Синдром адаптационного тиреоидного дисбаланса. Определение, классификация, распространенность при тяжелых соматических заболеваниях

Abstract

In severe somatic diseases, deviations in the content of thyroid hormones in the blood are possible in the absence of organic changes in the thyroid gland. Various terms are used in the literature to denote this condition: syndrome of non-thyroid diseases, euthyroid pathological syndrome, syndrome of euthyroid weakness, syndrome of pseudodysfunction of the thyroid gland, syndrome of euthyroid patient, euthyroid sick syndrome. The authors propose to call it the syndrome of adaptive thyroid imbalance (SATI) and I distinguish three types of it: Type 1 (SATI-1) — immobilization (low blood levels of total or free fractions T3 and T4), Type 2 (SATI-2) — transitional or intermediate (low or high blood levels of thyroid stimulating hormone), Type 3 (SATI-3) — mobilization (high blood levels of total or free T3 and T4). The work determined the frequency of SATI and its types in various severe somatic diseases. 1098 patients undergoing inpatient treatment in specialized medical institutions were examined. A high prevalence of SATI was shown in somatic patients (35.6%). The most common was SATI-1, which was found in 22.1% of patients. Its maximum frequency was recorded in patients with type 1 diabetes mellitus (58.6%). SATI-2 was intermediate in prevalence — 8.5%, most often it occurred in acute myocardial infarction (26.7%). SATI-3 was recorded only in 5% of patients. This type dominated in patients with active pulmonary tuberculosis (61.8%) and occurred in every 10 patients (10.3%) with cerebral stroke. It is concluded that SATI is widespread in somatic patients. The formation of this syndrome and its individual types is a reflection of the severity and phase of the underlying disease.