Research progress in thyroid hormone replacement therapy for low T3 syndrome / 中国综合临床

Low triiodothyronine syndrome (LT3S) is an abnormal alteration of thyroid hormone levels in patients with acute and severe illnesses in certain disease states, without clinical symptoms corresponding to altered thyroid function. There is a clear correlation between LT3S and the severity of the patient's condition and prognosis. The lower the triiodothyronine (T3) level is, the more severe the patient's condition is, and combined with acute physiology and chronic health score and other indicators, it can predict the prognosis of the patient's condition. The mechanism of occurrence and development of LT3S is relatively complex. In the early stage, it may be the adaptive change of the body to the stress condition. With the aggravation and extension of the disease course, it may participate in the disease progression.Current guidelines mostly do not recommend hormone replacement therapy (HRT) for patients with LT3S. New and more unified observational indicators should be available to fully verify the effectiveness of TH therapy.

Low triiodothyronine syndrome is associated with platelet function in patients with nephrotic syndrome

SUMMARY OBJECTIVE The objective of this study was to investigate the effects of low triiodothyronine syndrome (LT3S) on platelet function and clotting factors in patients with nephrotic syndrome(NS). METHODS Patients with primary nephrotic syndrome were divided into two groups, normal thyroid function (group A) and LT3S (group B), based on whether they had LT3S or not. Healthy subjects were selected as the control group (group C). Blood coagulation function was detected in each group. The platelet activation function (CD62P, CD63) was determined by flow cytometry. The platelet aggregation rate was detected by an optical method using adenosine diphosphate and arachidonic acid as inducers. RESULTS The proportion of primary nephrotic syndrome with LT3S was 23.2% (69/298). Compared with group C, group A had higher CD62P and PAgTADP, and group B had higher CD62P, CD63, PAgTAA, and PAgTADP; the difference was statistically significant (all P < 0.05). There was no significant difference in renal pathology between group A and group B (X2 = 4.957, P = 0.421). Compared with group A, the 24-hour urine protein, CD63, PAgTAA, and PAgTADP were higher in group B, and APTT and Alb were lower. The difference was statistically significant (P < 0.05). Logistic regression analysis showed that LT3S was associated with CD36 (OR: 3.516; 95% CI: 1.742~8.186; P = 0.004) and PAgTAA (OR: 0.442; 95% CI: 1.001~1.251; P = 0.037). CONCLUSION NS patients are prone to LT3S. Patients with LT3S may have abnormal platelet activation and increase of platelet aggregation.

RESUMO OBJETIVO O objetivo deste estudo foi investigar os efeitos da síndrome do baixo triiodotironina (LT3S) na função plaquetária e nos fatores de coagulação em pacientes com síndrome nefrótica (SN). MÉTODOS Pacientes com síndrome nefrótica primária foram divididos em dois grupos, função tireoidiana normal (grupo A) e LT3S (grupo B), com base na presença ou não de LT3S. Indivíduos saudáveis foram selecionados como grupo de controle (grupo C). A função de coagulação do sangue foi analisada em cada grupo. A função de ativação plaquetária (CD62P, CD63) foi determinada por citometria de fluxo. A taxa de agregação plaquetária foi detectada por um método óptico usando adenosina difosfato e ácido araquidônico como indutores. RESULTADOS A proporção de síndrome nefrótica primária com LT3S foi de 23,2% (69/298). Em comparação com o grupo C, o grupo A apresentou níveis mais altos de CD62P e PAgTADP, e o grupo B apresentou maiores CD62P, CD63, PAgTAA e PAgTADP; a diferença teve significância estatística (P < 0,05). Não houve diferença significativa na patologia renal entre o grupo A e o grupo B (X2 = 4,957, P = 0,421). Em comparação com o grupo A, a proteína em urina de 24 horas, CD63, PAgTAA e PAgTADP foram maiores no grupo B, já APTT e Alb foram mais baixos. A diferença apresentou significância estatística (P < 0,05). A análise de regressão logística mostrou uma associação entre LT3S e CD36 (OR: 3,516; 95% IC: 1,742~8,186; P = 0,004) e PAgTAA (OR: 0,442; 95% IC: 1,001~1,251; P = 0,037). CONCLUSÃO Pacientes com síndrome nefrótica estão propensos à síndrome do baixo triiodotironina (LT3S). Pacientes com LT3S podem ter ativação plaquetária anormal e aumento da agregação plaquetária.

