The incidence of non-thyroidal illness syndrome in children with type 1 diabetes mellitus and correlated factors analysis / 中华实用儿科临床杂志

Objective:To explore the incidence of non-thyroidal illness syndrome (NTIS) in children with type 1 diabetes mellitus (T1DM) and the correlation between triiodothyronine level and the severity of T1DM, thus providing evidence for clinical diagnosis and treatment.Methods:A total of 125 children initially diagnosed as T1DM at the Department of Endocrinology and Genetic Metabolism of Children′s Hospital of Shanghai Jiao Tong University from January 2015 to December 2019 were recruited.The data were retrospectively analyzed.The incidence of NTIS in T1DM children was explored.T1DM children were classified into euthyroid group and NTIS group, two independent sample t-test were used to compare the differences in multiple factors between euthyroid group and NTIS group in children with T1DM, and Spearman correlation analysis was used to further analyze the correlation between the levels of free triiodothyronine (FT3), total triiodothyronine (TT3) and the severity of children with primary T1DM. Results:The incidence of NTIS in 125 T1DM children was 26.4%(33/125 cases). FT3, TT3, total thyroxine (TT4), thyrotropin (TSH), pH value, HCO 3- and high density lipoprotein cholesterol (HDL-C) levels in NTIS group were significantly lower than those of euthyroid group [(3.10±0.45) pmol/L vs.(4.85±0.75) pmol/L, (0.60±0.28) nmol/L vs.(1.05±0.38) nmol/L, (65.77±23.41) nmol/L vs.(89.57±18.23) nmol/L, (0.91±0.89) mIU/L vs.(2.05±0.76) mIU/L, 7.21±0.17 vs.7.31±0.18, (11.49±7.54) mmol/L vs.(16.80±8.38) mmol/L, (1.08±0.49) mmol/L vs.(1.28±0.44) mmol/L]( t=4.56, 5.67, 4.48, 5.61, 2.82, 2.68, and 2.53, all P<0.05). Moreover, the anion gap (AG) level, blood glucose (BG) and triglyceride in NTIS group were significantly higher than those of euthyroid group [(22.53±8.33) mmol/L vs.(16.94±7.52) mmol/L, (24.85±4.71) mmol/L vs.(21.46±6.64) mmol/L, (2.72±2.05) mmol/L vs.(2.33±3.05) mmol/L]( t=3.22, 2.67 and 2.04, all P<0.05). The incidence of diabetic ketoacidosis (DKA) was statistically significant in euthyroid group, NTIS group and abnormal thyroid disease group (33.3% vs.63.6% vs.35.7%)( χ2=8.990, P<0.05). In T1DM children, FT3 was positively correlated with pH value and HCO 3-, and negatively correlated with AG level ( r=0.376 9, 0.439 7 and -0.411 9, all P<0.05). In addition, TT3 was positively correlated with pH value and HCO 3-, and negatively correlated with AG and BG ( r=0.513 2, 0.539 8, -0.482 4 and -0.211 5, all P<0.05). Conclusions:Children with T1DM are prone to have abnormal thyroid hormone levels, and the incidence of NTIS was 26.4%.The incidence of DKA differed in T1DM children with different thyroid functions.FT3 or TT3 level may contribute to evaluate the disease severity of T1DM children.

Effect of non-thyroidal illness syndrome on thyroid function and its prognosis in children / 中华实用儿科临床杂志

Some systemic diseases also can cause changes in thyroid hormone levels in the human body,called the non-thyroidal illness syndrome (NTIS),which occur in both children and adults.NTIS is more common in neonates,surgical patients,patients at intensive care unit and patients with genetic disease patients.Deiodinase activity,hypothalamic-pituitary-thyroid axis,thyroid hormone transporters,serum binding proteins,nuclear thyroid hormone receptors,cytokines,and oxidative stress are factors for developing NTIS.The prognosis of NTIS is often adaptive and self-limiting.The treatment of thyroid hormone supplementation during the disease needs further study.

Symptomatic Hypothyroidism after Aortic Valve Replacement in an Octogenarian / 日本心臓血管外科学会雑誌

Surgical stress is closely associated with the activity of the thyroid hormone. Although many patients undergoing cardiac surgery revealed markedly low triiodothyronine (T3), few patients showed symptomatic hypothyroidism. This condition is generally recognized as “non thyroidal illness (NTI) ” which is characterized by a low T3 level, despite the normal function of hypothalamus-pituitary-thyroid system. NTI is generally considered as one of the biological defense mechanisms rather than a pathological condition, eliminating the requirement of medical intervention. Even if low T3 is observed in blood biochemical examination after open heart surgery, a cautious interpretation is required. We report an elderly case presenting severe fatigue and mild disorientation accompanied by significantly low thyroid hormone after aortic valve replacement. The morbidity was remarkably improved with medical treatment, suggesting hypothyroidism after cardiac surgery.

