Biochemical indicators of euthyroid sick syndrome in critically ill children

Besci, Tolga; Besci, Özge; Arslan, Gazi; Ilgaz, Hande; Prencuva, Pınar; Özdemir, Göktuğ; Abacı, Ayhan; Demir, Korcan

doi:10.1515/jpem-2022-0232

Cited by 4 publications

(8 citation statements)

References 39 publications

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“…In terms of hormone levels, higher-risk patients were noted to have lower plasma levels of FT3, FT4 and TSH, although the FT3 hardly reached statistical significance. These results are consistent with other pediatric studies (18,19,21,22). It should also be noted that the prevalence of NTIS in the total sample is clinically relevant (30%).…”

Section: Comparative Analysissupporting

confidence: 92%

“…In the overall population column, variables are expressed as median (SD). To date, few studies have linked NTIS with mortality in unselected critically ill children (21,22), and to our knowledge, this prospective study is one of the first trying to assess thyroid hormone levels as predictors of outcome in daily clinical practice. We have seen that low levels of FT3 and FT4 are associated with increased risk of mortality scores in a heterogeneous sample of critically ill children.…”

Section: Discussionmentioning

confidence: 99%

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Non-thyroidal illness syndrome and its relationship with mortality risk in critically ill children

Carreras

Riaño²,

Vivanco³

et al. 2023

Front. Pediatr.

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IntroductionNon-thyroidal illness syndrome (NTIS) is considered to be associated with adverse outcomes in critically ill children.The hypothesis that thyroid hormones and inflammatory markers are associated with increased prediction of mortality risk scores is tested in this paper.MethodsA prospective observational study was set up in a pediatric intensive care unit (PICU). One hundred and three patients were included. NTIS was defined as a low free triiodothyronine (FT3) value for the patient's age. Thyroid hormones levels and inflammatory markers were determined at admission: FT3, FT4 (free thyroxine), TSH (thyroid-stimulating hormone), rT3 (reverse triiodothyronine), CRP (C-reactive protein) and PCT (Procalcitonin). They were compared between children with a pediatric risk of mortality score PRISM-III >75th percentile (group A, n= 25) and the rest (group B, n = 78).ResultsA FT4 value lower than 16.6 pmol/L showed an area under the curve (AUC) of 0.655 (0.56–0.78, p = 0.02), with 76% sensitivity and 61.5% specificity to detect a high risk of mortality. A multiple regression analysis revealed that a FT4 lower than 16.6 pmol/L [OR: 4.92 (1.60–18.19), p = 0.009] and having NTIS [OR: 6.04 (1.45–27.93), p = 0.016] could predict a high risk of mortality.ConclusionsIn unselected critically ill children, FT4 and FT3 values at admission could be used as a good predictor of a high mortality risk. We have not achieved a predictive model that combines hormones with inflammatory markers.

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Section: Comparative Analysissupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Non-thyroidal illness syndrome and its relationship with mortality risk in critically ill children

Carreras

Riaño²,

Vivanco³

et al. 2023

Front. Pediatr.

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“…Patients with AN often show typical hypothyroidism symptoms, such as hypothermia, hypotension, dry skin, reduced metabolic rate, delayed Achilles reflex half-relaxation time, and, importantly, bradycardia ( 66 ). Moreover, from a biochemical point of view, patients with AN have thyroid hormone abnormalities compatible with the so-called “sick euthyroid syndrome” or “non-thyroidal illness syndrome (NTIS)” ( 69 , 70 ).…”

Section: Hypothalamic-pituitary-thyroid Axis In Underweight/starved E...mentioning

confidence: 99%

“…Alteration in serum thyroid hormone-binding proteins . The majority of thyroid hormone in plasma is bound to various binding proteins, such as thyroxine-binding globulin (TBG), transthyretin, and albumin ( 69 , 70 ). Typically, the serum levels of binding protein are decreased in a state of malnutrition or high catabolism, as in AN ( 66 , 68 ).…”

Section: Hypothalamic-pituitary-thyroid Axis In Underweight/starved E...mentioning

confidence: 99%

Thyroid dysfunction in children and adolescents affected by undernourished and overnourished eating disorders

Calcaterra,

Magenes,

Siccardo

et al. 2023

Front. Nutr.

