The controversy of the treatment of critically ill patients with thyroid hormone

2001 ◽  
Vol 15 (4) ◽  
pp. 465-477 ◽  
Author(s):  
Nikolaos Stathatos ◽  
Claresa Levetan ◽  
Kenneth D. Burman ◽  
Leonard Wartofsky
Keyword(s):  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Reduced Activation and Increased Inactivation of Thyroid Hormone in Tissues of Critically Ill Patients

2003 ◽  
Vol 88 (7) ◽  
pp. 3202-3211 ◽  
Author(s):  
Robin P. Peeters ◽  
Pieter J. Wouters ◽  
Ellen Kaptein ◽  
Hans van Toor ◽  
Theo J. Visser ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Expression of thyroid hormone transporters during critical illness

2009 ◽  
Vol 161 (2) ◽  
pp. 243-250 ◽  
Author(s):  
Liese Mebis ◽  
Deborah Paletta ◽  
Yves Debaveye ◽  
Björn Ellger ◽  
Lies Langouche ◽  
...  
Keyword(s):  
Gene Expression ◽  
Skeletal Muscle ◽  
Critical Illness ◽  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rabbit Model ◽  
Monocarboxylate Transporter ◽  
Expression Levels ◽  
Gene Expression Levels

ObjectiveProlonged critically ill patients have low circulating thyroid hormone (TH) levels without a rise in TSH, a condition labeled ‘the low tri-iodothyronine (T3) syndrome’. Currently, it is not clear whether this represents an adaptive response. We examined the role of TH transporters monocarboxylate transporter 8 (MCT8, also known as SLC16A2) and MCT10 in the pathogenesis of the low T3 syndrome in prolonged critical illness.MethodsA clinical observational study in critically ill patients and an intervention study in an in vivo animal model of critical illness. Gene expression levels of MCT8 and MCT10 were measured by real-time PCR.ResultsIn prolonged critically ill patients, we measured increased MCT8 but not MCT10 gene expression levels in liver and skeletal muscle as compared with patients undergoing acute surgical stress. In a rabbit model of prolonged critical illness, gene expression levels of MCT8 in liver and of MCT10 in skeletal muscle were increased as compared with healthy controls. Treatment of prolonged critically ill rabbits with TH (thyroxine+T3) resulted in a downregulation of gene expression levels of MCT8 in liver and of MCT10 in muscle. Transporter expression levels correlated inversely with circulating TH parameters.ConclusionsThese data suggest that alterations in the expression of TH transporters do not play a major role in the pathogenesis of the ‘low T3 syndrome’ but rather reflect a compensatory effort in response to hypothyroidism.

Thyroid Hormone Receptor Isoform Expression in Livers of Critically Ill Patients

Thyroid ◽  
2007 ◽  
Vol 17 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Daphne C. Thijssen-Timmer ◽  
Robin P. Peeters ◽  
Pieter Wouters ◽  
Frank Weekers ◽  
Theo J. Visser ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hormone Receptor ◽  
Thyroid Hormone Receptor ◽  
Isoform Expression

scholarly journals Prognostic Significance of Thyroid Hormone For Prolonged Mechanical Ventilation In Critically Ill Patients With Cardiac Surgery

2021 ◽  
Author(s):  
Xiao Shen ◽  
Jiakui Sun ◽  
Liang Hong ◽  
Xiaochun Song ◽  
Cui Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Prognostic Significance ◽  
Multivariate Logistic Regression Analysis ◽  
Free Triiodothyronine ◽  
Total Triiodothyronine

Abstract Background: This study aimed to examine the correlation between thyroid hormone and prolonged mechanical ventilation (MV) in the adult critically ill patients having undergone cardiac surgery. Methods: The present study refers to a retrospective, cohort study that was conducted at Cardiovascular Intensive Care Unit (CVICU) of Nanjing First Hospital from March 2019 to December 2020. Patients receiving cardiac surgery and admitted to the center of the authors in the study period were screen for a potential inclusion. Demographic information, thyroid hormone and other laboratory measurements and outcome variables were recorded for analyses. Prolonged MV was defined as the duration of MV after cardiac surgery longer than 5 days. Thyroid hormones were assessed for the prognostic significance for prolonged MV.Results: On the whole, 118 patients having undergone cardiac surgery were included and analyzed in this study. Patients fell to the control (n=64) and the prolonged MV group (n=54) by complying with the duration of MV after cardiac surgery. The median total triiodothyronine (TT3) and free triiodothyronine (FT3) were 1.03 nmol/L and 3.52 pmol/L in the prolonged MV group before cardiac surgery, significantly lower than 1.23 nmol/L (P=0.005) and 3.87 pmol/L, respectively in the control (P=0.038). multivariate logistic regression analysis indicated that TT3 before surgery (pre-op TT3) had a good prognostic significance for prolonged MV (OR: 0.049, P=0.012). Conclusions: This study concluded that decreased triiodothyronine (T3) could be common in the cardiac patients with prolonged MV, and it would be further reduced after patients undergoing cardiac surgery. Besides, decreased T3 before surgery could act as an effective predictor for prolonged MV after cardiac surgery.

