La T3 baja marcaría peor evolución en pacientes internados por insuficiencia cardíaca descompensada / Low T3 Would Indicate Adverse Outcomes for Inpatients with Decompensated Heart Failure

RESUMEN Introducción: El síndrome de T3 baja se asocia con niveles elevados de interleucinas y citoquinas circulantes, lo que refuerza la hipótesis de una estrecha relación entre el sistema neuroendocrino y ciertos mecanismos inflamatorios e inmunológicos, involucrados en la insuficiencia cardíaca. Objetivo: Evaluar la evolución de pacientes ingresados por insuficiencia cardíaca descompensada según niveles de T3 al ingreso, y eventos durante la hospitalización y en el seguimiento. Material y métodos: Estudio prospectivo, observacional, analítico de 524 pacientes internados por primera vez con diagnóstico de insuficiencia cardíaca descompensada. Se evaluó la mortalidad intrahospitalaria, y al seguimiento y readmisiones de acuerdo con niveles de T3 normal o disminuida al ingreso. Se excluyeron 91 pacientes con distiroidismo conocido, hipotiroidismo o hipertiroidismo, cirugía tiroidea previa, sepsis o síndrome coronario agudo. Se realizó un análisis de subgrupo de pacientes según recibieran crónicamente amiodarona y se evaluaron variables pronosticas. Resultados: De 433 pacientes analizados, el 40,0% presentaban bajos niveles de T3 (BT3). La edad, albúmina, TFG y edad mayor de 75 años, fueron predictores independientes de BT3. Si bien se observó un aumento en ambos grupos en la adecuación de tratamientos recomendados por las guías, el grupo de BT3 mostró significativamente tasas menores de estos con respecto a aquellos con T3 normal (BT3 vs. NT3: betabloqueantes 81,5% vs. 89,4%, p = 0,02; IECA/ARAII 78,5% vs. 87,9% p <0,001; antialdosterónicos 29,2% vs. 40,5% p = 0,019). La mortalidad hospitalaria fue mayor en BT3 (5,8% vs. 1,5%) sin diferencias en readmisiones o mortalidad en el seguimiento. Del subgrupo de pacientes sin amiodarona al ingreso (353), 37,8% tenían BT3. Se halló que los pacientes de este subgrupo presentaron diferencias significativas en cuanto a mortalidad intrahospitalaria y mortalidad en seguimiento (5,3% en BT3 vs. 0,9% NT3; p = 0,03 y 40,2% vs. 26,6%; p = 0,023), respectivamente. Conclusiones: Los pacientes ingresados por insuficiencia cardíaca descompensada con T3 baja al ingreso representarían un subgrupo de pacientes con enfermedad más grave y peor pronóstico durante la internación.

ABSTRACT Background: Low T3 syndrome is associated with elevated circulating levels of cytokines and interleukins, reinforcing the hypothesis of a close relation between the neuroendocrine system and certain inflammatory and immunological mechanisms involved in heart failure. Objective: To assess the progress of patients admitted for decompensated heart failure according to T3 levels on admission, and events during hospitalization and follow-up. Materials and methods: It was a prospective, observational, analytical study of 524 patients hospitalized for the first time with a diagnosis of decompensated heart failure. In-hospital and follow-up mortality and readmissions were evaluated according to normal or low T3 levels on admission. Ninety-one patients with known dysthyroidism, hypo or hyperthyroidism, previous thyroid surgery, sepsis or acute coronary syndrome were excluded. A subgroup analysis of patients receiving chronic amiodarone therapy was conducted, and prognostic variables were evaluated. Results: Of the 433 patients analyzed, 40.0% had low T3 (LT3) levels. Age, albumin level, age >75 years, and glomerular filtration rate (GFR) were independent predictors of LT3. While adaptation of guideline-recommended treatments increased in both groups, treatment rates in the LT3 group were significantly lower than those in the normal T3 (NT3) group (LT3 vs. NT3: Betablockers 81.5% vs. 89.4%, p=0.02; ACEI/ARA II 78.5% vs. 87.9%, p=0.001; anti-aldosterone agents 29.2% vs. 40.5%; p=0.019). Hospital mortality was higher in the LT3 group (5.8 vs. 1.5%), with no difference in rehospitalizations or mortality rates at follow-up. Of the subgroup of patients without amiodarone on admission (353), 37.8% had LT3. Patients in this subgroup were found to have significant differences in follow-up and in-hospital mortality (5.3% in LT3 vs. 0.9% in NT3, p=0.03, and 40.2% vs. 26.6%, p=0.023) respectively. Conclusions: Decompensated heart failure patients with LT3 on admission would represent a subgroup with more severe disease and worse prognosis during hospitalization.

Impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis / 中华心血管病杂志

Objective@#To determine the impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis.@*Methods@#The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis (onset of symptoms<1 month,patients were divided into low serum free triiodothyronine (FT3, n=20) group and normal FT3 (n=114) group. General information, clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed. Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine (TT3), normal or decreased free thyroxine (FT4) and total thyroxine (TT4) as well as normal thyroid stimulating hormone (TSH). Composite adverse cardiovascular events included death, persistent ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiac arrest. Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis.@*Results@#Systolic blood pressure was significantly lower (P<0.01),while heart rate (P=0.004) and the prevalence of VT/VF were significantly higher (P=0.017) in low T3 group than in the normal T3 group. Level of white blood cell,C response protein,fasting glucose (all P<0.01) as well as creatinine (P=0.035) were significantly higher, while level of FT3 and left ventricular ejection fraction (LVEF) were significantly lower (both P<0.01) in low T3 group than in normal T3 group. Multivariate logistic regression analysis revealed that LVEF at admission less than 40% (OR=6.615,95%CI 1.186-36.907, P=0.031) and FT3 level less than 1.79 ng/L (OR=9.131, 95%CI 1.577-52.857, P=0.014) were independent risk factors of increased composite adverse cardiovascular events in patients with acute viral myocarditis.@*Conclusion@#Low FT3 increases the risk of adverse cardiovascular events in adult patients with acute viral myocarditis.

Is There Any Relationship between TSH Levels and Prognosis in Acute Coronary Syndrome? / Existe Alguma Relação entre Níveis de TSH e Prognóstico em Síndrome Coronariana Aguda?

Abstract Background: Some small studies have related higher levels of thyrotropin (TSH) to potentially worse prognosis in acute coronary syndromes. However, this relationship remains uncertain. Objective: To analyze the outcomes of patients with acute coronary syndromes in relation to the value of TSH at admission. Methods: Observational and retrospective study with 505 patients (446 in group I [TSH ≤ 4 mIU/L] and 59 in group II [TSH > 4 mIU/L]) with acute coronary syndromes between May 2010 and May 2014. We obtained data about comorbidities and the medications used at the hospital. The primary endpoint was in-hospital all-cause death. The secondary endpoint included combined events (death, non-fatal unstable angina or myocardial infarction, cardiogenic shock, bleeding and stroke). Comparisons between groups were made by one-way ANOVA and chi-square test. Multivariate analysis was determined by logistic regression. Analyses were considered significant when p < 0.05. Results: Significant differences between groups I and II were observed regarding the use of enoxaparin (75.2% vs. 57.63%, p = 0.02) and statins (84.08% vs. 71.19%, p < 0.0001), previous stroke (5.83% vs. 15.25%, p = 0.007), combined events (14.80% vs. 27.12%, OR = 3.05, p = 0.004), cardiogenic shock (4.77% vs. 6.05%, OR = 4.77, p = 0.02) and bleeding (12.09% vs. 15.25%, OR = 3.36, p = 0.012). Conclusions: In patients with acute coronary syndromes and TSH > 4 mIU/L at admission, worse prognosis was observed, with higher incidences of in-hospital combined events, cardiogenic shock and bleeding.

