Incidencia del síndrome de baja triiodotironina en pacientes con shock séptico / Incidence of low-triiodothyronine syndrome in patients with septic shock

RESUMEN Objetivo: Se ha visto asociación entre los bajos niveles de hormonas tiroideas y malos resultados clínicos. Esta situación metabólica designada bajo el término de enfermedad eutiroidea, ha sido interpretada como un estado de adaptación a diferentes procesos patológicos, caracterizada por la disminución plasmática de triiodotironina T3. El presente estudio busca determinar la incidencia de este trastorno en los pacientes con shock séptico y su relación con otros índices de gravedad, y resultados clínicos. Métodos: Estudio de corte prospectivo analítico, evaluó a los pacientes que ingresaron con shock séptico a la unidad de terapia intensiva, durante el periodo abril 2018 - julio 2019. Se registraron variables asociadas al shock séptico, y el perfil tiroideo al momento del diagnóstico de shock séptico, a los 7, 14 y 21 días. Resultados: Se analizaron 27 pacientes que cumplieron con los criterios de inclusión. La incidencia de alteración del eje tiroideo fue del 96,3%s, con una mortalidad a los 28 días de 36,7%. Los pacientes sin alteración hormonal no presentaron desenlaces negativos. Entre los que presentaron baja triiodotironina, 42,3% recupero la función tiroidea dentro de los 28 días, con mortalidad del 0%. No recuperaron función tiroidea (57,7%), con una mortalidad del 66,7%. Comparativamente se observó que aquellos que presentaron alteración del eje y no normalizaron la función, requirieron más dosis de vasoactivos, y deterioro del clearence de lactato. Conclusión: Los pacientes con shock séptico presentan una alta incidencia de alteración del eje tiroideo y esta disfunción se asoció a mayor mortalidad.

ABSTRACT Objective: Low levels of thyroid hormones have been associated with poor clinical outcomes. This metabolic situation, designated euthyroid sick syndrome, has been interpreted as a state of adaptation to different pathological processes, characterized by the decrease in plasma triiodothyronine. The present study seeks to determine the incidence of this disorder in patients with septic shock and its relationship with other severity indices and clinical outcomes. Methods: This prospective analytical study evaluated patients admitted to the intensive care unit with septic shock between April 2018 and July 2019. Variables associated with septic shock and thyroid profile were recorded at the time of the septic shock diagnosis and 7, 14, and 21 days later. Results: A total of 27 patients who met the inclusion criteria were analyzed. The incidence of an altered thyroid axis was 96.3%, with a mortality at 28 days of 36.7%. Patients without hormonal alteration did not present negative outcomes. Among those with low triiodothyronine, 42.3% recovered their thyroid function within 28 days, in whom mortality was 0%; 57.7% did not recover their thyroid function, in whom mortality was 66.7%. Those whose thyroid axis was altered and who did not normalize its function required more doses of vasoactives and had deteriorated lactate clearance. Conclusion: Patients with septic shock have a high incidence of alteration of the thyroid axis, and this dysfunction is associated with higher mortality.

Association of non-thyroidal illness syndrome with interleukin-6 and interleukin-10 in critically ill children with sepsis / 中国当代儿科杂志

OBJECTIVE@#To study the incidence rate of non-thyroidal illness syndrome (NTIS) in critically ill children with or without sepsis and the association of NTIS with interleukin-6 (IL-6) and interleukin-10 (IL-10).@*METHODS@#A retrospective analysis was performed on the medical data of 97 children with sepsis (sepsis group) and 80 non-sepsis children with bacterial infection (non-sepsis group). The correlations of IL-6 and IL-10 with the thyroid function parameters triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) were analyzed.@*RESULTS@#There were no significant differences in age and sex between the sepsis and non-sepsis groups (P>0.05). Compared with the non-sepsis group, the sepsis group had a significantly higher Sequential Organ Failure Assessment score, a significantly longer length of hospital stay, and a significantly higher rate of use of ventilator (P0.05), but the pooled analysis of the two groups showed that IL-6 level was negatively correlated with T3 and T4 levels (P<0.001).@*CONCLUSIONS@#Children with sepsis have a higher incidence rate of NTIS than those without sepsis. The high level of IL-6 may be associated with the development of NTIS.

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.

