Non-thyroidal illness syndrome in patients with cardiovascular diseases: A systematic review and meta-analysis

Wang, Bin; Liu, Sui‐Jun; Li, Ling; Yao, Qiuming; Song, Ronghua; Shao, Xiaorong; Li, Qian; Shi, Xiaohong; Zhang, Jin‐an

doi:10.1016/j.ijcard.2016.10.039

Cited by 81 publications

(62 citation statements)

References 78 publications

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“…As noted above, low-T3 syndrome and other components of NTIS correlate to severity of disease and independently predict the outcome of affected patients (54, 60, 64–66, 413–416). Guided by the idea that NTIS represents a form of illness-mediated hypothyroidism, it was suggested to treat the condition with levothyroxine (L-T4) or liothyronine (L-T3) with the expectation to improve the prognosis of critically ill patients (39, 70).…”

Section: Treatment Of Low-t3 Syndrome In Tacitus—an Open Questionmentioning

confidence: 80%

“…The last four decades witnessed the discovery of many more pathologies that are associated with the low-T3 syndrome or other patterns of NTIS, including sepsis, circulatory arrest, stroke, myocardial infarction, pulmonary embolism, inflammatory bowel disease, renal failure, and gastrointestinal fistulae (24, 25, 39, 56, 66). …”

Section: Historical Overviewmentioning

confidence: 99%

“…Characteristic patterns of NTIS have been described in a multitude of acute and chronic somatic illnesses including states of shock (284), circulatory arrest (285, 286), respiratory failure (65), community-acquired pneumonia (287), sepsis (288), chronic respiratory (289, 290) and cardiovascular (61, 64, 66, 291, 292) disease, renal failure (293–298), COPD (289), gastrointestinal diseases (299–301), autoimmune diseases (71, 302, 303), and cancer (130, 290, 304). Phenotypes of NTIS with high and high-normal FT4 concentrations have been described in dementia and frailty in elderly persons (305).…”

Section: Thyroid Allostasis In Various Physiological and Pathologicalmentioning

confidence: 99%

“…In severe illness, the presence of NTIS predicts poor prognosis (54, 60, 64–66). It is still a matter of fierce debate if patients affected by the syndrome may benefit from substituting thyroid hormones (67–70).…”

Section: Introductionmentioning

confidence: 99%

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Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming

Hoermann²,

et al. 2017

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The hypothalamus–pituitary–thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. The non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumors, uremia, and starvation (TACITUS), commonly observed in hospitalized patients, displays a historically well-studied pattern of allostatic thyroid response. This is characterized by decreased total and free thyroid hormone concentrations and varying levels of thyroid-stimulating hormone (TSH) ranging from decreased (in severe cases) to normal or even elevated (mainly in the recovery phase) TSH concentrations. An acute versus chronic stage (wasting syndrome) of TACITUS can be discerned. The two types differ in molecular mechanisms and prognosis. The acute adaptation of thyroid hormone metabolism to critical illness may prove beneficial to the organism, whereas the far more complex molecular alterations associated with chronic illness frequently lead to allostatic overload. The latter is associated with poor outcome, independently of the underlying disease. Adaptive responses of thyroid homeostasis extend to alterations in thyroid hormone concentrations during fetal life, periods of weight gain or loss, thermoregulation, physical exercise, and psychiatric diseases. The various forms of thyroid allostasis pose serious problems in differential diagnosis of thyroid disease. This review article provides an overview of physiological mechanisms as well as major diagnostic and therapeutic implications of thyroid allostasis under a variety of developmental and straining conditions.

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Section: Treatment Of Low-t3 Syndrome In Tacitus—an Open Questionmentioning

confidence: 80%

Section: Historical Overviewmentioning

confidence: 99%

Section: Thyroid Allostasis In Various Physiological and Pathologicalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming

Hoermann²,

et al. 2017

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“…Особливо часто синдром низького Т 3 розвивається при тяжких патологічних станах, що супроводжуються гіперпродукцією біологічно активних речовин, зокрема прозапальних цитокінів, асоціюється з гіршим прогнозом і вважається незалежним фактором ризику летальності, зокрема у хворих із серцево-судинними та цереброваскулярними захворюваннями [12][13][14]15].…”

