Relationship between thyroid hormone level and the change of left ventricular function in septic patients / 中华急诊医学杂志

ABSTRACT

Objective To investigate the occurrence of thyroid disorders in septic patients and the relationship between thyroid hormone level and the change of left ventricular function.Methods A total of 63 septic patients,43 male and 20 female,aged 50 to 88 years with mean 63.3 ± 18.5,were included in the present study.The thyroid hormone levels and C-reactive protein (CRP) levels were detected in all patients on the next day of admission.Clinical information of each patient was recorded including demographics and co-existed disease,APACHE Ⅱ score at admission and the incidence of shock and subsequent multiple organ dysfunction syndrome (MODS).At 24 hours,the second week and the third week after admission,a serial trans-thoracic echocardiography were performed in all patients to observe changes of left ventricular end diastolic dimension,left ventricular eject fraction and E/A (the ratio between maximal velocity of blood flow at mitral valve orifice in the early diastolic phase and maximal velocity of blood flow of atrium in systolic phase).Another 38 patients with ordinary infections,21 male and 17 female,with mean age 58.6 ± 16.8 (48-84 years) were selected as controls for comparison.The difference in thyroid function between sepsis group and control group was analyzed.The levels of serum thyroid hormone associated with the incidence of shock and MODS were studied among different types of the left ventricular structure and function in sepsis group.Results The levels of serum free tri-iodothyronine (FT3) and free tetra-iodothyronine (FT4) in sepsis group were significantly lower than those in control group (P ＜ 0.05),but there was no difference in level of thyroid stimulating hormone (TSH) between these two groups.The patients with sepsis had three types of the left ventricular dysfunctiondiastolic dysfunction without the enlargement of left ventricular (type Ⅰ) in 31 patients,the enlargement of left ventricular with diastolic dysfunction (type Ⅱ) in 18 patients and the enlargement of left ventricular with both systolic and diastolic dysfunction (type Ⅲ) in 14 patients.Compared with the other two types,the type Ⅲ patients had significantly lower levels of FT3 and FT4 and higher incidences of shock and MODS (P ＜ 0.05).No significant difference in TSH level was found among the three types.There were no significantly differences in FT3 and FT4 between type Ⅰ and type Ⅱ,but the higher incidences of shock and MODS were found in type Ⅰ (P ＞ 0.05).Conclusions Most septic patients have thyroid function disorder.Serum thyroid hormone levels in early stage of sepsis have certain role in predicting changes in left ventricular structure and function in the late stage of disease.