Adriaanse R, Romijn J A, Brabant G, Endert E, Wiersinga W M
Department of Endocrinology, Academic Medical Center, University of Amsterdam, The Netherlands.
J Clin Endocrinol Metab. 1993 Nov;77(5):1313-7. doi: 10.1210/jcem.77.5.8077326.
Pulsatile and nocturnal TSH secretion was investigated in 16 healthy controls (group A) and 21 patients with nonthyroidal illness (NTI; group B). Ten patients had normal plasma T3 and T4 values (group B1), and 11 patients had decreased plasma T3 with normal or low plasma T4 (group B2). Mean 24-h TSH secretion in NTI patients was higher than that in controls (3.1 +/- 0.7 vs. 1.7 +/- 0.7 mU/L; P < 0.01; mean +/- SD). This was associated with an increased TSH pulse amplitude in NTI patients relative to controls [Desade, 0.79 +/- 0.46 vs. 0.44 +/- 0.20 mU/L (P < 0.01); Cluster, 0.64 +/- 0.42 vs. 0.39 +/- 0.20 mU/L (P < 0.05)]. There was no difference in TSH pulse amplitude between subgroups B1 and B2. TSH pulse frequency was not different between NTI patients and controls (approximately 10 pulses/24 h). The mean 24-h TSH concentration was significantly related to the mean 24-h TSH pulse amplitude but not to the mean 24-h TSH pulse frequency. The absolute nocturnal TSH surge in NTI patients was lower than that in controls (0.6 +/- 0.6 vs. 1.0 +/- 0.6 mU/L; P < 0.05). The lower nocturnal TSH surge in patients with decreased plasma T3 (group B2) was associated with a loss of the usual nocturnal increase of TSH pulse amplitude; the usual nocturnal increase in TSH pulse frequency was preserved. This was also observed in the six patients (two in group B1 and four in group B2) in whom the nocturnal TSH surge was completely absent. The changes in nocturnal TSH secretion in NTI resemble those found in central hypothyroidism, suggesting that features of central hypothyroidism are involved in the euthyroid sick syndrome.
对16名健康对照者（A组）和21名非甲状腺疾病（NTI；B组）患者的促甲状腺激素（TSH）脉冲式及夜间分泌情况进行了研究。10名患者血浆三碘甲状腺原氨酸（T3）和甲状腺素（T4）值正常（B1组），11名患者血浆T3降低而血浆T4正常或降低（B2组）。NTI患者的24小时平均TSH分泌高于对照组（3.1±0.7 vs. 1.7±0.7 mU/L；P<0.01；均值±标准差）。这与NTI患者相对于对照组TSH脉冲幅度增加有关[德萨德，0.79±0.46 vs. 0.44±0.20 mU/L（P<0.01）；聚类，0.64±0.42 vs. 0.39±0.20 mU/L（P<0.05）]。B1组和B2组亚组之间的TSH脉冲幅度无差异。NTI患者和对照组之间的TSH脉冲频率无差异（约10次脉冲/24小时）。24小时平均TSH浓度与平均TSH脉冲幅度显著相关，但与平均24小时TSH脉冲频率无关。NTI患者夜间TSH的绝对峰值低于对照组（0.6±0.6 vs. 1.0±0.6 mU/L；P<0.05）。血浆T3降低患者（B2组）夜间TSH峰值较低与TSH脉冲幅度夜间通常的增加丧失有关；TSH脉冲频率夜间通常的增加得以保留。在6名夜间TSH峰值完全缺失的患者（2名在B1组，4名在B2组）中也观察到了这一情况。NTI患者夜间TSH分泌的变化类似于中枢性甲状腺功能减退症患者的变化，提示中枢性甲状腺功能减退症的特征参与了正常甲状腺病态综合征。
