Chen W L, Huang W S, Lin Y F, Shieh S D
Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
J Clin Endocrinol Metab. 1996 Feb;81(2):625-9. doi: 10.1210/jcem.81.2.8636279.
The effects of exertional heat stroke (ExHS), with or without acute renal failure (ARF), on thyroid hormone metabolism were investigated. Eighteen ExHS patients were recruited and divided into two groups based on the presence or absence of ARF. Eleven age-matched healthy subjects served as a control group. Serum values of T3, T4, TSH, free T4 (FT4), rT3, and sulfated T3 (T3S) were measured in these groups during the acute and recovery stages of ExHS. Serum T3, T4, and FT4 levels were reduced, with reciprocal increases in rT3 and T3S levels as the severity of ExHS increased. The following mean levels of thyroid hormones were found (controls vs. ExHS without ARF vs. with ARF): T3, 1514 vs. 1164 vs. 393 pmol/L (P < 0.05 each); T4, 97 vs. 79 vs. 49 nmol/L (P = NS and P < 0.05, respectively); FT4, 20.5 vs. 19.5 vs. 19.0 pmol/L (P = NS each); rT3, 371 vs. 617 vs. 805 pmol/L (P < 0.05 and P = NS, respectively); and T3S, 30.1 vs. 34.2 vs. 71.1 pmol/L (P = NS and P < 0.05, respectively). The serum TSH levels were not significantly different among the three groups. Significantly negative correlations were found between serum creatinine and T3 (r = -0.75; P < 0.001) and T4 levels (r = -0.65; P < 0.001), whereas no relationship was noted between serum creatinine and rT3 values (r = 0.11; P < 0.05). In contrast, a correlation was observed between serum glutamic pyruvic transaminase and rT3 (r = 0.45; P < 0.01). Thyroid function tests returned to normal after patients recovered. In conclusion, our results show that patients suffering from ExHS, with or without ARF, displayed altered serum thyroid function in proportion to the severity of their condition. No significant changes in serum levels of rT3 were observed between the two groups, whereas a positive relationship was observed between serum rT3 and serum glutamic pyruvic transaminase values, suggesting that the changes in serum rT3 levels were more dependent on extrarenal illness than on renal disease per se. The moderate increase in serum T3S levels found in patients suffering from both ExHS and ARF may represent a decrease in tissue 5'-monodeiodinase activity as found in other nonthyroidal illnesses. A return of serum thyroid function tests to normal values after recovery from ExHS suggests that the low T3 state may play a protective role to prevent undesirable catabolic effects. Replacement therapy is thus not recommended.
研究了劳力性热射病（ExHS）伴或不伴急性肾衰竭（ARF）对甲状腺激素代谢的影响。招募了18例ExHS患者，并根据是否存在ARF分为两组。11名年龄匹配的健康受试者作为对照组。在ExHS的急性期和恢复期，测量这些组中血清T3、T4、促甲状腺激素（TSH）、游离T4（FT4）、反三碘甲状腺原氨酸（rT3）和硫酸化T3（T3S）的值。随着ExHS严重程度的增加，血清T3、T4和FT4水平降低，rT3和T3S水平相应升高。发现以下甲状腺激素平均水平（对照组 vs. 无ARF的ExHS组 vs. 有ARF的ExHS组）：T3，1514 vs. 1164 vs. 393 pmol/L（每组P < 0.05）；T4，97 vs. 79 vs. 49 nmol/L（分别为P = 无显著性差异和P < 0.05）；FT4，20.5 vs. 19.5 vs. 19.0 pmol/L（每组P = 无显著性差异）；rT3，371 vs. 617 vs. 805 pmol/L（分别为P < 0.
