Non-thyroidal illness syndrome and short-term survival in a hospitalised older population

Tognini, Sara; Marchini, Francesca; Dardano, Angela; Polini, Antonio; Ferdeghini, M; Castiglioni, Maido; Monzani, Fabio

doi:10.1093/ageing/afp197

Cited by 67 publications

(56 citation statements)

References 21 publications

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“…The preoperative prevalence rate of low T3 syndrome (38%) in brain tumor patients corresponds to low T3 syndrome prevalence rates previously reported in hospitalized cardiac patients (30%) 21 and in acutely ill elderly patients (32%). 41 As expected, median free T3 concentrations decreased and the prevalence of low T3 syndrome (54%) increased within 24 hours after brain tumor surgery. A number of previous studies have documented decreased T3 concentrations within a few hours after major surgery, returning to preoperative levels within a week after surgery.…”

Section: Discussionsupporting

confidence: 70%

“…Our results regarding the independent prognostic role of low T3 syndrome correspond to results of previous studies showing that low T3 syndrome was an independent predictor of mortality in different populations of patients, including cardiac patients, 21 stroke patients, 2 and hospitalized elderly patients. 41 A dose-response relationship between low T3 concentrations and poor outcomes was previously described in hospitalized patients 46 and in general surgery patients. 43 Triiodothyronine is essential for proper functioning of the brain and cardiovascular system, and results from preclinical and clinical studies suggest that thyroid hormones can promote plasticity and regeneration in the CNS.…”

Section: 4348mentioning

confidence: 88%

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Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

Bunevičius

Deltuva

Tamašauskas³

et al. 2013

JNS

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Object A low triiodothyronine (T3) state is highly prevalent and is associated with a poor prognosis in critically ill patients. The authors investigated, in patients undergoing brain tumor surgery, the direct association of a perioperative low T3 syndrome with clinical outcomes and also with symptoms of depression and anxiety. Methods Ninety consecutive patients (71% women, median age 55 years), on admission for brain tumor surgery, were evaluated for sociodemographic and clinical characteristics. Their thyroid function profile was assessed on the morning of brain tumor surgery and on the morning after brain tumor surgery. Patients with free T3 concentrations of 3.1 pmol/L or less were considered to have low T3 syndrome. The patients were evaluated for symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) before and after surgery and for clinical outcomes using the Glasgow Outcome Scale (GOS) at discharge. Results After brain tumor surgery, free T3 concentrations decreased (p < 0.001) and the proportion of patients with low T3 levels increased from 38% to 54% (p = 0.02). Lower preoperative (rho = 0.30, p = 0.004) and postoperative (rho = 0.33, p = 0.002) free T3 concentrations correlated with low GOS scores at discharge. Preoperative low T3 syndrome (OR 5.49, 95% CI 1.27–23.69, p = 0.02) and postoperative low T3 syndrome (OR 8.73, 95% CI 1.49–51.21, p = 0.02) both increased risk for unfavorable clinical outcomes (GOS scores < 5) at discharge, after adjusting for age, sex, histological diagnosis of brain tumor, preoperative functional impairment, previous treatment for brain tumor, and depressive symptoms. Preoperative low T3 syndrome increased the risk for preoperative (HADS-depression subscale score ≥ 11; OR 4.12, 95% CI 1.16–14.58, p = 0.03) but not postoperative depressive symptoms independently from sociodemographic and clinical factors. Conclusions Low T3 syndrome is a strong independent predictor of unfavorable clinical outcomes and depressive symptoms, and its diagnosis and preoperative management should be considered in patients undergoing neurosurgery for the treatment of brain tumors.