Predictive value of non-thyroidal illness syndrome before definitive operation on postoperative surgical site infection in patients with enterocutaneous fistula / 中华消化外科杂志

Objective To investigate the predictive value of non-thyroidal illness syndrome (NTIS) before definitive operation on postoperative surgical site infection (SSI) in patients with enterocutaneous fistula (ECF).Methods The retrospective case-control study was conducted.The clinical data of 264 ECF patients (181 with euthyroidism and 83 with NTIS) who underwent definitive operation in the Nanjing General Hospital of Nanjing Military Command between April 2014 and November 2016 were collected.After definitive operation,86 with SSI and 178 without SSI were respectively allocated into the SSI group and non-SSI group.Observation indicators:(1) risk factor analysis of postoperative SSI;(2) effect of preoperative NTIS on postoperative SSI;(3) predictive power of serum free triiodothyronine 3 (FT3) level on postoperative SSI.Measurement data with normal distribution were represented as x-± s and was analyzed using the t test.Count data were described as absolute number or percentage,and were analyzed using the chi-square test.The comparison of ordinal data was done by the nonparamentric test.The multivariate analysis was done using the logistic regression model.The receiver operating characteristic (ROC) curve was drawn,and area under the curve (AUC) was calculated for analyzing predictive power of serum FT3 level on postoperative SSI.Results (1) Risk factor analysis of postoperative SSI:cases with volume of preoperative intestinal fluid loss through fistula stoma ＜ 200 mL/24 hours,from 200 to 500 mL/24 hours and ＞ 500 mL/24 hours,preoperative hemoglobin (Hb) level,cases with surgical site located in stomach and duodenum,small intestine,ileocolon and colorectum,cases with open surgery and laparoscopic surgery were respectively 65,15,6,(119±36)g/L,5,50,31,36,58,28 in the SSI group and 135,27,16,(125±39)g/L,11,91,53,71,127,51 in the non-SSI group,with no statistically significant difference between groups (x2 =0.471,t =1.202,x2 =0.332,0.422,P＞0.05).Cases with preoperative single.and multiple fistula stoma,serum albumin (Alb) level,cases with preoperative NTIS,volume of intraoperative blood loss ＜ 300 mL and ≥ 300 mL,operation duration ＜ 3 hours and ≥ 3 hours were respectively 57,29,(35±.8)g/L,36,67,19,53,33 in the SSI group and 146,32,(37±9)g/L,47,161,17,140,38 in the non-SSI group,with statistically significant differences between groups (x2 =8.089,t =2.422,x2 =6.426,7.746,8.547,P＜0.05).Results of multivariate analysis showed that preoperative multiple intestinal fistula and NTIS were independent factors affecting occurrence of postoperative SSI in ECF patients (odds ratio =1.873,2.464,95％ confidence interval:1.052-2.671,1.120-4.392).(2) Effect of preoperative NTIS on postoperative SSI:incidence of preoperative multiple intestinal fistula,proportion of cases with preoperative enteral nutrition time ＞3 months,incidence of postoperative SSI,postoperative superficial and deep incision infection rates and organ/space infection rate were respectively 31.3％ (26/83),72.3％ (60/83),43.4％ (36/83),9.6％ (8/83),21.7％(18/83),7.2％ (6/83) in patients with NTIS and 19.3％(35/181),57.5％(104/181),27.6％(50/181),11.6％(21/181),3.9％(7/181),8.8％ (16/181) in patients with euthyroidism,with statistically significant differences in incidence of multiple intestinal fistula,proportion of cases with preoperative enteral nutrition time ＞ 3 months,incidence of postoperative SSI,superficial and deep incision infection rates (x2 =4.603,5.319,6.426,4.256,4.377,P＜0.05),and no statistically significant difference in organ/space infection rate (x2=0.193,P＞0.05).(3) Predictive power of serum FT3 level on postoperative SSI:the ROC curve showed that optimal cut-off point of serum FT3 predicting postoperative SSI was 3.5 pmol/L,AUC,sensibility and specificity were respectively 0.75,72.6％ and 68.7％.Conclusion The presence of NTIS is associated with occurrence of postoperative SSI in patients with ECF before definitive operation,and optimal cut-off point of serum FT3 predicting postoperative SSI is 3.5 pmol/L.