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.

Clinical study on intervention of shenfu decoction in critically ill patients with spleen-kidney yang deficiency type low triiodothyronine syndrome / 中草药

Objective To evaluate the efficacy of Shenfu Decoction in treatment of critically ill patients with spleen-kidney yang deficiency type low triiodothyronine syndrome (LT3S). Methods Totally 110 critically ill patients with spleen-kidney yang deficiency type LT3S were randomized into two groups. Control group used standard Western treatment; Treatment group was given the combination of Western treatment and Shenfu Decoction; each group was treated for 7 d. The therapeutic effect indexes were serum T3, serum T4, serum TSH, APACHE II score, hospital day, results of treatment, and therapeutic efficacy of TCM syndromes. Results After treatment, the APACHE II score in control and treatment groups have been significantly improved (P < 0.05, 0.001). Compared with control group, the score in treatment group declined more drastically, and difference between two groups was statistically significant (P < 0.05); The serum T3 levels have been significantly improved in both groups and improved more in treatment group, and the difference between two groups was statistically significant (P < 0.05); The hospital day of treatment group was shorter than control group after treatment, and the difference between two groups was statistically significant (P < 0.05); The symptoms score progressed in both groups after treatment and have been significantly improved in treatment group, and the difference between two groups was statistically significant (P < 0.05); The treatment group had more significant clinical curative effect after treatment (P < 0.05). Conclusion Shenfu Decoction in critically ill patients with spleen-kidney yang deficiency type LT3S could improve the clinical curative effect, progress the TCM syndromes and results of treatment, and shorten the hospital stay.

Low triiodothyronine syndrome can predict poor prognosis in peritoneal dialysis patients / 上海交通大学学报（医学版）

Objective· To investigate the prevalence of low triiodothyronine syndrome (LT3S) in peritoneal dialysis (PD) patients and to evaluate the predictive value of long-term prognosis. Methods · From Jan. 2009 to Dec. 2015, all patients who started PD for 3 months were enrolled. According to thyroid hormone levels, there were classified into LT3S group (218 cases) and normal T3group (259 cases). The association between FT3and mortality in PD patients was estimated using Cox risk regression model. Results · Compared to the patients in normal T3group, patients with LT3S had lower hemoglobin[(97.90±23.71)g/L vs(105.54±22.94)g/L],adjusted serum calcium[(2.06±0.35)mmol/L vs(2.17±0.27)mmol/L](all P<0.01).Patients with LT3S had higher BNP{[311.00(134.59,776.00)pg/mL]vs[159.00(58.28,378.75)pg/mL]},hrCRP{[2.85(0.95,6.81)mg/L]vs[1.34(0.54,3.32)mg/L]}and serum total cholesterol[(3.18±1.29)mmol/L vs(2.76±0.93)mmol/L]than that in patients with normal T3group(all P<0.01).LVMI of LT3S group [(154.16±58.15)g/m2] vs (125.24±42.67)g/m2] was much higher than that of normal T3group (P<0.01). Cox risk regression model indicated that FT3 was significantly associated with all-cause mortality(HR 0.51,95% CI 0.41-0.63;P<0.01)and cardiovascular mortality(HR 0.60,95% CI 0.45-0.81;P<0.01). Conclusion·LT3S is common in PD patients.Lower FT3was an independent risk factor of all-cause and cardiovascular mortality in PD patients.

