Thyroid function in critically ill patients

Background: Abnormal thyroid function tests (serum thyrotropin [TSH], free thyroxine [T4] and free triiodothyronine [T3]) are frequently seen in hospitalized patients. Assessment of thyroid function in these patients is difficult. It has been suggested that acutely ill patients may be hypothyroid at the tissue level. Erythrocyte zinc (EZn) has been shown to be increased in hypothyroidism. The aim of this study was to examine EZn as an index of thyroid status of hospital patients. Methods: In order to assess the thyroid status at tissue level, we measured EZn in 26 healthy subjects, 39 critically ill patients and 19 hospitalized geriatric patients. EZn was measured in young cells, as the effect of illness is likely to be seen in the newly formed cells. Result: TSH and free T3 were lower in critically ill patients and serum free T3 was lower in geriatric patients. EZn in young cells was higher in both patient groups (by 13% and 23%, respectively). EZn in old cells was also higher in the geriatric group. Conclusion: We conclude that EZn is higher in hospitalized patients, suggesting that these patients may be hypothyroid at the tissue level.

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Thyroid Function as a Predictive Tool for The Prognosis of Traumatic Patients Admitted in Surgery ICUs

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.17.05.03.04 ◽

2017 ◽

Vol 5 (3) ◽

pp. 14

Author(s):

Ramin Azhough ◽

Reza Movassaghi ◽

Ali Farbod

Keyword(s):

Thyroid Hormones ◽

Critically Ill ◽

Thyroid Function ◽

Critically Ill Patients ◽

Analytical Study ◽

Serum Levels ◽

Predictive Tool ◽

Duration Of Hospitalization ◽

Patient Prognosis ◽

The Relationship

Background: APACHE Score is an important criterion for determining the patient prognosis, especially in critically ill patients. According to significantly changes in the serum levels of thyroidal hormones in patients, especially in critically ill patients, the aim of the present study was to evaluate the relationship between thyroid function and APACHE 4 score in the prognosis of the traumatic patients admitted in surgery ICU. Method & Material: In a descriptive-analytical study, 90 patients with multiple trauma were studied. Thyroid hormones and APACHE 4 Score were evaluated on 1st, 5th and10th days of admission for each patient. Their clinical features and duration of hospitalization, either in trauma unit or ICU, elation between thyroidal hormones and APACHE 4 Score, duration of hospitalization, and survival of patients were evaluated. Results: This study included 90 patients. A statistically significant relation was detected between thyroid hormones (TT3) and APACHE 4 Score and duration of hospitalization. Conclusion: TT3 might be utilized as a prognostic factor in the traumatic patients admitted to ICU.

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Outcome of critically ill patients with non-thyroidal illness

BIRDEM Medical Journal ◽

10.3329/birdem.v11i1.51029 ◽

2020 ◽

Vol 11 (1) ◽

pp. 47-51

Author(s):

Faria Afsana ◽

Kaniz Fatema ◽

ASM Areef Ahsan ◽

Bishwajit Bhowmik ◽

Tasnima Siddique

Keyword(s):

General Hospital ◽

Critically Ill ◽

Thyroid Function ◽

Critically Ill Patients ◽

Adaptive Response ◽

Gastrointestinal Disease ◽

Underlying Disease ◽

Thyroid Function Tests ◽

Nonthyroidal Illness ◽

Hpt Axis

Background: During period of critical illness, there are diverse alterations in the hypothalamus-pituitarythyroid (HPT) axis. This diversity in critically ill patients and the etiological relationship between underlying disease and non-thyroidal illness (NTI) is poorly understood. The aims of this study were to examine the features of NTI and outcomes in critically ill patients admitted in Critical Care Medicine (CCM) Department, BIRDEM General Hospital. Methods: A total of 86 patients admitted to CCM department, BIRDEM General Hospital during the period of July to December 2015 , having nonthyroidal illness, detected by thyroid function tests during ICU stay were enrolled in this study. All patients discharged from hospital were followed up for a period of 6 months. Patients with known thyroid diseases or taking medications that affect thyroid function were excluded. Condition at hospital discharge and mortality in the ICU or later at home after discharge within next 6 months was assessed as outcomes. Results: Mean age of the study subjects was 63.87(±13.5)years and 45(52.3%)of the study subjects were female. Most of the study subjects had diabetes (84.88%) and hypertension (82.55%).Mean (±SD) of FT3 (pmol/l), FT4(pmol/l), TSH (uIU/ml) were 2.85(±1.35),12.74(±8.17) and 2.81(±8.57)respectively. Among the total study subjects 44.18% patients died in ICU and 2.32% patients after shifting to ward. Among the patients having pneumonia, Myocardial Infarction(MI) /Arrhythmia, Stroke, Sepsis and Gastrointestinal disease, 50.94% 51.02%, 56.0%,53.85%,37.50% died in hospital (ICU or after shifting toward).The 46 patients ,who were discharged from hospital were followed up for next 6 months. Conclusion: NTI is a transient adaptive response affecting individuals with acute and chronic illness and is more common among patients admitted in intensive care unit (ICU). The prognosis of patients having NTI depends on severity of thyroid dysfunction. Birdem Med J 2021; 11(1): 47-51

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Non-thyroidal illness syndrome predicts outcome in adult critically ill patients: a systematic review and meta-analysis

