Derangements in thyroid hormone status in seriously ill patients: does it matter?
Keywords:Hormone, T3, T4, Thyroid, Thyroxine, Triiodothyronine
Background: Derangements in stress hormone levels i.e. steroids, thyroid hormones is routinely encountered in almost all the seriously ill patients, which have been found to be associated with morbidity and mortality. The present study was planned to assess the thyroid hormone derangements in seriously ill patients, with respect to mortality.
Methods: The present study was a retrospective, observational, record-based study done at Krishna Institute of Medical Sciences, Karad, Maharashtra, India.
Results: Out of total 170 patients, 108 were females (63.5%) and 62 (36.4%) were males. On age wise analysis, it was found that majority of the patients were in the age group >50 years comprising of 78 (45.8%) patients. Thyroid hormonal status was deranged in 94 patients (55%), out of which 53 (31%) died and 41 patients (24%) were alive. Most common derangement was seen in free T3 (triiodothyronine), with 60% of the patients showing lowered values, 35% showing raised values and 5% showing normal values. T4 (thyroxine) levels were normal in major bulk of the patients.
Conclusions: Serum T3 levels should be routinely done in critically ill patients, to detect any thyroid disorders, which might go undetected until it is too late.
DeGroot LJ. Non-thyroidal illness syndrome is functional central hypothyroidism, and if severe, hormone replacement is appropriate in light of present knowledge. J Endocrinol Invest. 2003;26(12):1163-70.
Van den Berghe G. Endocrine evaluation of patients with critical illness. Endocrinol Metab Clin North Am. 2003;32(2):385‑410.
Marx C, Petros S, Bornstein SR, Weise M, Wendt M, Menschikowski M, et al. Adrenocortical hormones in survivors and no survivors of severe sepsis: diverse time course of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol. Crit Care Med. 2003 May 1;31(5):1382-8.
Schuetz P, Müller B, Nusbaumer C, Wieland M, Christ‑Crain M. Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients. Eur J Endocrinol. 2009;160(2):157‑63.
Qari FA. Thyroid function status and its impact on clinical outcome in patients admitted to critical care. Pak J Med Sci. 2015;31(4):915-9.
De Groot LJ. Dangerous dogmas in medicine: The nonthyroidal illness syndrome. J Clin Endocrinol Metab. 1999;84(1):151‑64.
Sahana PK, Ghosh A, Mukhopadhyay P, Pandit K, Chowdhury BK, Chowdhury S. A study on endocrine changes in patients in intensive care unit. J Indian Med Assoc. 2008;106(6):362-4.
Gutch M, Kumar S, Gupta KK. Prognostic value of thyroid profile in critical care condition. Indian J Endocr Metab. 2018;22(3):387-91.
Bhat K, Sharma S, Sharma K, Singh RK. Assessment of thyroid function in critically ill patients. Biomed Res. 2016;27(2):449-52.
Zucker AR, Chernow B, Fields AI, Hung W, Burman KD. Thyroid function in critically ill children. Clinical and lab observations. 1985;107(4):552-4.
Debaveye Y, Ellger B, Mebis L, Van Herck E, Coopmans W, Darras V, et al. Tissue Deiodinase Activity during Prolonged Critical Illness: Effects of Exogenous Thyrotropin-Releasing Hormone and Its Combination with Growth Hormone- Releasing Peptide-2. Endocrinol. 2005;146(12):5604-11.
Chopra IJ, Chopra U, Smith SR, Reza M, Solomon DH. Reciprocal changes in serum concentrations of 3, 3, 5-triiodothyronine (T3) in systemic illness. J Clin Endocrinol Metab. 1975;41(6):1043-9.
Maldonado LS, Murata GH, Hershman JM, Braunstein GD. Do thyroid function tests independently predict survival in the critically ill? Thyroid. 1992;2(2):119‑23.
Ray DC, Macduff A, Drummond GB, Wilkinson E, Adams B, Beckett GJ, et al. Endocrine measurements in survivors and non‑survivors from critical illness. Intensive Care Med. 2002;28(9):1301‑8.
Suresh M, Srivastava NK, Jain AK, Nandy P. Thyroid dysfunction in critically ill patients in a tertiary care hospital in Sikkim, India. Thyroid Res Pract. 2017;14(2):58-62.
Sasi Sekhar TVD, Appalaneni R, Jada A, Pinnamaneni S. Study of thyroid function in patients admitted in intensive care unit in a tertiary care centre. Int J Res Med Sci. 2018;6(8):2717-21.
Van der Poll T, Romijn JA, Wiersinga WM, Sauerwein HP. Tumor necrosis factor: a putative mediator of the sick euthyroid syndrome in man. J Clin Endocrinol Metab. 1990 Dec;71(6):1567-72.
Cowley HC, Heney D, Gearing AJ, Hemingway I, Webster NR. Increased circulating adhesion molecule concentrations in patients with the systemic inflammatory response syndrome: a prospective cohort study. Critical Care Med. 1994 Apr;22(4):651-7.
Pande GV, Rastogi A, Gupta A. Thyroid dysfunction in patients of hemorrhagic stroke. Thyroid Res Pract. 2016;13(1):19-24.
Karadag F, Ozcan H, Karul AB, Yilmaz M, Cildag O. Correlates of nonthyroidal illness syndrome in chronic obstructive pulmonary disease. Resp Med. 2007 Jul;101(7):1439-46.
Warner M, Beckett G. Mechanisms behind the non-thyroidal illness syndrome: an update. J Endocrinol. 2010;205(1):1-13.
Bello G, Pennisi M, Montini L. Nonthyroidal illness syndrome and prolonged mechanical ventilation in patients admitted to the ICU. Chest. 2009;135(6):1448-54.