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.

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.

A study on endocrine changes in patients in intensive care unit.

Pattern of endocrine changes in moderate to severely ill patients in a medical intensive care unit, correlation with the severity of illness and whether these changes can predict outcome of the critically ill patients were evaluated and studied in 80 patients admitted with acute physiology and chronic health evaluation (APACHE) II score >10 and without any pre-existing endocrinopathies or on drugs likely to affect the endocrine axis. Adrenal insufficiency was present in 45%, and mortality was higher in those with lower (<15 microg/dl) and higher (>30 microg/dl) serum cortisol. Sick euthyroid syndrome was detected in 80%, and those with low mean T3 (<0.6 ng/ml), free T4 (<0.89 ng/dl) and total T4 (<4 microg/dl) and had increased mortality. Hypotestosteronaemia was found in 92% of men and was significantly associated with severity of illness in men. Though prolactin is the first hormone to be elevated, there was no correlation between prolactin and severity of illness or mortality.

Síndrome de eutiroidismo enfermo / Ill euthyroidism syndrome

El síndrome de eutiroidismo enfermo (SEE) o enfermedad sistémica no tiroídea, descrito por primera vez en 1974 y 1975, es un síndrome caracterizado por alteraciones de laboratorio de las pruebas tiroídeas, encontrándose valores inapropiadamente bajos de TSH, junto a bajas concentraciones de tiroxina (T4 y triyodotironina (T3) totales. El SSE es un indicador de mal pronóstico. Pareciera que el tratamiento del estado de T3 disminuido en pacientes con SEE con hormonas tiroídeas es al menos no benéfico, y tal vez, perjudicial, y podría empeorar un mecanismo importante de normalización de la función tiroídea durante la recuperación de la patología de base, al suprimir la fuente de TSH durante este período. Se revisa el fundamento fisiológico de este síndrome, su incidencia, su laboratorio, las bases de su diagnóstico diferencial, sus distintas hipótesis etiológicas y, finalmente, su manejo terapéutico