Altered thyroid function in severely injured patients

Abstract

Background Hemorrhagic shock profoundly affects the neuroendocrine profile of trauma patients, and we hypothesized that massive resuscitation would negatively impact thyroid function. Methods A prospective, observational study investigating thyroid function in hypotensive trauma patients (systolic blood pressure <90 mm Hg × 2) who survived >48 h was conducted at a Level I center over a 6-mo period. Blood samples for thyroid function were collected at time of presentation to the trauma bay and serially for 48 h. Collected data included demographics, injury data, vital signs, transfusion needs, crystalloid use, and vasopressor requirements. Patients receiving >5 units packed red blood cells (PRBC) within 12 h were compared with those receiving ≥ 5 units. Results Patients who required >5 units of PRBC/12 h had significantly lower total and free T4 levels on initial presentation, and levels remained significantly depressed over the next 48 h when compared with patients who required a less aggressive resuscitative effort. T3 values were markedly suppressed during the initial 48 h post trauma in all patients, but were significantly lower in patients requiring >5 units PRBC. TSH levels remained within the normal range for all time points. Lower trauma admission T4 levels were associated with the need for greater crystalloid resuscitation within the first 24 h. Conclusion Measurements of thyroid function are significantly altered in severely injured patients on initial presentation, and low T4 levels predict the need for large resuscitation. Further research investigating the profile and impact of thyroid function in trauma patients during resuscitation and recovery is warranted.

Thyroid hormone alterations in trauma patients requiring massive transfusion: An observational study

“…[11,15] However, in the current survey, the rate of fT3 decline from 24 hours onward in both groups was similar, at 23.4% and 28.9% in groups C and M, respectively. Moreover, fT4 levels in group M remained static despite a considerable level of resuscitation, which did not involve the administration of thyroid hormones.…”

“…Although Grill et al [11] examined fT3, all levels were below the lower limit of 0.92 pg/dL. Therefore, they did not demonstrate alterations.…”

“…Grill et al [11] reported that trauma patients requiring more than 5 units of PRBC had T4 and T3 levels on admission that were lower than the normal range. In the current study, however, fT4 was not reduced below the normal range at any stage.…”

“…This is consistent with the report of Grill et al, who observed that no biphasic response occurred in patients with penetrating trauma. [11] Therefore, we assume that the initial biphasic response does not occur in humans; if it does, the fi rst phase either occurs earlier than we have assessed to date.…”

“…[7] Some studies have evaluated thyroid hormones in trauma patients. [8][9][10] Grill et al [11] evaluated 18 trauma patients and reported that low T4 levels were predictive of the need for major resuscitation. Although total plasma T3 and T4 levels are meaningful indicators of thyroid metabolism, the status of their free, protein-unbound fractions is metabolically more important.…”