scholarly journals Thyroid Hormone Replacement Therapy in Critically Ill Patients: Lack of Promising Evidence for Physiologically Sound Approaches

2019 ◽  
Vol 7 (1) ◽  
pp. 48
Author(s):  
Tara Sabzevari ◽  
Masoumeh Emamvidri
Keyword(s):  
Hormone Replacement Therapy ◽  
Thyroid Hormone ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hormone Replacement ◽  
Thyroid Hormone Replacement ◽  
Thyroid Hormone Replacement Therapy ◽  
Sick Euthyroid ◽  
Low Serum

The sick euthyoid syndrome, also known as nonthyroidal illness syndrome, refers to changes seen in patient thyroid function tests administered in the medical intensive care unit during episodes of critical illness(1). Low serum T3 is the most common abnormality in euthyroid sick syndrome. Both low T3 and low T4 syndrome are reported in critically ill patients and low serum T4 is related with worst outcome. These features in laboratory findings of sick euthyroid patients have been explained by circulating thyroid binding hormone inhibitor (2). Thyroid hormone signalling regulates crucial biological functions, including energy expenditure, thermogenesis, development and growth. Fliers et al. (3), in their review “Thyroid function in critically ill patients”, concluded that routine thyroid hormone replacement therapy is not recommended in non-thyroid illness syndrome in critically ill patients. As we know, decreased plasma concentrations of thyroid hormones, especially T3, in critically ill patients represent the severity of the disorder and are associated with poor outcomes. On the other hand, thyroid hormone administration has been reported to be associated with improved hemodynamics, increased cardiac output, decreased ICU length of stay, reduced need for inotropic agents and mechanical devices, decreased incidence of myocardial ischaemia and decreased incidence of atrial fibrillation and pacemaker therapy (4-6). There are some studies reported the link between low levels of thyroid hormone and sarcopenia which leads to critical ill weakness (7.8). So it may be a rational to use hormone replacement therapy in selected critically ill patients with sick euthyroid syndrome.Not to implement physiologically sound approaches just because “evidence is lacking” might be disadvantageous for these patients over time as it might probably take years until clinical evidence become available. Subsequently, based on previous trials that have introduced effectiveness or at least no effects of hormone replacement therapy for non-thyroid illness syndrome, it seems that critically ill patients without limiting conditions such as advanced age or cardiac dysfunction (e.g. CHF or ACS) might benefit from thyroid replacement therapy and depriving these patients from what they might have benefited seems unethical.As we mentioned sick euthyroid syndrome occurs with different faces in critically ill patients with some good and some bad characteristics. Tolerating the early onset hibernation response with its concomitant changes in thyroid hormone parameters seems to be beneficial and safe. But the other type of sick euthyroid syndrome which develops later during prolong ICU admission may have a different face and needs some interventions as it has impact on patients outcome.

scholarly journals Thyroid hormone alterations in critically and non-critically ill patients with SARS-CoV-2 infection

2021 ◽  
Author(s):  
Dimitra Argyro Vassiliadi ◽  
Ioannis Ilias ◽  
Maria Pratikaki ◽  
Edison Jahaj ◽  
Alice G Vassiliou ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Critically Ill ◽  
Thyroid Function ◽  
Critically Ill Patients ◽  
Icu Patients ◽  
Similar Frequency ◽  
Normal Thyroid ◽  
Severity Of Disease ◽  
Normal Thyroid Function ◽  
High Prevalence

Objective: Following evolution of COVID-19 pandemic, reports pointed on a high prevalence of thyroiditis related thyrotoxicosis. Interpretation of thyroid tests during illness, however, is hampered by changes occurring in the context of non-thyroidal illness syndrome (NTIS). In order to elucidate these findings, we studied thyroid function in carefully selected cohorts of COVID-19 positive and negative patients. Design: Cohort observational study. Methods: We measured TSH, FT4, T3 within 24hours of admission in 196 patients without thyroid disease and/or confounding medications. 102 patients were SARS-CoV-2 positive; 41 admitted in the ICU, 46 in the ward and 15 outpatients. Controls consisted of 94 SARS-CoV-2 negative patients; 39 in the ICU and 55 in the ward. We designated the thyroid hormone patterns as consistent with NTIS, thyrotoxicosis and hypothyroidism. Results: A NTIS pattern was encountered in 60% of ICU and 36% of ward patients, with similar frequencies between SARS-CoV-2 positive and negative patients (46.0% vs 46.8%, p=NS). A thyrotoxicosis pattern was observed in 14.6% SARS-CoV-2 ICU patients vs. 7.7% in ICU negative (p=NS) and, overall in 8.8% of SARS-CoV-2 positive vs. 7.4% of negative patients. In these patients thyroglobulin levels were similar to those with normal thyroid function or NTIS. The hypothyroidism pattern was rare. Conclusions: NTIS pattern is common and relates to the severity of disease rather than SARS-CoV-2 infection. A thyrotoxicosis pattern is less frequently observed with similar frequency between patients with and without COVID-19. It is suggested that thyroid hormone monitoring in COVID-19 should not differ from other critically ill patients.

