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Background: The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome. Any acute severe illness can cause abnormalities of circulating Thyroid Stimulating Hormone (TSH) or Thyroid Hormone (TH) levels in the absence of underlying thyroid disease. The laboratory parameters of this syndrome include low serum levels of T3 and high levels of reverse T3, with normal or low levels of thyroxine (T4) and normal or low levels of TSH. This condition may affect 60-70% of critically ill patients. The severity of illness correlates well with the reduction in total serum T3 level. Objectives of the study was to assess the thyroid status of critically ill patients admitted in intensive care unit of a tertiary care hospital.Methods: This is a retrospective observational study done at Department of General Medicine, MIMS, Mandya among patients admitted with critical illness to ICU. 100 patients admitted with critical illness to ICU are included in this study. Thyroid function reports obtained from case sheets, data entered into MS Excel sheet and analysed.Results: Out of 100 patients studied 34 patients had sepsis, 26 patients had respiratory failure, 20 patients had Congestive cardiac failure, 12 patients had acute renal failure and 8 patients had Diabetic ketoacidosis. Among 100 patients 63% had abnormal thyroid function test, 56% had low T3, 12% had low T4, 2% had high T4 and 3% had low TSH.Conclusions: Thyroid function abnormality suggesting Non thyroid illness or euthyroid sick syndrome is common among critically ill patients.
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Chronic Kidney failures are progressive diseases and are divided into stages 1 to 5 based on the severity. Glomerular filtration rate (GFR) falls as the severity of kidney failure increases. Hypothyroidism was found to be present along with chronic renal failure and a presence of Low T3 was associated with increased chance of mortality due to cardiovascular complications. Significant association was known to exist in between thyroid dysfunction and chronic kidney disease progression. Aims & objectives: To study the pattern of thyroid dysfunction in chronic kidney disease population (who are not dialyses dependent) admitted at a tertiary care hospital of Tripura & to evaluate the correlation existing in between severity of kidney failure and thyroid dysfunction. Methods: 260 chronic kidney disease patients were included in the study. Diagnosis of chronic kidney failure was performed as per criteria laid down by Kidney Disease Outcome Quality Initiative. Blood was drawn for estimation of serum creatinine, GFR and thyroid profile. Data collected were analysed statistically and P≤0.05 was considered statistically significant. The statistical software namely SPSS 15.0 were used for statistical data analysis. Results: Among 260 individuals 138 were male and 122 female with age ranging from 20 to 82 years with mean age of 60.08±11.35 years. Calculation of GFR showed a mean GFR of 35.37±26.20 & mean serum creatinine level of 2.74±1.61mg/dl. Of the 260 patients, 68(26.1%), 74(28.5%), 74(28.5%), 31(11.9%) & 13(5%) patients belonged to CKD Stages 5,4,3,2 & 1 respectively. Low T3 is the most common thyroid dysfunction & the earliest abnormality noticed in CKD patients. The prevalence of low T3 syndrome in this study was 41.5 %( n=108). Increasing trend for Low T3 prevalence with increasing severity of CKD was noticed in this study and was statistically significant(P<O.001). The prevalence seen for LowT3 was CKD1-7.7%; CKD2-16.1%; CKD3-29.7%; CKD4-50% & CKD5- 63.2%. Statistically significant correlation was also seen with increasing prevalence of hypothyroidism & fall in GFR as the severity of kidney dysfunction increased (P<0.001). Conclusion: The present study was done to study the correlation of thyroid dysfunctions and chronic kidney diseases. It was observed that hypothyroidism both subclinical and overt exist with CKD and the most early and common dysfunction was lowT3 syndrome. The prevalence of thyroid dysfunction increase significantly as kidney failure progress .Low T3 is associated with increased chance of mortality due to cardiovascular complications and serves as a prognostic indicator in CKD individuals.
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Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with CKD. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases . Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine under nephrology unit, Dr. Bhimrao Ambedkar Hospital Raipur (C.G.), during the period of February 2018-March 2018 were selected in this prospective study. The result showed that out of the 50 patients with CKD 29 patients had low T3 syndrome (0.2-2.0ng/ml, mean 0.67) which accounts for 58% of the patients, 12 patients had low T4 syndrome (0.5-8.5μg/ml, mean 5.65) which accounts for 24% of the patients and 4 patients had primary hypothyroidism TSH >20μIU/ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance, p < 0.001. Thyroid Dysfunction occurred in 66%% of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness/malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure
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Objective To explore the correlation of metabolic syndrome (MS ) with low triiodothyronine(T3)syndrome(LT3S ,or It is known as ESS :euthyroid sick syndrome) ,subclinical hypothyroidism (SCH )and a high serum total homocysteine (tHcy )level (hyperhomocysteinemia )in elderly patients. Methods We retrospectively analyzed thyroid function ,serum glucose ,lipids and homocysteine(Hcy)level in 83 MS patients(MS group) ,30 patients with low T3 syndrome(low T3 group) ,41 patients with SCH (SCH group)and 80 healthy individuals (control group)aged over 60 years from January 2015 to March 2017 in outpatient and inpatient departments of our hospital. The correlations of thyroid function and serum Hcy level with MS components were analyzed by multiple Logistic regression model. Results The incidence of low T3 syndrome and SCH in MS patients was 37.3％ (31/83)and 49.4％ (41/83) ,respectively.Low T3 group versus control group showed the lower levels in free triiodothyronine ,FT4 ,folic acid ,and Hcy ,with statistically significant differences (all P<0.05).SCH group versus control group showed a lower levels of FT 4 ,of Hcy and of folic acid ,but an increased TSH level ,with statistically significant differences (all P<0.05).Patients with TSH >5.5 mU/L had decreased FT3 which occurred later than the rise of TSH (P<0.05) .Univariate correlation analysis showed that FT3 was negatively correlated with Hcy (P< 0.01) ,and TSH was negatively correlated with high-density lipoprotein cholesterol(P<0.01).Multivariate linear regression analysis found linear correlations of TSH with triglyceride ,high-density lipoprotein cholesterol ,and Hcy(all P < 0.05).Logistic regression analysis showed that FT3 ,Hcy and TSH are highly associated with hypertension after adjustment for gender and body mass index (all P< 0.05).Decreased FT3(P<0.01) ,elevated Hcy(P<0.05) ,and increased TSH(P<0.05)were independent risk factors for MS in elderly patients. Conclusions The incidences of low T3 syndrome and SCH are increased with aging. FT3 ,TSH ,and Hcy are independent risk factors for MS in the elderly.