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Section: Discussionsupporting

confidence: 70%

Section: 4348mentioning

confidence: 88%

Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

Bunevičius

Deltuva

Tamašauskas³

et al. 2013

JNS

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“…This last group was mainly represented by NTI (n:278, 62.2%). In contrast, Tognini et al, 6 excluding patients requiring intensive care unit facilities, found only 31.9% of 301 hospitalized older adults with this syndrome. Although higher hospital mortality has been linked to NTI, 5,6 it is still unclear whether it is involved in the progression of disease or simply represents a marker of worse outcome for patients during hospitalization.…”

mentioning

confidence: 88%

High TSH and low T4 as prognostic markers in older patients

Mingote¹,

Meroño²,

Rujelman³

et al. 2012

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th percentile), and mortality assessed during an 18-month follow-up period after their hospital discharge. rESulTS: Out of 2599 older patients admitted to our hospital, 7% had TFT performed for various reasons. The patients who had TFT were mostly women and presented in a more serious clinical condition compared to the rest of the patients. The patients were grouped as per their thyroid values as follows: 61% of them had a non-thyroidal illness, 25% were euthyroid, 7% had overt hyperthyroidism, 5% overt hypothyroidism and 1% had subclinical hyper-or hypothyroidism. The hypothyroid patients had a worse clinical outcome compared to the others. Patients with increased MM exhibited higher TSH and lower TT4 (p<0.005). Short-term MM (Or=2.0,95%cI=1.1-3.6, p<0.01) was associated with the decrease of TT4 adjusted by age, sex, T3 and TSH, while for long-term MM the increase in TSH (Or=1.6,95%cI 1.1-2.3, p<0.05) was also significant. cONcluSION: Among hospitalized older patients who had TFT tests, low TT4 and high TSH were associated with a worse prognosis. We propose that TFT be used as an additional tool in assessing MM in elderly hospitalized patients.

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“…The RAS in low-T 3 syndrome and subclinical thyroid disorders Changes in thyroid function parameters are observed in starvation and fasting, cardiac disease (Kozdag et al 2005, Pingitore et al 2005, renal disease (Lim et al 1980, Zoccali et al 2005, renal transplantation (Hekmat et al 2010), ageing (Tognini et al 2010), and increased saline intake (Cruz et al 2011), leading to low-T 3 syndrome (also known as non-thyroidal illness syndrome or euthyroid sick syndrome). This syndrome is characterized by low circulating T 3 levels and normal or decreased T 4 levels and, usually, by normal thyroid stimulating hormone (TSH) levels.…”

Section: New Ras Componentsmentioning

confidence: 99%

The renin–angiotensin system in thyroid disorders and its role in cardiovascular and renal manifestations

Vargas¹,

Rodríguez-Gómez²,

Vargas-Tendero³

et al. 2011

Journal of Endocrinology

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Thyroid disorders are among the most common endocrine diseases and affect virtually all physiological systems, with an especially marked impact on cardiovascular and renal systems. This review summarizes the effects of thyroid hormones on the renin-angiotensin system (RAS) and the participation of the RAS in the cardiovascular and renal manifestations of thyroid disorders. Thyroid hormones are important regulators of cardiac and renal mass, vascular function, renal sodium handling, and consequently blood pressure (BP). The RAS acts globally to control cardiovascular and renal functions, while RAS components act systemically and locally in individual organs. Various authors have implicated the systemic and local RAS in the mediation of functional and structural changes in cardiovascular and renal tissues due to abnormal thyroid hormone levels. This review analyzes the influence of thyroid hormones on RAS components and discusses the role of the RAS in BP, cardiac mass, vascular function, and renal abnormalities in thyroid disorders.

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Non-thyroidal illness syndrome and short-term survival in a hospitalised older population

Abstract: low T3 syndrome is very common in the hospitalised older population, emerging as the most sensitive independent predictor of short-term survival. Serum FT(3) determination should be included in the assessment of short-term prognosis of acutely ill older patients.

Cited by 67 publications

References 21 publications

Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

High TSH and low T4 as prognostic markers in older patients

The renin–angiotensin system in thyroid disorders and its role in cardiovascular and renal manifestations

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