Nonthyroidal Illnessにおける血中遊離甲状腺ホルモンと下垂体分泌能について
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概要
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The change in the levels of free thyroid hormones and the pathophysiology of the hypothalamo-pituitary-thyroid axis of patients with nonthyroidal illness (NTI) have not been clearly elucidated so far. Therefore, it was thought of interest to investigate this problem by determining free thyroid hormones and TSH in serum and the response of TSH to TRH in these patients. The subjects employed in this study were 71 cases with hemodialysis, 40 cases with diabetes mellitus, 24 cases with liver cirrhosis, 12 cases with various cancers, 10 cases with anorexia nervosa and 110 normal subjects as controls. The serum total protein, albumin, free T<SUB>4</SUB>, free T<SUB>3</SUB> TSH and other parameters of throid function were determined, and the TRH test was performed on about 10 patients of each group. Serum TSH was not only determined by a conventional assay system, but with a highly sensitive method, and the data were compared with one another. It was found that the serum free T<SUB>3</SUB> levels were significantly low in all the groups investigated, but the serum free T<SUB>4</SUB> levels were significantly low only in the groups with hemodialysis, decompensated liver cirrhosis, cancers and anorexia nervosa. No significant lowering of serum free T<SUB>4</SUB> was observed in the patients with diabetes mellitus, acute hepatitis and compensated liver cirrhosis. However, serum TSH levels tended to be higher in all the groups studied, though they were not significant. The response of TSH to TRH was low or delayed in about 20-50% of patients with hemodialysis, diabetes mellitus, liver cirrhosis, cancers and anorexia nervosa. It was observed that the serum rT<SUB>3</SUB> concentration was significantly high in the patients with diabetes mellitus and anorexia nervosa but significantly low in the patients on hemodialysis. In the rest of the groups, there were found many cases who showed high levels of serum rT<SUB>3</SUB> although they were not statistically significant. These results indicate that low concentrations of serum free T<SUB>3</SUB> observed in the majority of the patients with severe NTI were, at least in part, due to the decrease in the peripheral conversion of T<SUB>4</SUB> to T<SUB>3</SUB> and the lowered sensitivity of the anterior pituitary to thyroid hormones and TRH.
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