Endocrine Connections ◽

10.1530/ec-21-0504 ◽

2022 ◽

Author(s):

Josi Vidart ◽

Paula Jaskulski ◽

Ana Laura Kunzler ◽

Rafael Aguiar Marschner ◽

André Ferreira de Azeredo da Silva ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Thyroid Function ◽

Critically Ill Patients ◽

Animal Studies ◽

Case Reports ◽

Meta Analysis ◽

Univariate Analysis ◽

Prognostic Information ◽

Increased Risk

We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of nonthyroidal illness syndrome (NTIS) in critically ill patients. We included studies that assessed thyroid function by measuring the serum thyroid hormone level and in-hospital mortality in adult septic patients. Reviews, case reports, editorials, letters, animal studies, duplicate studies, and studies with irrelevant populations and inappropriate controls were excluded. A total of 6869 patients in 25 studies were included. The median prevalence rate of NTIS was 58% (IQR 33.2-63.7). In univariate analysis, triiodothyronine (T3) and free T3 (FT3) levels in non-survivors were relatively lower than that of survivors (8 studies for T3; standardized mean difference (SMD) 1.16; 95% confidence interval (CI), 0.41–1.92; I2 = 97%; P < 0.01). Free thyroxine (FT4) levels in non-survivors were also lower than that of survivors (12 studies; SMD 0.54; 95% CI, 0.31–0.78; I2 = 83%; P < 0.01). There were no statistically significant differences in TSH levels between non-survivors and survivors. NTIS was independently associated with increased risk of mortality in critically ill patients (OR = 2.21, 95% CI 1.64.- 2.97, I2 = 65% p < 0.01) The results favor the concept that decreased thyroid function might be associated with a worse outcome in critically ill patients. Hence, the measurement of TH could provide prognostic information on mortality in adult patients admitted to ICU.

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Impairment of Thyroid Function in Critically Ill Patients in the Intensive Care Units

The American Journal of the Medical Sciences ◽

10.1016/j.amjms.2017.06.026 ◽

2018 ◽

Vol 355 (3) ◽

pp. 281-285 ◽

Cited By ~ 8

Author(s):

Eashaa Kumar ◽

Michael T. McCurdy ◽

Christian A. Koch ◽

Abdurrahman Hamadah ◽

Tibor Fülöp ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Thyroid Function ◽

Critically Ill Patients

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Thyroid hormone alterations in critically and non-critically ill patients with SARS-CoV-2 infection

Endocrine Connections ◽

10.1530/ec-21-0029 ◽

2021 ◽

Author(s):

Dimitra Argyro Vassiliadi ◽

Ioannis Ilias ◽

Maria Pratikaki ◽

Edison Jahaj ◽

Alice G Vassiliou ◽

...

Keyword(s):

Thyroid Hormone ◽

Critically Ill ◽

Thyroid Function ◽

Critically Ill Patients ◽

Icu Patients ◽

Similar Frequency ◽

Normal Thyroid ◽

Severity Of Disease ◽

Normal Thyroid Function ◽

High Prevalence

Objective: Following evolution of COVID-19 pandemic, reports pointed on a high prevalence of thyroiditis related thyrotoxicosis. Interpretation of thyroid tests during illness, however, is hampered by changes occurring in the context of non-thyroidal illness syndrome (NTIS). In order to elucidate these findings, we studied thyroid function in carefully selected cohorts of COVID-19 positive and negative patients. Design: Cohort observational study. Methods: We measured TSH, FT4, T3 within 24hours of admission in 196 patients without thyroid disease and/or confounding medications. 102 patients were SARS-CoV-2 positive; 41 admitted in the ICU, 46 in the ward and 15 outpatients. Controls consisted of 94 SARS-CoV-2 negative patients; 39 in the ICU and 55 in the ward. We designated the thyroid hormone patterns as consistent with NTIS, thyrotoxicosis and hypothyroidism. Results: A NTIS pattern was encountered in 60% of ICU and 36% of ward patients, with similar frequencies between SARS-CoV-2 positive and negative patients (46.0% vs 46.8%, p=NS). A thyrotoxicosis pattern was observed in 14.6% SARS-CoV-2 ICU patients vs. 7.7% in ICU negative (p=NS) and, overall in 8.8% of SARS-CoV-2 positive vs. 7.4% of negative patients. In these patients thyroglobulin levels were similar to those with normal thyroid function or NTIS. The hypothyroidism pattern was rare. Conclusions: NTIS pattern is common and relates to the severity of disease rather than SARS-CoV-2 infection. A thyrotoxicosis pattern is less frequently observed with similar frequency between patients with and without COVID-19. It is suggested that thyroid hormone monitoring in COVID-19 should not differ from other critically ill patients.

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Thyroid status among critically ill patients admitted in the intensive care unit of the government tertiary care hospital in Mandya: a retrospective study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20200527 ◽

2020 ◽

Vol 7 (3) ◽

pp. 401

Author(s):

Chethan Kumar K. L. ◽

Shivakumar K. M.

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Thyroid Function ◽

Critically Ill Patients ◽

Tertiary Care ◽

Thyroid Status ◽

Euthyroid Sick Syndrome ◽

Low T3 ◽

Low Levels

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.

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