Changes in the thyroid hormone profiles in children with nephrotic syndrome / 소아과

PURPOSE: We compared thyroid hormone profiles in children with nephrotic syndrome (NS) during the nephrotic phase and after remission. METHODS: This study included 31 pediatric NS patients. The thyroid hormone profiles included serum levels of triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and free T4. RESULTS: Of the 31 patients, 16 (51.6%) showed abnormal thyroid hormone profiles: 6 had overt hypothyroidism, 8 had subclinical hypothyroidism, and 2 had low T3 syndrome. The mean serum T3, T4, and free T4 levels in the nephrotic phase and after remission were 82.37±23.64 and 117.88±29.49 ng/dL, 5.47±1.14 and 7.91±1.56 µg/dL, and 1.02±0.26 and 1.38±0.23 ng/dL, respectively; the levels were significantly lower in the NS nephrotic phase (P=0.0007, P<0.0001, and P=0.0002). The mean serum TSH levels during the nephrotic phase and after remission were 8.05±3.53 and 4.08±2.05 µIU/ mL, respectively; they were significantly higher in the nephrotic phase (P=0.0005). The urinary protein/ creatinine ratio during the nephrotic phase was significantly correlated with serum T3, T4, and free T4 levels (r=-0.5995, P=0.0032; r=-0.5797, P=0.0047; r=-0.5513, P=0.0078) as well as with TSH levels (r=0.5022, P=0.0172). A significant correlation was found between serum albumin and serum T3 levels during the nephrotic phase (r=0.5385, P=0.0018) but not between serum albumin and T4, TSH, or free T4 levels. These significant correlations all disappeared after remission. CONCLUSION: Abnormal thyroid hormone profile findings were observed in 51.6% of pediatric patients with NS. Thyroid hormone levels normalized after remission, regardless of levothyroxine therapy.

Interpretation of puzzling thyroid function tests

With the generalized use of highly sensitive thyroid stimulating hormone (TSH) and free thyroid hormone assays, most thyroid function tests (TFTs) are straightforward to interpret and confirm the clinical impressions of thyroid diseases. However, in some patients, TFT results can be perplexing because the clinical picture is not compatible with the tests or because TSH and free T4 are discordant with each other. Optimizing the interpretation of TFTs requires a complete knowledge of thyroid hormone homeostasis, an understanding of the range of tests available to the clinician, and the ability to interpret biochemical abnormalities in the context of the patient's clinical thyroid status. The common etiologic factors causing puzzling TFT results include intercurrent illness (sick euthyroid syndrome), drugs, alteration in normal physiology (pregnancy), hypothalamic-pituitary diseases, rare genetic disorders, and assay interference. Sick euthyroid syndrome is the most common cause of TFT abnormalities encountered in the hospital. In hypothalamic-pituitary diseases, TSH levels are unreliable. Therefore, it is not uncommon to see marginally high TSH levels in central hypothyroidism. Drugs may be the culprit of TFT abnormalities through various mechanisms. Patients with inappropriate TSH levels need a differential diagnosis between TSH-secreting pituitary adenoma and resistance to thyroid hormone. Sellar magnetic resonance imaging, serum α-subunit levels, serum sex hormone-binding globulin levels, a thyrotropin-releasing hormone stimulation test, trial of somatostatin analogues, and TR-β sequencing are helpful for the diagnosis, but it may be challenging. TFTs should be interpreted based on the clinical context of the patient, not just the numbers and reference ranges of the tests, to avoid various pitfalls of TFTs and unnecessary costly evaluations and therapies.

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.

Insulin resistance and glucose levels in subjects with subclinical hypothyroidism

Objective: To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism

Study Design: Comparative cross-sectional study

Place and Duration of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology [AFIP], Rawalpindi, from December 2015 to September 2016

Methodology: Subjects referred for executive screening of apparently healthy population [without any known history of diabetes, hypertension, heart disease or other chronic ailments], were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism

Results: Median [IQR] insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 [n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mlU/L] and group-2 [n=26, 13%, Thyroid Stimulating Hormone: 3.51 -15 mlU/L] were 7.6 [6.70] vs. 11.4 [13.72, p=0.040] and 1.77 [1.79] vs. 2.8 [3.07, p=0.071]