Contrastive analysis of low triiodothyronine syndrome and acute physiology and chronic health evaluation Ⅱ score on prognosis evaluation value in critical patients / 中国医师进修杂志

Objective To study the incidence of low triiodothyronine (T3) syndrome in critical patients,and compare the prognosis evaluation value between low T3 syndrome and acute physiology and chronic health evaluation (APACHE) Ⅱ score.Methods A total of 160 critical patients were enrolled.APACHE Ⅱ score of patients were recorded at admission,and thyroid hormone levels were measured on the first and the third day after admission.The patients who were low T3 level were enrolled into observation group,and the patients who were normal T3 level were as control group.The patients were followed up for 28 d,then were divided into death group and survival group according to the prognosis.The prognosis evaluation value was compared between T3 and APACHE Ⅱ score by receiver operating characteristic (ROC) curve.Results The incidence rate of low T3 syndrome was 25.6％ (41/160).During the follow-up phase,the fatality rate in observation group was 41.5％(17/41),and in control group was 29.4％ (35/119),there was statistical difference (P ＜ 0.05).The ROC area under curve of T3 was 0.657 (95％ CI:0.712-0.846),APACHE Ⅱ score was 0.672 (95％ CI:0.721-0.857),and there was no statistical difference (P ＞ 0.05).Best cut-off value of T3 was 0.41 μ g/L resulting in 76.9％(40/52) sensitivity and 78.7％(85/108) specificity.Conclusion Critical patients complicated with low T3 syndrome has poor prognosis,and T3 may be a predictive marker in evaluating the prognosis of critical patients.

Clinical significance of low triiodothyronine syndrome in critical patients and triiodothyronine impact on evaluation of prognosis / 中华急诊医学杂志

Objective To identify the clinical significance of low triiodothyronine syndrome and the potential impact of triiodothyronine (T3) on prognosis in critical patients.Methods A total of 150 critically ill patients enrolled from October 2012 to April 2013 were divided into two groups,namely low thyroidhormone group (n =38,group A) and normal T3 group (n =112,group B).APACHE Ⅱ scores of patients were recorded at admission and thyroid hormone levels were measured on the first and the third day after admission.Then the survival state of 28-day in each group was observed and then the relationship between prognosis and T3 levels was analyzed by receiver operating characteristic (ROC) curve.Results About 25.3％ of 150 critical patients were suffered from low thyroidhormone syndrome and the mortality rate in this group was 42.1％,which was much higher than 29.5％ in normal T3 group.There was no difference in prediction of death rate analyzed by ROC curve between the T3 level and APACHE Ⅱ scores.The area under curve of T3 level was 0.768 (95％ CI:0.701-0.835) and APACHE Ⅱ was 0.783 (95％CI:0.719-0.846).Best cut-off value of T3 level was 0.41 ng/mL resulting in 76.6％ sensitivity and 78.4％ specificity.Conclusions Critically ill patients complicated with low thyroidhormone syndrome has poor prognosis and T3 may be a predictive marker in evaluating the prognosis of critically ill patients.

Levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome / 中华临床感染病杂志

Objective To evaluate the efficacy of low-dose levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome(ESS). Methods One hundred and twenty inpatients with severe pulmonary tuberculosis and ESS were randomly divided into treatment group and control group by gender, age, disease duration and severity. Both groups were given anti- tuberculosis, antiinfection treatment and nutritional support for 2 weeks; patients in treatment group were given low-dose levothyroxine sodium additionally. Thyroid function, clinical improvements, increase of albumin, reduction of acid-fast bacilli, improvements on images and the mortality rates were compared between the groups.Results After 2 weeks of treatment, symptoms including fever, cough and night sweats were improved in both groups. Marked improvements were observed in 19 patients(31.7%)of treatment group and 8 patients (13.3%)of control group(χ2 = 5. 73, P ＜ 0.05). Clearance rate of acid-fast bacilli in treatment group was 25.0%(15/60), but that in the control was only 6.7%(4/60)(χ2 = 7. 50, P ＜ 0.01). Serum albumin in the treatment group was increased to(34.2 ±0.4)g/L after the treatment, and that in the control group was(29.1 ±0.6)g/L(t =2.42, P＜0.05). T3 and FT3 were significantly increased in both groups, but more significant difference was observed in the treatment group(t = 59. 42 and 50. 66, P ＜ 0. 01). No empty closed after treatment in both groups, but the effective rate in treatment group was significantly higher than that in the control group(93.3% vs. 76.7%, χ2 =6. 54, P＜0.05). Two patients in control group died(2/60, 3. 3%), while no death was reported in treatment group. Conclusions Low-dose levothyroxine sodium treatment is effective for ESS in patients with severe pulmonary tuberculosis.Improvement on low T3 syndrome may be an important indicator for the overall improvement or recovery.