Resumo Fundamento: Estudos pequenos têm relacionado níveis mais elevados de hormônio tireoestimulante (TSH) a pior prognóstico em pacientes com síndrome coronariana aguda (SCA). Tal relação, no entanto, permanece incerta. Objetivo: Analisar os desfechos de pacientes com SCA, relacionando-os aos níveis de TSH medidos no setor de emergência. Métodos: Estudo retrospectivo observacional incluindo 505 pacientes com SCA (446 no grupo I: TSH ± 4 mUI/L; 59 no grupo II: TSH > 4 mUI/L) entre maio de 2010 e maio de 2014. Dados sobre comorbidades e medicamentos usados foram obtidos. O desfecho primário foi mortalidade intra-hospitalar por todas as causas. O desfecho secundário incluiu eventos combinados (morte, angina instável não fatal ou infarto do miocárdio, choque cardiogênico, sangramento e acidente vascular encefálico). A comparação entre grupos foi realizada através de ANOVA de uma via e teste do qui-quadrado. A análise multivariada foi realizada por regressão logística, adotando-se o nível de significância de p < 0,05. Resultados: Diferenças significativas foram observadas entre os grupos I e II relacionadas ao uso de enoxaparina (75,2% vs. 57,63%; p = 0,02) e estatinas (84,08% vs. 71,19%; p < 0,0001), acidente vascular encefálico prévio (5,83% vs. 15,25%; p = 0,007), eventos combinados (14,80% vs. 27,12%, OR = 3,05; p = 0,004), choque cardiogênico (4,77% vs. 6,05%, OR = 4,77; p = 0,02) e sangramento (12,09% vs. 15,25%, OR = 3,36; p = 0,012). Conclusão: Em pacientes com SCA e TSH > 4 mUI/L à admissão hospitalar, observou-se pior prognóstico associado à maior incidência de eventos combinados intra-hospitalares, choque cardiogênico e sangramentos.

Analysis of influential factors of non-thyroidal illness syndrome in elderly inpatients / 中华老年医学杂志

Objective To investigate the effects of risk factors on non thyroidal Illness syndrome (NTIS) in elderly inpatients.Methods A total of 819 elderly inpatients who met inclusion criteria were consecutively recruited in thiscross-sectional study.Physicalmeasurements and mini nutritional assessment using the mini nutritional assessment-short form (MNA-SF) score were conducted.A serum levels of thyroid stimulating hormone (TSH),free triiodothyronine (FT3),free thyroxine (FT4),brain natriuretic peptide (BNP) and C-reactive protein (CRP) were examined.Data were analyzed with multivariatelogistic regression.Results The significant differences were found between NTIS group (n=145) versus control group (n=674)inage (78.5±8.1) years vs.(75.1±8.6) years(t=5.422,P＜0.01),in body mass index (23.0 ±3.8) kg/m2 vs.(24.1±3.6) kg/m2,in MNA-SF score 11.2±2.3 vs.12.3± 1.8(t=-3.315,6.754,P＜0.01),in level of serum albumin (36.0±4.5) g/L vs.(38.4±3.6) g/L (t=-6.977,P＜0.01),in triglyceride level (1.3± 0.9) mmol/L vs.(1.5±1.0) mmol/L(t=-3.039,P＜0.01),inCRP (Z=-8.857,P＜0.01)),and in BNP (t=6.331,P＜0.01).Logistic regression analysis revealed that age＞ =80 years (OR=2.433,95％CI:1.357 4.361),malnutrition (OR=1.946,95％CI:1.261-3.001),renal insufficiency (eG FR＜60 ml/min,OR =2.131,95％ CI:1.367-3.322),and high level of CRP (10 mg/L and 50 mg/L:OR=3.446,95％CI:2.117-5.611;over 50 mg/L:OR =10.029,95％CI:4.693-21.432,all P＜0.01)) were risk factors for NTIS.Conclusions Non-thyroidal illness syndrome in elderly inpatients is correlated with advanced age,renal insufficiency,malnutrition and stress,which are the independent risk factors.

