Clinical Concepts on Thyroid Emergencies

Papi, Giampaolo; Corsello, Salvatore Maria; Pontecorvi, Alfredo

doi:10.3389/fendo.2014.00102

Cited by 54 publications

(50 citation statements)

References 112 publications

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“…[4][5][6][7][8] NTIS has been used as an interesting parameter of severity, since it has been verified that more severe patients have more prolonged alterations and a later recovery, and that the prognosis in adults is poor, and may even lead to death. [9][10][11][12] However, there are still no reports of there being a worse prognosis in infants, let alone those presenting fungal sepsis.…”

mentioning

confidence: 99%

“…All of these hormones decrease within 24 hours, remaining at higher levels than those of the cord blood for 2 to 3 days. [4][5][6][7][8][9] In the same manner as the thyroid hormones, there is a rapid increase in cortisol in term infants at birth, which can reach 20 μg/dL. This hormone stimulates the increase in serum T3, which is essential for activation of type 1 deiodinase (D1) enzyme between 4 and 6 hours after birth, and very low levels of reverse T3.…”

mentioning

confidence: 99%

“…[19][20][21][22][23][24][25][26][27][28] Currently, four stages of NTIS are recognized in adults and children, known as low T3 syndrome, low T3-T4 syndrome, high T4 syndrome, and mixed syndromes. [4][5][6][7][8][9][10][20][21][22][23][24][25][26][27][28] Low T3 syndrome This is characterized by low serum levels of T3, normal or slightly increased TSH, and normal free T4 and T4. The level of reverse T3 may be normal or increased.…”

mentioning

confidence: 99%

“…This change is due to inhibition of the activity of the D1 enzyme, which is responsible for both peripheral degradation of T4 to T3 as well as lower clearance of reverse T3. [6][7][8][9][10][11][12] The decline in T3 levels appears to occur a few hours after the onset of sepsis. 6,10,[23][24][25][26][27][28] Recovery occurs in parallel with the improvement of the underlying disease.…”

mentioning

confidence: 99%

“…It is currently believed that a mechanism occurs in this type of NTIS related to the effects of cytokines in the hypothalamic-pituitary axis, associated with reduced peripheral T4 action. [4][5][6][7][8][9][10][11][12][19][20][21][22][23][24][25][26][27][28] The response of TSH to thyrotropin-releasing hormone (TRH) seems to be reduced in patients in critical clinical condition. There is evidence that in certain periods of severe disease there may be genuine central and transient hypothyroidism, in which there is not a nighttime peak in TSH, as well as evidence of changes in the glycosylation process regulated by TRH.…”

mentioning

confidence: 99%

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Thyroid abnormalities in term infants with fungal sepsis

Silva¹,

Araújo²,

Diniz

et al. 2016

Rev. Assoc. Med. Bras.

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Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

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