The median differences for fasting plasma glucose were 5.0 [1.0] in group-1 vs. 5.0 [1.47] for Group-2 [p=0.618], and glycated hemoglobin was 5.60 [1.1] vs. 5.60 [1.7, p=0.824]. Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median [IQR] 86.67 [92.94]] than group-1 [111.6 [189.64, p= 0.040]]

Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism

Retrospective evaluation of circulating thyroid hormones in critically ill dogs with systemic inflammatory response syndrome

Critical illness can be associated with transient alterations in circulating thyroid hormone concentrations, indicating the presence of non-thyroidal illness (NTI). NTI is well described in humans, but there are few reports on its occurrence and prognostic significance in dogs. This retrospective study assessed the occurrence of NTI in a population of dogs with systemic inflammatory response syndrome (SIRS) and investigated its association with disease severity (APPLE(fast) scores). A total of 41 SIRS dogs were included and were divided by SIRS origin (non-septic SIRS, n = 10; septic SIRS, n = 41) and final outcome (survivors, n = 37; non-survivors, n = 4). Healthy, age-matched dogs (n = 15) were included as controls. Serum thyroid hormone levels including total T3, free T3, total T4, and reverse T3 were measured upon admission. Compared to controls, there were significant changes in serum thyroid hormone concentrations in SIRS dogs, suggesting the presence of NTI. Septic SIRS dogs had higher APPLE(fast) scores and lower serum thyroid hormones concentrations than those in non-septic SIRS and control dogs. In conclusion, NTI was frequent in dogs with SIRS and may be associated with the presence of sepsis or high illness severity.

Thyroxine increases Serca2 and Ryr2 gene expression in heart failure rats with euthyroid sick syndrome

ABSTRACT Objective The current study was aimed at analyzing sarcoplasmic reticulum Ca2+ ATPase (Serca2) and ryanodine receptor type 2 (Ryr2) gene expression in rats subjected to surgery that induced HF and were subsequently treated with T4 using physiological doses. Materials and methods HF was induced in 18 male Wistar rats by clipping the ascending thoracic aorta to generate aortic stenosis (HFS group), while the control group (9-sham) underwent thoracotomy. After 21 weeks, the HFS group was subdivided into two subgroups. One group (9 Wistar rats) with HF received 1.0 µg of T4/100 g of body weight for five consecutive days (HFS/T4); the other group (9 Wistar rats) received isotonic saline solution (HFS/S). The animals were sacrificed after this treatment and examined for signs of HF. Samples from the left ventricles of these animals were analyzed by RT-qPCR for the expression of Serca2 and Ryr2 genes. Results Rats with HF developed euthyroid sick syndrome (ESS) and treatment with T4 restored the T3 values to the Sham level and increased Serca2 and Ryr2 gene expression, thereby demonstrating a possible benefit of T4 treatment for heart function in ESS associated with HF. Conclusion The T4 treatment can potentially normalize the levels of T3 as well elevated Serca2 and Ryr2 gene expression in the myocardium in heart failure rats with euthyroid sick syndrome.

Thyroid abnormalities in term infants with fungal sepsis / Alterações tireoidianas no recém-nascido de termo com sepse fúngica

Summary Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Resumo Objetivo: descrever as alterações tireoidianas em recém-nascidos de termo (RNT) que apresentaram sepse fúngica durante internação na UTI neonatal. Método: foram incluídos seis RNT que, durante as manifestações clínicas e laboratoriais de sepse, com culturas positivas para fungo, apresentaram alterações dos hormônios tireoidianos, denominadas síndrome do T3 baixo e síndrome do T3 e T4 baixo. Foram excluídos RNT que apresentaram alteração hormonal por doença, como RNT filhos de mães com doença tireoidiana, asfixia perinatal e cirurgias de grande porte. Resultados: dos seis RNT com sepse fúngica, cinco apresentavam cultura positiva para Candida albicans e um para C. tropicalis. A síndrome do T3 baixo foi observada em duas crianças (50%) e a do T3 e T4 baixo em dois RN (100%). As quatro crianças evoluíram com choque séptico. Conclusão: a sepse fúngica é cada vez mais frequente nos recém-nascidos internados em UTI neonatal. A insuficiência tireoidiana pode vir a ser marcadora de gravidade da doença, e a suplementação hormonal pode ser necessária.

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

ABSTRACT Objective To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34.