The influence o end-stage liver disease and liver transplantation on thyroid hormoess / Avaliação do impacto da cirrose e do transplante hepático na função tireoidiana

Background Thyroid dysfunction has been reported in most chronic illnesses including severe liver disease. These defects in thyroid hormone metabolism result in the sick euthyroid syndrome, also known as low T3 syndrome. Objectives Our objective was to evaluate the thyroid function in patients with end stage liver disease prior and after deceased donor liver transplantation and to correlate thyroid hormonal changes with the MELD score (Model for End stage Liver Disease). Methods In a prospective study, serum levels of thyrotropin (thyroid stimulating hormone TSH), total thyroxine (tT4), free thyroxine (fT4) and triiodothyronine (T3) from 30 male adult patients with end stage liver disease were measured two to four hours before and 6 months after liver transplantation (LT). MELD was determined on the day of transplant. For this analysis, extra points were not added for patients with hepatocellular carcinoma. Results The patients had normal TSH and fT4 levels before LT and there was no change after the procedure. Total thyroxine and triiodothyronine were within the normal range before LT, except for four patients (13.3%) whose values were lower. Both hormones increased to normal values in all four patients after LT (P=0.02 and P<0.001, respectively). When the patients were divided into two groups (MELD <18 and MELD >18), it was observed that there was no change in the TSH, freeT4, and total T4 levels in both groups after LT. Although there was no significant variation in the level of T3 in MELD <18 group (P=0.055), there was an increase in the MELD >18 group after LT (P=0.003). Conclusion Patients with end stage liver disease subjected to liver transplantation had normal TSH and fT4 levels before and after LT. In a few patients with lower tT4 and T3 levels before LT, the level of these hormones increased to normal after LT. .

Contexto A disfunção tireoidiana tem sido relatada em associação com a maioria das doenças crônicas, incluindo a doença hepática terminal. Estes defeitos no metabolismo dos hormônios tireoidianos resultam na síndrome do doente eutireoideo ou, também conhecida como síndrome do T3 baixo. Objetivos Avaliar a função tireoidiana em pacientes com doença hepática avançada, antes e depois de serem submetidos ao transplante hepático cadavérico (THC) e, correlacionar as alterações hormonais da tireóide com o MELD. Métodos Em um estudo prospectivo, os níveis séricos de tireotropina (hormônio estimulante da tireóide TSH), tiroxina total (T4 total), tiroxina livre (T4 livre) e triiodotironina (T3) de 30 pacientes adultos do sexo masculino com doença hepática terminal foram dosados 2 e 4 horas antes e 6 meses após o THC. O valor do MELD foi determinado no dia do procedimento. Para esta análise, os pontos extras não foram adicionados para os pacientes com carcinoma hepatocelular. Resultados Os pacientes apresentaram níveis de TSH e T4 livre normais antes do THC e não houve nenhuma alteração após o procedimento. As dosagens de T4 total e T3 no início do estudo estavam dentro da faixa normal, exceto por quatro pacientes (13,3%), os quais apresentavam valores abaixo da referência. Ambos os hormônios apresentaram um aumento 6 meses após o THC (P=0,02 e P<0,001, respectivamente). Quando os pacientes foram divididos em dois grupos (MELD <18 e MELD >18) não observamos diferença nos níveis de TSH, T4 total e T4 livre entre os grupos após THC. Apesar de não haver variação nos níveis de T3 no grupo com MELD <18 (P=0,055), houve um aumento no grupo MELD >18 após THC (P=0,003). Conclusão Os pacientes com cirrose hepática submetidos a transplante hepático tinham valores normais de TSH e T4 livre antes e após o THC. Nos poucos pacientes que apresentavam valores baixos de T4 total e T3 antes do THC, houve normalização destes hormônios após o THC. .

Relationship between serum level of thyroid hormones and plasma level of N-terminal Pro-brain natriuretic peptide in elderly patients with type 2 diabetes / 中华老年医学杂志