Section: причини розвиткуunclassified

Псевдотиреоїдна Дисфункція В Клінічній Практиці: Як Уникнути Діагностичних Помилок

Pashkovska

2021

Mìžnarodnij endokrinologìčnij žurnal

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У клінічній практиці часто доводиться зустрічатися з аномальними результатами дослідження тиреоїдної функції без яких-небудь даних щодо наявності захворювань щитоподібної залози (ЩЗ) або порушень її регуляторної ланки. Це є причиною діагностичних помилок, насамперед гіпердіагностики тиреоїдної патології і, як наслідок, необґрунтованого призначення тиреоїдних або антитиреоїдних препаратів. У літературі такі зміни називають по-різному: «синдром нетиреоїдних захворювань», «синдром еутиреоїдної патології», «синдром позатиреоїдної дисфункції», «синдром псевдотиреоїдної дисфункції» тощо [1-4]. Останнє визначення, на нашу думку, найбільш повно відображає весь спектр порушень показників тиреоїдного гомеостазу, зумовлених різноманітними ендо-та екзогенними чинниками. Необхідно чітко усвідомлювати різницю понять тиреоїдної і псевдотиреоїдної дисфункції. Тиреоїдна дисфункція-це патологічний стан, що виникає внаслідок порушення синтезу тиреоїдних гормонів ЩЗ або їх дії на периферичні тканини. Під псевдотиреоїдною дисфункцією розуміють відхилення показників вмісту сироваткових тиреоїдних гормонів внаслідок периферичних змін їх метаболізму та/або транспорту на тлі відсутності супутньої патології ЩЗ, гіпофіза та/або гіпоталамуса.

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Low T3 syndrome predicts more adverse events in patients with hypertrophic cardiomyopathy

He,

Zhu,

Fan

et al. 2023

Clinical Cardiology

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BackgroundHypertrophic cardiomyopathy (HCM) is a common cardiac genetic disorder that clinically manifests with sudden death and progressive heart failure. Moreover, thyroid dysfunction is associated with increased cardiovascular morbidity and mortality risks. Therefore, this study aimed to clarify whether thyroid hormones could serve as an independent predictor of adverse events in patients with HCM.MethodsThe cohort consisted of 782 patients with HCM who had thyroid hormones baseline data and were admitted to the Affiliated Hospital of Jiaxing University. Patients were divided into two groups according to serum levels of free triiodothyronine (fT3): the normal fT3 and low triiodothyronine (T3) syndrome groups. Low T3 syndrome was defined as fT3 < 2.43 pmol/L with a normal thyroid‐stimulating hormone (TSH) level. Patients whose TSH levels were abnormally high or abnormally low were excluded from this study. The primary endpoint was the occurrence of sudden cardiac death (SCD) events, and the secondary endpoint was a composite of worsening heart failure (WHF) events, including heart failure death, cardiac decompensation, hospitalization for heart failure, and HCM‐related stroke. The Kaplan–Meier and Cox regression were performed for the survival analysis.ResultsAfter a median follow‐up of 52 months, 75 SCD events and 134 WHF events were recorded. The Kaplan–Meier survival curves showed that the cumulative incidence of SCD events and WHF events were significantly higher in patients with low T3 syndrome (log‐rank p = .02 and log‐rank p = .001, respectively). Furthermore, multivariate Cox regression analysis demonstrated that low T3 syndrome is a strong predictor of SCD events and WHF events (adjusted hazard ratio [HR: 1.53, 95% confidence interval [CI]: 1.13–2.24, p < .01; HR: 3.87, 95% CI: 2.91–4.98, p < .001, respectively).ConclusionsLow T3 syndrome is highly prevalent among patients with HCM and was independently associated with an increased risk of SCD events and WHF events. The routine assessment of serum fT3 levels may provide risk stratification in this population.

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Non-thyroidal illness syndrome in patients with cardiovascular diseases: A systematic review and meta-analysis

Cited by 81 publications

References 78 publications

Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming

Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming

Псевдотиреоїдна Дисфункція В Клінічній Практиці: Як Уникнути Діагностичних Помилок

Low T3 syndrome predicts more adverse events in patients with hypertrophic cardiomyopathy

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