Variação transcardíaca da concentração dos hormônios tireoidianos induzida por hipóxia miocárdica em pacientes submetidos à circulação extracorpórea / Transcardiac thyroid hormone variation induced by myocardial hypoxia in patients undergoing cardiopulmonary bypass

As doenças cardíacas são a principal causa de morte em todo o mundo. Os hormônios tireoidianos desempenham um papel chave no metabolismo miocárdico e na fisiologia do sistema cardiovascular. A doença cardíaca aguda ou crônica promove uma queda sistêmica da concentração dos hormônios tireoidianos que se associa a um prognóstico pior da doença e aumento da sua mortalidade. Essa redução dos hormônios tireoidianos pode ocorrer na presença de função normal da tireóide, entidade clínica conhecida por síndrome da doença não-tireoidiana ou síndrome do enfermo eutireoideo (SEE). A participação do músculo cardíaco na patogênese da SEE é desconhecida. O entendimento do papel do músculo cardíaco na SEE é essencial para o tratamento das doenças cardíacas. Este estudo se propõe a avaliar a variação dos hormônios tireoidianos promovida pelo metabolismo cardíaco nos pacientes submetidos a cirurgias cardíacas com diferentes graus de isquemia miocárdica aguda, bem como estudar os principais mecanismos envolvidos nessa variação. Para avaliar a variação sistêmica de hormônios tireoideanos induzida pela cirurgia cardíaca com e sem circulação extracorpórea (CEC), 35 pacientes com estenose aórtica grave e doença coronariana submetidos à cirurgia com CEC e 12 pacientes submetidos à cirurgia de revascularização miocárdica sem CEC tiveram as concentrações sistêmicas dos hormônios tireoidianos dosadas no início do procedimento cirúrgico, imediatamente antes do clampeamento da aorta, 3 minutos após o desclampeamento da aorta, 6 e 24h após o procedimento. Além disso, a avaliação da participação isolada do coração foi feita pela dosagem dos hormônios tireoidianos na raiz da aorta e no seio coronário antes e após a isquemia miocárdica aguda induzida pelo clampeamento da aorta. Foram ainda quantificadas, em amostras do tecido miocárdico colhidas após a CEC, a expressão do gene das desiodades, enzimas responsáveis pela conversão dos hormônios tireoidianos nos tecidos...

Heart diseases are the main cause of death over the world and thyroid hormones are key elements in myocardial metabolism and cardiovascular physiology. In heart disease patients, low thyroid hormone levels lead to a worse prognosis and increase in the mortality, even with regular thyroid function, in a condition known as Euthyroid Sick Syndrome (ESS). There is no evidence that myocardial tissue is involved in ESS pathophysiology. The better understanding of heart role might be important to optimal treatment of heart disease. The current study aims to evaluate thyroid hormones variation induced by myocardial metabolism in patients submitted to several acute myocardial ischemic intensities and study the main mechanisms associated to this condition. To reach this objective, 35 stable severe aortic stenosis coronary artery disease submitted to in-pump cardiac surgery and 12 patients submitted to off-pump myocardial revascularization surgery were analyzed at the procedure beginning, before aortic clamping, 3 minutes after aortic cross-clamp release, six and 24h after procedure by measuring thyroid hormones concentration in systemic circulation. Therefore, cardiac metabolism was evaluated alone by the thyroid hormones concentration measurement in aortic root and coronary sinus just before and after myocardial ischemia induced by aortic clamping, as well the gene expression of thyroid hormones metabolism related enzyme in myocardial tissue samples. There was a significant 37.6% reduction in T3 systemic concentration, a 261.6% elevation in rT3 and no variation in free T4 systemic values during the observation time in three groups. However, there were no statistically differences among the groups. Central analysis showed a 4.6% significant reduction in T3 and 6.9% increase in rT3 in coronary sinus, compared to aortic root, in aortic stenosis group before cardiopulmonary bypass. The same behavior was not observed in coronary artery disease before aortic...