Objective To investigate the relationship between thyroid function indexes and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) among patients who had high risks for cardiovascular diseases without thyroid diseases and heart failure.Methods Totally 166 elderly type 2 diabetic patients aged 80 years and over with normal range of thyroid stimulating hormone (TSH) were divided into group of euthyroid sick syndrome (ESS,n=62) and group of normal thyroid hormones (NESS,n=104).The patients in normal thyroid hormones group were divided into three subgroups according to the levels of total triiodothyronine (TT3),(low-level group,n=26; middle-level group,n=50; high-level group,n=28).Levels of thyroid hormones,NT-proBNP,cholesterol,low-density lipoprotein cholesterol,fibrinogen,HbA1C,glomerular filtration rate (eGRF),left ventricular ejection fraction (LVEF) and the incidences of concomitant diseases were measured and detected.lgNT-proBNP was used to calculated after NT-proBNP was changed by Log transformation.Results Compared with NESS group,ESS group showed that age was increased,systolic pressure and LVEF were decreased [(86.3 ± 5.8) years vs.(85.6 ± 5.2) years,(126.6±15.5) mmHg vs.(135.6±17.8) mmHg,(63.9±7.6)％ vs.(67.4±7.5)％,all P＜0.01].Compared with NESS group,ESS group showed that the levels of serum total T3 and free T3 were decreased [(0.89±0.17) nmol/L vs.(1.45±0.31) nmol/L,(3.31±0.55) pmol/L vs.(3.96± 0.59) pmol/L,both P＜0.01].The lgNT-proBNP level was higher and serum total thyroxine (TT4) level was lower in ESS group than in NESS group [(2.40±0.40) ng/L vs.(2.26±0.44) ng/L,(101.80±36.11) nmol/L vs.(111.07±23.29) nmol/L,both P＜0.05].Pearson analysis revealed that serum levels of TT3,TT4 and FT3 were negatively correlated with lgNT-proBNP (r=-0.217,-0.180,-0.174,respectively,all P＜0.05) after adjustment for age,systolic pressure and LVEF.Stepwise regressive analysis showed TT3 was the risk factors for lgNT-proBNP (β=-0.267,P＜ 0.01).Compared with the low-level group,the lgNT-proBNP were significantly reduced in the middle-,and high-level groups [(2.19±0.42) ng/L,(2.19±0.46) ng/L vs.(2.44±0.39) ng/L,both P＜0.05].Conclusions TT3 has a close correlation with NT-proBNP in elderly type 2 diabetic patients with normal TSH.It has a significant meaning to test TT3 level for monitoring heart function in clinical medicine.

Relationship among thyroid function,FT3 level and coronary artery disease in patients with coronary heart disease / 心血管康复医学杂志

Objective:To explore the relationship among thyroid function ,free thyroxine (FT3) level and coronary artery disease in patients with coronary heart disease (CHD) .Methods :A total of 238 CHD patients ,who hospital-ized in our hospital from 2012 to 2014 and were proved by coronary angiography (CAG) ,were selected .Their thy-roid function was analyzed .After patients with hyperthyroidism ,hypothyroidism ,subclinical hyperthyroidism and subclinical hypothyroidism were excluded ,the remaining 217 patients were divided into normal FT3 group (n=192) and low FT3 group (n=25) according to FT3 level . General clinical condition and CAG results were compared be-tween two groups . Results:(1 ) Among the 238 CHD patients , there were two cases with hyperthyroidism (0.84% ) ,11 cases with hypothyroidism (4.62% ) ,three cases with subclinical hyperthyroidism (1.26% ) ,five ca-ses with subclinical hypothyroidism (2.10% ) and 25 cases with low T3 syndrome (10.50% );(2) Compared with normal FT3 group ,there were significant rise in levels of total cholesterol [TC ,(4.14 ± 1.59) mmol/L vs .(7.33 ± 1.72) mmol/L] ,apoprotein E [ApoE ,(3.91 ± 0.98) mmol/L vs .(4.55 ± 1.52) mmol/L] ,creatinine [Cr ,(97.99 ± 30.85)μmol/L vs .(116.64 ± 43.20) μmol/L] and N terminal pro brain natriuretic peptide [NT-proBNP ,140 (62~462) pg/ml vs .739 (304~4922) pg/ml] in low T3 group , P<0.01 all;(3) In CHD patients ,percentage of triple-vessel coronary disease in low FT3 group was significantly higher than that of normal FT3 group (76.0% vs . 40.1% , P<0.01) .Conclusion:Low free thyroxine syndrome is a most frequent thyroid dysfunction in patients with coronary heart disease ,and patients with low free thyroxine are more likely to involve multi-vessel disease .

