甲状腺ホルモン代謝に関する臨床的研究:第1篇 健康人・各種未治療甲状腺疾患々者及び各種肝疾患々者に於けるI<SUP>131</SUP>標識Thyroxine代謝並びにその年令別比較に関する研究
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The metabolism of thyroxine was studied using I<SUP>131</SUP>-labeled 1-thyroxine on normal subjects, on patients with untreated thyroid disorders and on those with liver disorders.<BR>1) The <I>Thyroxine Degradation Rate </I> (TDR) was derived from the fate of thyroxine after intravenous administration of the radiothyroxine. Some investigations have been made on the calculation of the TDR by the extrapolation method. In this case, the inorganic iodine, liberated after the peripheral degradation of thyroxine, was reaccumulated in the thyroid gland and was incorporated into hormones and then the radioiodine was released into the blood stream. This turnover rate was very high especially in hyperthyroidism. Therefore, antithyroid drugs or potassium iodide were administered by month to the patient in order to block the uptake by the thyroid gland of inorganic iodine liberated from the injected thyroxine. However, it is possible that the pathological physiology of the thyroid disease was influenced by this treatment.<BR>In this experiment, the patients were examined without this treatment. For two weeks after the administration of radiothyroxine 30-80μc (2-5, μg of 1-thyroxine), the thyroid I<SUP>131</SUP> uptake rate, serum I<SUP>131</SUP> concentration, urinary I<SUP>131</SUP> excretion, fecal I<SUP>131</SUP> excretion and the radioactivity over the liver and the thigh were measured daily. As the radioactivity over liver and thigh diminished at almost the same exponential rate as the serum I<SUP>131</SUP> concentration, it was considered that, during the peripheral degradation of radiothyroxine accumulated in three sites : the thyroid, urine and feces. <I>Daily Volume Turnover</I> (DVT), the volume of the thyroxide distribution space in which hormones were replaced daily, and TDR were calculated according to the following formulas : <BR>TDR (μg/day) =DVT (l/day) × PBI (μg/l) <BR>DVT=U+F+T<BR>U= urinary portion (l/day) =<SUP>n</SUP> ∑ <SUB>j=1</SUB> <SUP>j</SUP> ∑ <SUB>k=1</SUB> U<SUB>k</SUB>/<SUP>j</SUP> ∑ <SUB>k=1</SUB> P<SUB>k</SUB>/n<BR>F = fecal portion (l/day) =<SUP>n</SUP> ∑ <SUB>j=1</SUB>(<SUP>j</SUP> ∑ <SUB>k=1</SUB> f<SUB>k</SUB>/<SUP>j</SUP> ∑ <SUB>k=1</SUB> P<SUB>k</SUB>)/n<BR>T =thyroid reaccumulation portion (l/day) = <SUP>2</SUP> ∑ <SUB>j=1</SUB> (t<SUB>j</SUB>/ <SUP>j</SUP> ∑ <SUB>k=1</SUB> P<SUB>k</SUB>) /2<BR>(T was calculated for two days. During this period of time, the process by which inorganic radioiodine entered the thyroid gland and was incorporated into hormones, and the radioiodine was released into the blood stream could be disregarded.)<BR>n, j, k : days (n> j, k) <BR>p<SUB>k</SUB> : serum I<SUP>131</SUP> concentration rate at time k (%/l) <BR>u<SUB>k</SUB> : urinary I<SUP>131</SUP> excretion rate at time k (%) <BR>f<SUB>k</SUB> : fecal I<SUP>131</SUP> excretion rate at time k (%) <BR>t<SUB>j</SUB> : thyroid I<SUP>131</SUP> uptake rate at time j (%) <BR>2) The averμge of DVT and TDR by this calculation in subjects under forty years old was 1.24±0.25 l/day, 62.9±20.1, μg/day in normal subjects, 2.13±0.52 l/day, 231.1±120.4 μg/day in hyperthyroidism and 0.78±0.16 l/day 21.0±5.3/μg/day in hypothyroidism respectively. Thus, hyperthyroidism and hypothyroidism could be differentiated from normal subjects without over-lapping. When the DVT was plotted against the PBI value for the above mentioned subjects, the DVT was found to be roughly proportional to the PBI value. By the method of least squares the relation between PBI (μg/dl) and DVT (l/day) was expressed by the following formula : <BR>DVT = 0.4118 + 0.1656 x (PBI) (A) <BR>Thus the TDR could be calculated from the PBI value.<BR>3) The age difference of TDR in normal subjects was studied. The PBI values of normal subjects over seventy years old were higher than those of subjects with hypothyroidism.
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