Thyroid Disorders in Premature and Sick Newborns

Thyroid hormone is important in brain development. Thus, thyroid hormone deficiency during the critical period of brain development results in severe cognitive and motor dysfunctions. Along with the development of intensive care for premature infants, the survival rates of premature babies and the long-term complications associated with neurodevelopment and motor function have increased. Premature infants differ from full-term infants in terms of the change in thyroid hormone level after birth because of the immaturity of their hypothalamus-pituitary-thyroid axis. Therefore, the diagnostic and therapeutic criteria for hypothyroidism in premature infants still remain unclear. In addition, as the thyroid function of premature infants can be affected by various diseases or drugs, periodic thyroid function tests are required. Although transient hypothyroxinemia is known to spontaneously recover in most infants, some studies have shown further complications associated with neurodevelopmental disorders. Accordingly, although thyroid hormone therapy in preterm infants has been introduced, its efficacy is yet controversial. In order to understand the thyroid abnormalities observed in premature infants or patients in neonatal intensive care units, this article intends to present a comprehensive review of the physiology of the thyroid gland, transient hypothyroxinemia/delayed thyroidstimulating hormone elevation, and euthyroid sick syndrome that affects thyroid function.

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.

Disfunción tiroidea en adultos infectados por el virus de inmunodeficiencia humana

Los pacientes con infección por el virus de inmunodeficiencia humana (HIV) tienen una mayor prevalencia de disfunción tiroidea cuando se los compara con la población general. Las manifestaciones más frecuentemente observadas son: el síndrome del eutiroideo enfermo, la enfermedad de Graves y el hipotiroidismo subclínico. La relación entre el uso de la terapia antirretroviral y el incremento en la prevalencia de alteraciones tiroideas fue demostrada en varias series de pacientes. La enfermedad de Graves se reconoce claramente como una consecuencia del síndrome de restitución inmune. Además, existen estudios que sugieren una relación entre hipotiroidismo y el uso de inhibidores nucleósidos de la transcriptasa reversa, en particular estavudina y el inhibidor no nucleósido de la transcriptasa reversa efavirenz. Nuevos estudios podrán aportar evidencia adicional sobre la necesidad de evaluaciones rutinarias de la función tiroidea en pacientes infectados por HIV.

Patients infected with human immunodeficiency virus (HIV) have a higher prevalence of thyroid dysfunction when compared with the general population. The most frequently observed manifestations are euthyroid sick syndrome, Graves´ disease and subclinical hypothyroidism. The relationship between the use of highly active antiretroviral therapy and the increased prevalence of thyroid dysfunction has been demonstrated in several series of patients. Grave’s disease is recognized as a consequence of immune restitution syndrome. Besides, several studies have suggested an association between hypothyroidism and the use of nucleoside reverse transcriptase inhibitors, particularly stavudine and non-nucleoside reverse transcriptase inhibitors such as efavirenz. Further studies could provide additional evidence of the need for routine assessment of thyroid function in HIV-infected patients.

Cardiac Death Risk in Diabetic Haemodialysis Patients Increased Due to Thyroid Problems

A prospective study found that diabetic haemodialysis patients' subclinical hyperthyroidism and euthyroid sick syndrome might increase the risk of sudden cardiac-related deaths. Dr Christiane Drechsler; of University Hospital Wurzburg in Wurzburg; Germany; and colleagues conducted a study that included 1 000 patients undergoing haemodialysis for diabetes. Of those patients; 78.1 had euthyroidism; 13.7 had subclinical hyperthyroidism; 1.6 had subclinical hypothyroidism and 5.4 had euthyroid sick syndrome

Síndrome eutiroideo enfermo en pacientes con insuficiencia renal crónica terminal en hemodiálisis / Sick euthyroid syndrome in end-stage renal disease patients on hemodyalisis

El es una patología frecuente en pacientes con enfermedades crónicas como la insuficiencia renal crónica (IRC). Los objetivo. Conocer la prevalencia del síndrome eutiroideo enfermo (SEE) en un grupo de pacientes con IRC en hemodiálisis y su relación con diferentes marcadores de morbilidad. Material y Métodos. Se estudió 40 pacientes del Servicio de Hemodiálisis del Hospital Nacional EsSalud Carlos Alberto Seguín Escobedo de Arequipa, con al menos seis meses en el programa de hemodiálisis. Se les realizó dosaje de TSH, T3, creatinina, albúmina, transferrina, calcio, fósforo, paratohormona, proteína C reactiva, entre otros. resultados. Se encontró una prevalencia de SEE del 23,1%. Los niveles de transferrina, albumina y paratohormona estuvieron disminuidos y la proteína C reactiva aumentada con una asociación significativa con la presencia de SEE en los pacientes estudiados. conclusión. Se halló una prevalencia relativamente alta de SEE en pacientes con IRC en hemodiálisis.

