Facktor M A, Mayor G H, Nachreiner R F, D'Alecy L G
Department of Physiology, University of Michigan Medical School, Ann Arbor 48109.
Resuscitation. 1993 Oct;26(2):141-62. doi: 10.1016/0300-9572(93)90174-o.
Circulating concentrations of thyroxine (T4), triiodothyronine (T3), and reverse triiodothyronine (rT3) were followed in dogs subjected to 9 min of normothermic ventricular fibrillation. Significant decreases were detected 12 h post-arrest when compared to pre-arrest levels in total T4 (P < 0.0005), free T4 (P < 0.0005), total T3 (P < 0.003), and free T3 (P < 0.003), and levels of reverse T3 were significantly elevated (P = 0.0001). Similar changes occurred with only 30 s of arrest. Post-arrest replacement therapy with 7.5 micrograms/kg per h (Rx-7.5) and 15 micrograms/kg per h (Rx-15) levothyroxine sodium (L-T4) increased total T4, free T4, and total T3 (P < 0.01). Free T3 decreased in the Rx-7.5 group (P < 0.01) and did not fall in the Rx-15 group (P = 0.16). Reverse T3 increased with either treatment (P < 0.005). Both treatment groups had higher levels of all five hormones than non-treated animals (P < 0.001). Neurologic function, assessed with a standardized scoring system, showed significant improvement in the treated groups by 6 h (P < 0.05, compared to non-treated group) and remained significant through 24 h post-arrest (P < 0.05). The documentation of rapid and dramatic changes in thyroid hormones immediately following cardiac arrest and resuscitation indicates a significant acute hypothyroid state that may potentially benefit from replacement therapy.
对经历9分钟常温性心室颤动的犬类，监测其甲状腺素（T4）、三碘甲状腺原氨酸（T3）和反三碘甲状腺原氨酸（rT3）的循环浓度。与心脏停搏前水平相比，心脏停搏12小时后，总T4（P < 0.0005）、游离T4（P < 0.0005）、总T3（P < 0.003）和游离T3（P < 0.003）显著降低，而反T3水平显著升高（P = 0.0001）。仅30秒的心脏停搏也出现了类似变化。心脏停搏后，以每小时7.5微克/千克（Rx - 7.5）和每小时15微克/千克（Rx - 15）的剂量补充左甲状腺素钠（L - T4），可使总T4、游离T4和总T3升高（P < 0.01）。游离T3在Rx - 7.5组降低（P < 0.01），而在Rx - 15组未下降（P = 0.16）。两种治疗方式均使反T3升高（P < 0.005）。两个治疗组的所有五种激素水平均高于未治疗动物（P < 0.001）。用标准化评分系统评估神经功能，结果显示治疗组在6小时时显著改善（与未治疗组相比，P < 0.05），且在心脏停搏后24小时内一直保持显著（P < 0.05）。心脏骤停和复苏后甲状腺激素迅速而显著变化的记录表明存在明显的急性甲状腺功能减退状态，可能从替代治疗中获益。