Thyroid Hormone Binding Inhibition in Critically ill Patients – Who is the Inhibitor?

2009 ◽  
Vol 95 (02) ◽  
pp. 267-270 ◽  
Author(s):  
E. Schifferdecker ◽  
S. Hering ◽  
B. O. Böhm ◽  
H. Förster ◽  
P.-H. Althoff ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hormone Binding ◽  
Binding Inhibition

scholarly journals Correlation of Thyroid Hormones in the Prognosis of Critically Ill Patients

2021 ◽  
Vol 73 (3) ◽  
pp. 161-166
Author(s):  
Sneha R. Chavanda ◽  
Rajendra R. Mane
Keyword(s):  
Intensive Care ◽  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Hormone Levels ◽  
Thyroid Hormone Levels ◽  
Thyroid Profile

Objective: Non-thyroidal illness syndrome (NTIS) is associated with outcomes in Intensive Care Unit(ICU) patients. The objectives of the study were to assess the prognostic value of complete thyroid profile in critically ill patients and to determine the effect of thyroid hormone level in predicting mortality when used along with acute physiology and chronic health evaluation (APACHE) II score.Methods: The observational study was conducted at a tertiary care centre in Kolhapur, India. Critically ill adult patients admitted to intensive care units with APACHE II >10 was included(n=50). Relevant clinical investigations along with thyroid profile evaluation was carried out and APACHE II was calculated.  Baseline characteristics of patients were compared.  Performance of variables in predicting mortality was analysed. Correlation of APACHE II score with thyroid was also assessed in R software v-3.6.1.Results: The survival rate at ICU discharge was 54%. Mean T3, FT3, and T4 levels were significantly low in non-survivors(p=0.006758, p=0.0245 and p=0.00070 respectively).  Mean APACHE II score was significantly high in non- survivor(p=2.94E-06). APACHE II score was significantly associated with the severity of disease (p=0.0235). APACHE II scores and FT3 were better predictors of mortality compared to other thyroid hormones (AUC =0.8519±0.0535). FT3 showed high correlation with APACHE II score(r=-0.4083; p=0.0032). Inclusion of thyroid hormone levels with APACHE II scores improved the prediction of mortality in critically ill patients by 5.63%.Conclusion: Among thyroid hormones, FT3 is a better predictor of mortality. Use of thyroid hormone levels in conjunction with APACHE II scores improves the prognostication.

Erythrocyte zinc content in critically ill patients

2005 ◽  
Vol 43 (9) ◽  
Author(s):  
Darren Cutinha ◽  
Sashi Vaja ◽  
David Treacher ◽  
R. Swaminathan
Keyword(s):  
Thyroid Hormone ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Zinc Content ◽  
Tissue Level ◽  
Thyroid Hormone Metabolism ◽  
Tissue Marker ◽  
Hypothyroid Patients ◽  
Hyperthyroid Patients ◽  
Surgical Group

AbstractAbnormalities in thyroid hormone metabolism are common in critically ill patients. However, it is not known if these patients are truly hypothyroid at tissue level. Erythrocyte zinc has been shown to be a tissue marker of thyroid hormone status. In this study we have measured the erythrocyte zinc in critically ill patients.In this observational study we measured the zinc content of young erythrocytes in blood samples from 33 healthy subjects, 26 hypothyroid patients, four hyperthyroid patients, and 44 patients in the intensive care unit – 22 of these were admitted after a major surgical procedure (surgical group) and the other 22 patients had a variety of conditions (non-surgical group). Erythrocytes were separated according to age by centrifugation. Plasma thyroid hormone concentrations were abnormal in 70% of the critically ill group. Erythrocyte zinc was significantly lower in hyperthyroid patients and higher in hypothyroid patients. In the non-surgical patients, erythrocyte zinc of young cells (median 256μmol/L of cells) was significantly higher than (p<0.01) the corresponding cells in the healthy controls (202μmol/L of cells), whereas in the surgical group it was not different (197μmol/L of cells). We conclude that in non-surgical critically ill patients, erythrocyte zinc content is higher, suggesting that these patients may be hypothyroid at tissue level.

Sign in / Sign up

Export Citation Format

Share Document