Objective. To know the prevalence of the euthyroid sick syndrome (ESS) in end-stage renal disease (ESRD) patients on hemodialysis and their relation to different markers of disease. Material and Methods. We studied 40 patients from the Hemodialysis Service of the Carlos Alberto Seguin Escobedo, EsSalud National Hospital, Arequipa, that were at least six months in hemodialysis. It was measured levels of TSH, T3, creatinine, albumin, transferrin, calcium, phosphorus, parathyroid hormone, C-reactive protein, among others. results. We found a prevalence of 23,1% ESS. Transferrin, albumin and parathyroid hormone levels were decreased and CRP was increased significantly with the presence of ESS in CKD patients on hemodialysis. Conclusión. Se halló una prevalencia relativamente alta de SEE en pacientes con IRC en hemodiálisis.

Analysis of influencing factors of transient hypothyroxinemia and low T3 syndrome in premature infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the influencing factors of transient hypothyroxinemia (THT) and low T3 syndrome (LT3S) in premature infants.</p><p><b>METHOD</b>We have studied 418 premature infants whose gestational age was between 26 and 36 weeks.Serum thyronine (T4), triiodothyronine (T3) and thyrotropin (TSH) of them were detected on the fourteenth day approximately after birth. The patients were divided according to their serum T4, T3 and TSH into 3 groups (transient hypothyroxinemia, low T3 syndrome and normal). Then 20 Perinatal factors which may be associated with THT and LT3S were collected. The factors were analyzed by using Chi-square test and Logistic regression.</p><p><b>RESULT</b>Forty-nine infants were found suffering from THT, 35 infants suffering from LT3S, and 334 infants in normal group. The prevalence rate of THT was 11.7%, and the prevalence rate of LT3S was 8.4%. Among the 20 factors, the factors related to the incidence of THT were male gender (OR = 1.863, 95%CI 0.966-3.594), albumin (OR = 2.401, 95%CI 1.294-4.455), dopamine (OR = 3.295, 95%CI 1.110-9.783) and those related to the incidence of LT3S were male gender (OR = 2.592, 95%CI 1.171-5.736), gestational age ≤ 28 wk (OR = 3.503, 95%CI 1.275-9.627).</p><p><b>CONCLUSION</b>Male gender, albumin and dopamine are perinatal risk factors of THT, meanwhile, male gender and gestational age ≤ 28 wk are perinatal risk factors of LT3S.With the use of risk factors identified in our study, it may be possible to separate infants having the highest risk of THT and LT3S, so as to form optimizing treatment strategies.</p>

Risk factors for short term thyroid dysfunction after hematopoietic stem cell transplantation in children / 소아과

PURPOSE: The purpose of this study was to evaluate short-term thyroid dysfunction and related risk factors in pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) during childhood. METHODS: We studied 166 patients (100 boys and 66 girls) who underwent HSCT at the Catholic HSCT Center from January 2004 through December 2009. The mean age at HSCT was 10.0+/-4.8 years. Thyroid function of the patients was tested before and during 3 months of HSCT. RESULTS: Out of 166 patients, 165 (99.4%) underwent allotransplantation. Acute graft-versus-host disease (GVHD, grades II to IV) developed in 76 patients. Conditioning regimens before HSCT include total body irradiation (n=57), busulfan (n=80), and reduced intensity (n=29). Forty-five (27.1%) had thyroid dysfunction during 3 months after HSCT (29 euthyroid sick syndrome [ESS], 6 subclinical hyperthyroidism, 4 subclinical hypothyroidism, 3 hypothyroxinemia, 2 overt hyperthyroidism, and 1 high T4 syndrome). In a univariate logistic regression analysis, age at HSCT (P=0.002) and acute GVHD (P=0.009) had statistically significant relationships with thyroid dysfunction during 3 months after HSCT. Also, in a univariate logistic regression analysis, ESS (P=0.014) showed a strong statistically significant association with mortality. CONCLUSION: In our study 27.1% patients experienced thyroid dysfunction during 3 months after HSCT. Increase in age and acute GVHD may be risk factors for thyroid dysfunction during 3 months after HSCT. There was a significant association between ESS and mortality.