Enfermedad no tiroidea / Non-thyroidal illness

La enfermedad no tiroidea es una entidad que se presenta frecuentemente en los pacientes que se encuentran cursando algún tipo de enfermedad, ya sea crítica o no; y puede manifestarse aun en ausencia de enfermedad tiroidea subyacente, condicionando cambios en el eje tiroideo. Es importante poder reconocer la enfermedad no tiroidea para hacer diagnóstico diferencial con la patología tiroidea verdadera y evaluar si merece ser tratada. Aún no existe consenso acerca de si la enfermedad no tiroidea representa una respuesta fisiológica a una enfermedad sistémica para que disminuyan los requerimientos de energía o si se trata de una condición adaptativa que induce un estado hipotiroideo que finalmente resulta perjudicial a nivel tisular.

Non-thyroidal illness is a disorder that occurs frequently in patients that are experiencing some kind of illness, whether critical or not. It can manifest even in the absence of thyroid dysfunction, leading to changes in the thyroid axis. It is important to detect Non-Thyroidal Illness in order to establish a differential diagnosis with the true thyroid disease and to determine whether treatment is required. Currently, there is still no consensus on whether Non-Thyroidal Illness is a physiological response to a systemic disease to reduce energy requirements or whether it is an adaptive condition that induces a hypothyroid state that ultimately is harmful at the tissue level.

Changes in thyroid hormones in patients undergoing liver transplantation

BACKGROUND: Critical illness that requires major surgery is often associated with non-thyroidal illness syndrome (NTIS). The characteristic feature of NTIS is low serum triiodothyronine (T3) levels, and in severe illness, the levels of serum thyroxine (T4) are also low in the absence of a rise in thyroid stimulating hormone (TSH). However, little is known about the changes in thyroid hormones during and after liver transplantation (LT). This study was conducted in order to evaluate the intra- or postoperative changes in thyroid hormones. METHODS: Twenty-two patients who underwent LT were enrolled. Serum levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), free T3 (FT3) and free T4 (FT4) were measured immediately after the induction of anesthesia (T1), at the end of the anhepatic period (T2), at the end of the surgical procedure (T3), and at 24 hours (T4) and 120 hours postoperatively (T5). RESULTS: The mean levels of T3, T4, FT3, FT4 and TSH were significantly decreased throughout the study when compared with the T1 value. The mean levels of T3, T4 FT3 and TSH were below the normal range from T2, T4 and T5. CONCLUSIONS: We suggest that LT may induce NTIS by at least postoperative day 5. In the future, longer follow-up studies, and the effects of thyroid hormones on the prognosis and determination of the advantages and disadvantages of T3 replacement therapy to these patients will be required.

Study on non-thyroidal illness syndrome in patients with coronary artery disease / 中华内分泌代谢杂志

Objective To determine the prognostic significance of non-thyroidal illness syndrome(NTIS) and FT3 on long-term all-cause and cardiovascular mortality in patients with coronary artery disease(CAD).Methods A total of 1 354 patients underwent coronary angiograhy and participated in the study.After screening,984 patients with CAD were enrolled finally and divided into NTIS group and euthyroid group.The admitted patients were also classified into Tertile 1-3 groups based on FT3 value.The relationship of long-term all-cause and cardiovascular mortality with FT3 was investigated by multivariate Cox regression analysis.Results 129 out of 984 patients had NTIS.As FT3 value decreased,both long-term all-cause mortality (Tertile 1 group 9.6％,Tertile 2 group 11.5％,Tertile 3 group 20.9％,P＜0.01) and cardiovascular mortality (Tertile 1 group 4.5 ％,Tertile 2 group 7.2％,Tertile 3 group 11.0％,P＜0.01) gradually increased.After adjusting for all factors,FT3 (HR =0.614,95％ CI 0.439-0.859)was independently associated with long-term all-cause mortality.FT3 (HR =0.605,95％ CI 0.370-0.986)was also a risk factor for cardiovascular mortality.Conclusion NTIS exists in patients with CAD without myocardial infarction.FT3 reduction is an independent risk factor for long-term all-cause and cardiovascular mortality in patients with CAD.

Thyroid hormone alterations in trauma patients requiring massive transfusion: An observational study / 世界急诊医学杂志（英文）

@#BACKGROUND: Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported. METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation. RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL;P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 μIU/mL) were higher than at admission (1.48±0.5 μIU/mL) in group C (P<0.05). CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.