Changes of iodothyronine deiodinase type 1 and type 3 mRNA level and activity in liver of mice with endotoxemia / 中华实用儿科临床杂志

Objective To explore the effect of endotoxemia on triiodothyronine (T3) and thyroxine (T4),and the level and activity of iodothyronine deiodinase type 1 and type 3 mRNA.Methods Sixteen mice were randomly divided into control group and lipopolysaccharide (LPS) group,with 8 mice in each group.The mouse model of endotoxemia was replicated in the LPS group.In the both groups,blood samples from femoral week were collected to assay T3 and T4 levels,and the livers were sampled to inspect D1 and D3 mRNA levels and activities.Serum T3 and T4 levels were assayed with radioimmunoassay,D1 and D3 mRNA levels in liver were detected with real-time polymerase chain reaction,the activity of D1 and D3 in liver were measured by using ion-exchange chromatography combined with immunoassay.The data were statistically analyzed by SPSS 13.0 software.Results Statistical differences of T3,D1 and D3 mRNA levels and activities between the 2 groups were found (all P ＜0.01),while,there was no statistic difference in the statuses of T4 (P ＞ 0.05).Conclusions It is possible that euthyroid sick syndromes happens in endotoxemia episodes,and the changes of D1 and D3 mRNA levels and activities are the possible influencing factors.

The clinical features of acute coronary syndrome combined with low T3 syndrome / 中国医师进修杂志

Objective To investigate the clinical features of acute coronary syndrome (ACS) combined with low T3 syndrome and its prognosis.Method Eighty-seven ACS patients with low free triiodothyronine (FT3) level (low FT3 group) and additional 64 ACS patients with normal FT3 level(control group) were selected in parallel; all the patients underwent coronary angiography.The contents of FT3,N-terminal pro-brain natriuretic peptide (NT-proBNP),cardiac troponin I (cTnI) and high sensitivity-C reactive protein (hs-CRP) were recorded,and the related factors were evaluated.The number of stenotic vessels was calculated.Results The contents of NT-proBNP,cTnI and hs-CRP in low FT3 group were elevated significantly compared with those in control group [(1242.14 ± 226.32) ng/L vs.(1126.36 ±195.55) ng/L,(0.92 ± 0.23) ng/L vs.(0.84 ± 0.19) ng/L,(6.46 ± 2.25) mg/L vs.(5.71 ± 1.78) mg/L],and there were significant differences (P ＜ 0.01 or ＜ 0.05).The contents of FT3 were negatively correlated with NT-proBNP,cTnI and hs-CRP in two groups (P ＜ 0.05).There was no significant difference in the number of stenotic vessels between two groups (x2 =4.512,P =0.105).Conclusion In patients with ACS,there is a negative correlation between contents of FT3 and the prognosis,but there is no correlation between contents of FT3 and the number of stenotic vessels.

Preventive efficacy of oral small-dose thyroid hormone tablet premedication for a short time on euthyroid sick syndrome in children undergoing open heart surgery under cardiopulmonary bypass / 中华麻醉学杂志

Objective To evaluate the preventive efficacy of oral small-dose thyroid hormone tablet premedication for a short time on euthyroid sick syndrome (ESS) in children undergoing open heart surgery under cardiopulmonary bypass (CPB) .Methods Forty ASA Ⅰ or Ⅱ children aged 3-12 yr, weighing 10-30 kg, scheduled for elective congenital heart disease surgery under CPB, were randomly allocated into 2 groups ( n = 20 each):placebo group (group P) and thyroid hormone tablet group (group T). Group T received oral thyroid hormone tablets 0.4 mg/kg every day for 4 consecutive days before surgery, while group C were given placebo. CPB was routinely established, and mild hypothermia, moderate hemodilution and high flow perfusion were adopted. Blood samples were taken from radial veins before administration (baseline) and on 1st, 2nd and 4th day after surgery to detect the serum concentrations of triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH).SP, DP and HR were recorded before administration, immediately after surgery, and on 1st and 2nd day after surgery. The endotracheal extubation time, length of ICU stay, application of positive inotropic agents and occurrence of ESS were recorded. Results No significant difference was found in hemodynamic parameters, endotracheal extubation time and length of ICU stay between the two groups ( P ＞ 0.05). As compared with the baseline values,the serum T3 levels on 1st, 2nd and 4th day after surgery, and the serum TSH levels on 1 st day after surgery were significantly decreased in the two groups, and the serum T4 levels were significantly decreased on 1 st day after surgery in group P ( P ＜ 0.05). The serum levels of T3 and T4 were significantly higher, the severity of postoperative ESS and the number of positive inotropic agent administration were significantly lower in group T than in group P (P ＜ 0.05 ). Conclusion Although oral small-dose thyroid hormone tablet premedication for 4 days (0.4 mg/kg per day) can reduce the severity of postoperative ESS, but it can not prevent the occurrence of ESS in children undergoing open heart surgery under CPB.