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Eating disorders (ED) are one of the most prevalent chronic disorders in adolescents and young adults, with a significantly increasing prevalence in younger children, particularly in girls. Even if obesity in essence is not framed as an eating disorder and has always been considered a separate pathology, ED and obesity could be considered part of a continuum. It has become evident that one condition can lead to another, such as binge eating disorder (BED) and bulimia nervosa, and that they share the same repercussions in terms of psychosocial, metabolic, and nutritional health. This narrative review aims to investigate the hypothalamic-pituitary-thyroid axis in undernourished and overnourished patients with ED, including obesity, in order to highlight the relationship between weight control and thyroid function and its effects and to consider therapeutic and preventive strategies in children and adolescents. Literature data report that thyroid alterations occur in patients with ED, both underweight and overweight, and represent a continuum of changes depending on the severity and time course of the disease involving the endocrine system. Considering the relevant role thyroid hormones (TH) play not only in energy expenditure (EE) but also in metabolic control and cardiovascular risks related to dysmetabolism and mood regulation, continuous monitoring of thyroid homeostasis in patients with ED is mandatory to prevent severe complications and to start early treatment when necessary.

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“…FT3 has emerged as an independent prognostic indicator for ICU patients. Studies have shown that ESS also has a high mortality risk in critically ill children ( 12 , 13 ), but the area under the curve of FT3 is 0.644 (95% confidence interval 0.555-0.789). The area under the curve (AUC) of FT4 is 0.655 (0.56-0.78, p = 0.02), with a sensitivity of 76% and a specificity of 61.5% for detecting high mortality risk.…”

Section: Introductionmentioning

confidence: 99%

Association between dynamic fluctuations in triiodothyronine levels and prognosis among critically ill patients within comprehensive intensive care units

Xu,

Guo

et al. 2023

Front. Endocrinol.

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ObjectiveDecrease in free thyroid hormone T3 (FT3) can be used as an independent prognostic indicator for the risk of death in ICUs. However, FT3 as a predictive marker is hindered by its accuracy. The study introduces the concept of dynamic FT3 data as a means to bolster the value of FT3 as a prognostic tool. Therefore, the aim of this study is to investigate the prognostic value of dynamic FT3 evolution in a comprehensive ICU setting, analyze the consistency between dynamic FT3 changes and variations in disease severity, and explore the feasibility of FT3 as an objective indicator for real-time clinical treatment feedback.MethodsEmploying a single-center prospective observational study, FT3 measurements were taken on multiple days following enrollment, corresponding clinical data were collected. To investigated the pattern of dynamic changes of FT3,its prognostic significance in forecasting the risk of 28-day mortality, the alignment between dynamic FT3 changes and variations in the Sequential Organ Failure Assessment (SOFA) score.ResultsThe survival group exhibited higher last FT3 levels compared to the lowest point (p<0.05), while the death group did not show statistically significant differences (p>0.05). The study also identifies the optimal correlation between FT3 and SOFA score at day 5 (optimal correlation coefficient -0.546).The ROC curve for FT3 at day 5 yielded an optimal AUC of 0.88, outperforming the SOFA score. The study categorizes FT3 curve patterns,Kaplan-Meier survival analysis of these patterns highlighted that the descending-type curve was significantly associated with increased risk of death (P<0.001). Additionally, the research explores the consistency between changes in FT3 and SOFA scores. While overall consistency rates were modest, subgroup analyses unveiled that greater disease severity led to higher consistency rates.ConclusionsThis study introduces the concept of dynamic FT3 changes to augment its prognostic utility in comprehensive ICU settings. The research identifies day 5 as the optimal time point for predictive efficacy, the descending FT3 curve as indicative of poor prognosis. While overall consistency with SOFA scores is modest, the correlation strengthens with greater disease severity.

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Biochemical indicators of euthyroid sick syndrome in critically ill children

Cited by 4 publications

References 39 publications

Non-thyroidal illness syndrome and its relationship with mortality risk in critically ill children

Non-thyroidal illness syndrome and its relationship with mortality risk in critically ill children

Thyroid dysfunction in children and adolescents affected by undernourished and overnourished eating disorders

Association between dynamic fluctuations in triiodothyronine levels and prognosis among critically ill patients within comprehensive intensive care units

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