the level of which rose markedly for reasons as yet unknown. 3. If increases in TBG during abstinence are taken into account, the decreases in rT3 concentrations may reach the level of statistical significance. These falls in rT3 concentrations may reflect an increase in rT3 metabolization (deiodination) in various tissues, including the CNS, leading to a reduction in serum rT3 bioavailability. 4. Factors such as liver disease, protein caloric malnutrition, and "psychological stress" do not fully explain all these abnormalities. A direct effect of ethanol on intracellular thyroid hormone metabolism and/or function seems conceivable.
在14名慢性酒精中毒者戒断期间及禁欲21天后，测定了甲状腺素（T4）、游离T4（fT4）、三碘甲状腺原氨酸（T3）、游离T3（fT3）、反T3（rT3）、促甲状腺激素（TSH）、甲状腺素结合球蛋白（TBG）以及T3摄取量。将结果与16名健康志愿者的结果进行了比较。戒断期间，fT4和fT3浓度低于正常水平，而各自的蛋白结合部分正常。禁欲期间，T4、T3和TBG升高，在第二次测量时，T3和TBG显著高于正常水平。T3摄取值下降，但在两个测量时间均保持在正常范围内。禁欲期间，fT3水平仍显著低于健康受试者。rT3浓度下降，但不显著。TSH值始终正常。这些结果表明酒精中毒者下丘脑 - 垂体 - 甲状腺轴存在许多异常，其原因尚不清楚。提出以下几种可能的解释：1. 戒断期间血清fT3和fT4水平异常低可能反映组织摄取增加。2. 禁欲期间T4以及部分T3的升高似乎反映了TBG结合增加，其水平因未知原因显著升高。3. 如果考虑禁欲期间TBG的增加，rT3浓度的下降可能达到统计学显著水平。rT3浓度的这些下降可能反映包括中枢神经系统在内的各种组织中rT3代谢（脱碘）增加，导致血清rT3生物利用度降低。4. 诸如肝病、蛋白质热量营养不良和“心理压力”等因素不能完全解释所有这些异常。乙醇对细胞内甲状腺激素代谢和/或功能的直接影响似乎是可以想象的。
