Saini J S, Naqvi S, Gandhi B, Karnani I
Army Hospital Delhi Cantt.
J Assoc Physicians India. 1993 Jul;41(7):415-7.
Fifteen IDDM patients were evaluated for thyroid hormone abnormalities before and after control of diabetes mellitus/ketoacidosis. Blood sugar mean +/- SEM mg/dl on admission was 430 +/- 20.3 and after therapy fasting and post prandial blood sugar values were 120 +/- 14.5 and 150 +/- 20.2 respectively. GHb mean +/- SEM % on admission was 15.2 +/- 0.36. Serum T3 mean +/- SEM ng/dl of 0.36 +/- 0.04 was in hypothyroid range and rT3 mean +/- SEM ng/ml 0.40 +/- 0.6 was significantly raised (P < 0.001) before therapy. After metabolic control both T3 and rT3 became normal. T4 concentration mean +/- SEM meg/dl of 5.5 +/- 0.7 was well within normal range before therapy and rose to mean +/- SEM mcg/dl 8.8 +/- 0.5 after therapy (P < 0.01). TSH response to TRH was blunted in uncontrolled state. It is concluded that peripheral changes in T3, T4 and rT3 (low T3, high rT3 and low or normal T4) occurred in uncontrolled diabetic state during ketoacidosis. TSH response to TRH was blunted due to suppression of hypothalamic pituitary thyroid axis which takes more than a week for complete recovery.
对15名胰岛素依赖型糖尿病（IDDM）患者在糖尿病/酮症酸中毒得到控制前后进行了甲状腺激素异常情况的评估。入院时血糖均值±标准误（mg/dl）为430±20.3，治疗后空腹及餐后血糖值分别为120±14.5和150±20.2。入院时糖化血红蛋白均值±标准误（%）为15.2±0.36。治疗前血清总三碘甲状腺原氨酸（T3）均值±标准误（ng/dl）为0.36±0.04，处于甲状腺功能减退范围，而反三碘甲状腺原氨酸（rT3）均值±标准误（ng/ml）为0.40±0.6显著升高（P<0.001）。代谢得到控制后，T3和rT3均恢复正常。治疗前血清总甲状腺素（T4）浓度均值±标准误（μg/dl）为5.5±0.7，在正常范围内，治疗后升至均值±标准误（μg/dl）8.8±0.5（P<0.01）。在未得到控制的状态下，促甲状腺激素（TSH）对促甲状腺激素释放激素（TRH）的反应迟钝。结论是，在酮症酸中毒期间未得到控制的糖尿病状态下，T3、T4和rT3出现外周变化（低T3、高rT3和低或正常T4）。由于下丘脑-垂体-甲状腺轴受到抑制，TSH对TRH的反应迟钝，而这种抑制需要一周多时间才能完全恢复。
