Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC20110.15690/vramn.v68i3.597РATHOPHYSIOLOGY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПАТОФИЗИОЛОГИИNONTHYROIDAL ILLNESS SYNDROME IN ACUTE BACTERIAL ENDOTOXICOSIS: PATHOGENESIS AND METHODS OF CORRECTIONСИНДРОМ НЕТИРЕОИДНЫХ ЗАБОЛЕВАНИЙ ПРИ ОСТРОМ БАКТЕРИАЛЬНОМ ЭНДОТОКСИКОЗЕ: ПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ И МЕТОДЫ КОРРЕКЦИИYaglovaN. V.ЯгловаН. В.
Russian Federation

доктор медицинских наук, заведующая лабораторией развития эндокринной системы ФГБУ «НИИ морфологии человека» РАМН Адрес: 117418, Москва, ул. Цюрупы, д. 3; тел.: (499) 120-80-65

yaglova@mail.ruInstitute of Human Morphology of Russian Academy of Medical Sciences, Moscow, Russian FederationНИИ морфологии человека РАМН, Москва, Российская Федерация13032013683Vestnik Rossiiskoi akademii medetsinskikh nauk / Annals of the Russian academy of medical sciencesВестник Российской академии медицинских наук243207082015Copyright ©; 1970, "Paediatrician" Publishers LLCCopyright ©; 1970, Издательство "Педиатръ"1970"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/201

Nonthyroidal illness syndrome is characterized by alterations of thyroid status in patients with severe nonthyroidal illness who are clinically euthyroid. Mechanisms of nonthyroidal illness syndrome are poorly understood and controversial. Our investigations on nonthyroidal illness syndrome in acute endotoxicosis revealed two principal mechanisms of its development. The peripheral mechanism is the first to develop and referred to disturbance of thyrocytes secretory cycle due to increase of thyroglobulin synthesis, endocytosis and decrease of its proteolytic cleavage. It manifests with drop of serum thyroxine, not triiodthyronine, and increase of serum thyroid stimulating hormone. The central mechanism is associated with hypothalamic-pituitary hypofunction developed simultaneously with systemic inflammatory response. Rate of supplementation of the peripheral mechanism with the central one accounts for different types of nonthyroidal illness syndrome with high, normal and low serum levels of thyroid stimulating hormone. Our research showed that thyroid hormone replacement in nonthyroidal illness syndrome could only suppress thyroid function. Unlike thyroid hormones administration of thyroid stimulating hormone restores thyroid hormone secretion in nonthyroidal illness syndrome, decreases endotoxinemia and secretion of proinflammatory cytokines and improves liver function.

Синдром нетиреоидных заболеваний — дисфункция щитовидной железы, развивающаяся в острой стадии соматических заболеваний различного генеза у лиц, не страдающих заболеваниями щитовидной железы, и проявляющаяся снижением продукции тиреоидных гормонов. Патогенез синдрома нетиреоидных заболеваний малоизучен, существует несколько гипотез его развития. В статье обобщены имеющиеся в научной литературе сведения о синдроме нетиреоидных заболеваний и результаты собственных исследований. Описаны патогенетические механизмы, лежащие в его основе при остром грамотрицательном эндотоксикозе. Периферический механизм развития синдрома нетиреоидных заболеваний наиболее ранний, обусловлен разобщением фаз синтеза, резорбции и расщепления тиреоглобулина в тироцитах. Его проявлением является снижение в первую очередь продукции тироксина, а не трийодтиронина, и повышение секреции тиреотропного гормона. Центральный механизм связан со снижением активности гипоталамо-гипофизарного комплекса. Темпы присоединения центрального механизма развития к периферическому объясняют выявление разновидностей синдрома нетиреоидных заболеваний с повышенным, нормальным и пониженным уровнем тиреотропного гормона в сыворотке крови. Также описаны биохимические и морфологические проявления синдрома нетиреоидных заболеваний при остром эндотоксикозе. Показана роль выраженности реакций иммунной системы в развитии и регрессе синдрома. Предложен способ его коррекции, восстанавливающий тиреоидный статус, оказывающий иммуномодулирующий и гепатотропный эффект.

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