老年病与正常甲状腺病态综合征

Geriatric disease and euthyroid sick syndrome

摘要:

正常甲状腺病态综合征是由于甲状腺以外的全身疾病、手术或禁食等引起甲状腺功能实验结果的异常。各年龄段均可发生, 但以老年人及老年病最为常见。其中低T3综合征最常见。低T3综合征的发生机制包括机体“保护性”防御机制、硒缺乏、下丘脑-垂体-甲状腺轴异常、甲状腺激素结合球蛋白的改变等。各种老年病发生低T3综合征的风险均明显增加, 如糖尿病、心力衰竭、慢性呼吸系统疾病及手术等。老年病伴低T3综合征者提示病情更重, 因此正确判断甲状腺功能非常重要。低T3综合征是否需要治疗这一话题仍存在很大争议。

Abstract:

Euthyroid sick syndrome(ESS) is a condition where the thyroid function is abnormal because of the systemic disease outside the thyroid gland, surgery, or fasting, etc. ESS can be seen in all ages, but is most common in the elderly, and the most common type is low-T3 syndrome. Mechanism of low-T3 syndrome includes bodily "protective" defense, selenium deficiency, hypothalamus-pituitary-thyroid axis abnormalities, thyroid hormone binding globulin (TBG) changes, and so on. The risk of low-T3 syndrome significantly increases in the elderly with diabetes, heart failure, chronic respiratory diseases and surgery, etc. These geriatric diseases complicated with low-T3 syndrome suggest more serious condition and worse prognosis, so it is very important to have an accurate judgement for the thyroid function. Whether low-T3 syndrome needs treatment or not is still highly controversial.