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Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) combined with hypothyroidism, and to explore the correlation between thyroid function and AMI. Methods The clinical data of 511 patients with AMI combined with hypothyroidism were retrospectively analyzed. According to thyroid function, patients were divided into hypothyroidism group (n=40), subclinical hypothyroidism group (n=67), low T3 syndrome group (n=52) and normal thyroid function group (the normal group, n=352). The general situation, biochemical indexes, coronary lesions and echocardiographic indexes were compared between the four groups. Multivariate Logistic regression analysis of the influencing factors of hypothyroidism were analysed in patients with myocardial infarction. Results Compared with the control group, patients showed higher age, increased proportion of hypertension, Gensini score and lower level of high-density lipoprotein cholesterol (HDL-C) in the hypothyroidism group and the low T3 group (P<0.05). Compared with the control group, the level of low-density lipoprotein cholesterol (LDL-C) was significantly elevated, left atrial diameter (LAD) increased, and left ventricular ejection fraction (LVEF) decreased in hypothyroidism group (P < 0.05). Logistic regression analysis showed that advanced age (OR=1.038), hypertension (OR=1.992) and high level of LDL-C (OR=1.649) were the risk factors for the occurrence of hypothyroidism in patients with myocardial infarction, and the high level of HDL-C ( OR=0.172), free triiodothyronine (FT3, OR=0.550) and LVEF (OR=0.953) may be protective factors. Conclusion Patients with AMI and hypothyroidism show dyslipidemia, increased coronary stenosis, cardiac insufficiency, and the lower level of FT 3. In the early clinical stage, the development of myocardial infarction can be predicted from the thyroid function in patients, especially the level of FT3.
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Low-triiodothyronine syndrome is a condition characterized by decreased total serum T 3 and free T3 , along with in-creased serum reverse triiodothyronine but normal levels of thyroxine and thyrotropin .However , it is not caused by the thyroid gland diseases.The latest research progress of mechanisms , diagnosis and clinical significance , and therapy strategy of low T 3 syndrome is reviewed in this paper .
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Objective To analyze the severity of coronary artery lesions and the prognosis in patients with low levels of free triiodothyronine (fT3)undergoing coronary angiography (CAG). Methods From August 2011 to August 2012, 600 consecutive suspected patients with coronary heart disease (CHD) who undergone CAG were selected. The patients were divided into two groups based on thyroid function prior to CAG:euthyroidism group (450 patients) and low T3 group (150 patients). All the patients underwent elective coronary angiography, then the severity of coronary artery lesions was assessed by the Gensini scores , and the patients were followed up for cardiovascular events. Results The incidence rate of CHD in low T3 group was significantly higher than that in euthyroidism group (P=0.01). Multiple variables logistic regression analysis showed that fT3 was a protective factor for CHD (OR = 0.351,P < 0.001); The severity of coronary artery lesions was greater in low T3 group than in euthyroidism group (P < 0.001). The mean duration of follow-up was (15.4 ± 3.6) months; the incidence of the composite end-point (death, non-fatal myocardial infarction and target vessel revascularization ) was significantly higher in low T3 group than in euthyroidism group (P=0.023). Conclusions Patients with a decreased T3 level has a higher incidence rate of CHD , an increase in the severity of coronary artery lesions , and a poorer prognosis.
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Objective To investigate the prevalence of low T3 syndrome in patients with acute myocardial infarction(AMI) and explore the effect of low T3 syndrome on outcome of AMI.MethodsThree hundred and thirty-eight patients with AMI admitted to cardiac care unit(CCU) underwent examinations of thyroid function and cardial ultrasound,and were further categorized according to thyroid hormone profile.The records of noninvasive bi-level positive airway pressure(BiPAP)ventilation utilization,length of hospital stay,mortality during hospitalization were evaluated,and the related factors were analysed.ResultsOne hundred and thirty-nine of the 338 patients(41.12%) with AMI complicated with low T3 syndrome.Free triiodothyronine(FT3) was the independent influential factor for length of hospital stay.Low FT3 was significantly correlated with noninvasive BiPAP ventilation utilization and mortality during hospitalization.The average time of follow-up was(21.4?8.1) months.It was revealed by multivariate Cox regression analysis that FT3 was the chief predictor for cumulative death(risk ratio,4.25;95% confidential interval,2.30-7.87),followed by age and left ventricular ejection fraction.ConclusionThe recognition of AMI complicated with low T3 syndrome plays an important role in predicting the disease severity and outcome.
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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.