Circulating IL-8 and IL-10 in Euthyroid Sick Syndromes following Bone Marrow Transplantation

It is generally agreed that euthyroid sick syndromes (ESS) are associated with an increased production of cytokines. However, there has been scarce data on the relationship thyroid hormone changes and cytokines among the patients undergoing bone marrow transplantation (BMT). Because interleukin-8 (IL-8) has been identified as a potent proinflammatory and interleukin-10 (IL-10) as an antiinflammatory cytokine, we studied the relation between thyroid hormone parameters and these cytokines following BMT. We studied 80 patients undergoing allogeneic BMT. Serum T3 decreased to nadir at post-BMT 3 weeks. Serum T4 was the lowest at the post-BMT 3 months. Serum TSH sharply decreased to nadir at 1 week and gradually recovered. Serum free T4 significantly increased during 3 weeks and then returned to basal level. Mean levels of serum IL-8 significantly increased at 1 week after BMT. Mean levels of serum IL-10 significantly increased until 4 weeks after BMT. No significant correlation was found between serum thyroid hormone parameters and cytokines (IL-8, IL-10) after adjusting steroid doses during the entire study period. In conclusion, ESS developed frequently following allogeneic BMT and cytokine levels were increased in post-BMT patients. However, no significant correlation was found between serum thyroid hormone parameters and these cytokines.

A Case of Nonthyroidal Illness Syndrome in a Patient with Severe Liver Cirrhosis with Difficult Differential Diagnosis from Central Hypothyroidism

BACKGROUND: The nonthyroidal illness syndrome, alternately known as the euthyroid sick syndrome, usually occurs in individuals who have non-thyroidal illness of varying severity. Most prominent is the generally used name the 'low triiodothyronine (T3) syndrome', but recently authors have experienced a case of non-thyroidal illness syndrome in a patient with liver cirrhosis with difficult differential diagnosis from central hypothyroidism. Therefore, we report it with a review of the literature. CASE: A 39-year old female came to our outpatient clinic due to liver cirrhosis. During symptomatic treatment, her pitting edema was changed into non-pitting. She had low levels of serum T3, free thyroxine (FT4) and thyroid-stimulating hormone (TSH) by third-generation assay. The thyroid function test results were same after dopamine was discontinued. To rule out central hypothyroidsm, 24-hour urinary free cortisol was measured and was within normal limits with 41.9microgramml/day (reference intervals 21-85microgram/ml/day). She became worse, then died as a results of hepatic encephalopathy and hepatorenal syndrome complicated from liver cirrhosis. CONCLUSIONS: In patients with nonthyroidal illness, the degree and the rate of reduction in thyroid hormone levels appears to be correlated with the severity of nonthyroidal illness and may predict prognosis in some cases including severe liver diseases. Low serum levels of T3, FT4, TSH in patients with severe non-thyroidal illness should be distinguished from levels in patients with central hypothyroidism. Central hypothyroidism can often be ruled out in patients with severe nonthyroidal illness syndrome by evaluating appropriate elevated levels of cortisol.

Thyroid function in patients with severe acute respiratory syndrome / 中华内分泌代谢杂志

Plasma thyroid hormones were measured in 8 patients with severe acute respiratory syndrome (SARS). The results showed that plasma TT_3 and FT_3 levels were decreased and plasma rT_3 level tended to increase in these patients. These findings are in accord with the diagnosis of low T_3 syndrome.