Thyroid status among critically ill patients admitted in the intensive care unit of the government tertiary care hospital in Mandya: a retrospective study
DOI:
https://doi.org/10.18203/2349-3933.ijam20200527Keywords:
Critically ill, Euthyroid sick syndrome, Low T3 syndrome, Thyroid statusAbstract
Background: The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome. Any acute severe illness can cause abnormalities of circulating Thyroid Stimulating Hormone (TSH) or Thyroid Hormone (TH) levels in the absence of underlying thyroid disease. The laboratory parameters of this syndrome include low serum levels of T3 and high levels of reverse T3, with normal or low levels of thyroxine (T4) and normal or low levels of TSH. This condition may affect 60-70% of critically ill patients. The severity of illness correlates well with the reduction in total serum T3 level. Objectives of the study was to assess the thyroid status of critically ill patients admitted in intensive care unit of a tertiary care hospital.
Methods: This is a retrospective observational study done at Department of General Medicine, MIMS, Mandya among patients admitted with critical illness to ICU. 100 patients admitted with critical illness to ICU are included in this study. Thyroid function reports obtained from case sheets, data entered into MS Excel sheet and analysed.
Results: Out of 100 patients studied 34 patients had sepsis, 26 patients had respiratory failure, 20 patients had Congestive cardiac failure, 12 patients had acute renal failure and 8 patients had Diabetic ketoacidosis. Among 100 patients 63% had abnormal thyroid function test, 56% had low T3, 12% had low T4, 2% had high T4 and 3% had low TSH.
Conclusions: Thyroid function abnormality suggesting Non thyroid illness or euthyroid sick syndrome is common among critically ill patients.
References
Economidou F, Douka E, Tzanela M, Nanas S, Kotanidou A. Thyroid function during critical illness. Hormones. 2011 Apr 1;10(2):117-24.
Adler SM, Wartofskv I. The non-thyroidal illness syndrome. Endocrinol Metab Clin N Am, 2007;36:657-72.
De Groot LJ. Non-thyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, should be treated with appropriate replacement therapies. Criti Care Clin. 2006 Jan 1;22(1):57-86.
Docter R, Van Toor H, Krenning EP, De Jong M, Hennemann G. Free thyroxine assessed with three assays in sera of patients with nonthyroidal illness and of subjects with abnormal concentrations of thyroxine-binding proteins. Clin Chem. 1993 Aug 1;39(8):1668-74.
Peeters RP, Wouters PJ, Kaptein E, van Toor H, Visser TJ, Van den Berghe G. Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients. J Clin Endocrinol Metab. 2003 Jul 1;88(7):3202-11.
Rodriguez‐Perez A, Palos‐Paz F, Kaptein E, Visser TJ, Dominguez‐Gerpe L, Alvarez‐Escudero J, et al. Identification of molecular mechanisms related to nonthyroidal illness syndrome in skeletal muscle and adipose tissue from patients with septic shock. Clin Endocrinol. 2008 May;68(5):821-7.
Kumar KH, Kapoor U, Kalia R, Chandra NA, Singh P, Nangia R. Low triiodothyronine predicts mortality in critically ill patients. Ind J Endocrinol Metab. 2013 Mar;17(2):285.
Agrawal V, Kshirsagar A, Patil V. Derangements in thyroid hormone status in seriously ill patients: does it matter?. Inter J Advan Med. 2019 Jul;6(4):1216.
Bhat K, Sharma S, Sharma K, Singh RK. Assessment of thyroid function in critically ill patients. Biomed Res. 2016;27:449-52.
Bhavana I, Kommineni R, Gayatri GK. Study on Assessment of Thyroid Status among Critically Ill Patients Admitted in a Tertiary Care Hospital. J Assoc Phys Ind. 2019 Jan;67(1):46-8.
Sekhar TS, Appalaneni R, Jada A, Pinnamaneni S. Study of thyroid function in patients admitted in intensive care unit in a tertiary care centre. Intern J Res Med Sci. 2018 Aug;6(8):2717.
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. Criti Care Med. 1994 Apr;22(4):651-7.
Lodha R, Vivekanandhan S, Sarthi M, Arun S, Kabra SK. Thyroid function in children with sepsis and septic shock. Acta Paediatr. 2007;96:406‑9.
Sripad DV, Chowdary NVS, Sivaprabodh V, Shekhar R. Relationship between Free T3 and ICU Mortality: A Prospective Observation. Inter J Sci Res Publi. 2015;5:1-5.
