Non-Thyroidal Illness Syndrome in Patients Exposed to Indoor Air Dampness Microbiota Treated Successfully with Triiodothyronine

Abstract

Long-term exposure to dampness microbiota induces multi-organ morbidity. One of the symptoms related to this disorder is non-thyroidal illness syndrome (NTIS). A retrospective study was carried out in nine patients with a history of mold exposure, experiencing chronic fatigue, cognitive disorder, and different kinds of hypothyroid symptoms despite provision of levothyroxine (3,5,3′,5′-tetraiodothyronine, LT4) monotherapy. Exposure to volatile organic compounds present in water-damaged buildings including metabolic products of toxigenic fungi and mold-derived inflammatory agents can lead to a deficiency or imbalance of many hormones, such as active T3 hormone. Since the 1970s, the synthetic prohormone, levothyroxine (LT4), has been the most commonly prescribed thyroid hormone in replacement monotherapy. It has been presumed that the peripheral conversion of T4 (3,5,3′,5′-tetraiodothyronine) into T3 (3,5,3′-triiodothyronine) is sufficient to satisfy the overall tissue requirements. However, evidence is presented that this not the case for all patients, especially those exposed to indoor air molds. This retrospective study describes the successful treatment of nine patients in whom NTIS was treated with T3-based thyroid hormone. The treatment was based on careful interview, clinical monitoring, and laboratory analysis of serum free T3 (FT3), reverse T3 (rT3) and thyroid-stimulating hormone, free T4, cortisol, and dehydroepiandrosterone (DHEA) values. The ratio of FT3/rT3 was calculated. In addition, some patients received adrenal support with hydrocortisone and DHEA. All patients received nutritional supplementation and dietary instructions. During the therapy, all nine patients reported improvements in all of the symptom groups. Those who had residual symptoms during T3-based therapy remained exposed to indoor air molds in their work places. Four patients were unable to work and had been on disability leave for a long time during LT4 monotherapy. However, during the T3-based and supportive therapy, all patients returned to work in so-called “healthy” buildings. The importance of avoiding mycotoxin exposure via the diet is underlined as DIO2 genetic polymorphism and dysfunction of DIO2 play an important role in the development of symptoms that can be treated successfully with T3 therapy.

Theory: Treatments for Prolonged ICU Patients May Provide New Therapeutic Avenues for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

“…The type of supplement (synthetic T4 or T3), the timing of treatment and the dosage could explain the variable, but often poor outcomes. Specifically, given that thyroid hormone conversion from its "inactive" (T4) to "active" (T3) form by deiodinase enzymes is impaired during illness through the actions of pro-inflammatory cytokines (13,16,114,119,120), it has been suggested that T3 supplementation may be more effective than T4 supplementation (121)(122)(123). In fact, given that T4 up-regulates the enzyme (deiodinase D3) which converts thyroid hormones into "inactivated" forms and down-regulates the enzyme (D2) responsible for thyroid hormone conversion to the "active" forms (124,125), any T4 supplementation could exasperate NTIS.…”

Medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen – Update 2023 (AWMF-Register-Nr. 161/001)

“…Im Gegensatz zu den zuvor besprochenen Syndromen thematisieren nur wenige Studien einen möglichen Zusammenhang zwischen Feuchte-/Schimmelexposition in Innenräumen und CFS [561][562][563].…”

“…Vereinzelt werden in (nicht-wissenschaftlichen) Veröffentlichungen und Internet-Foren Hypothesen über Zusammenhänge zwischen Schimmelpilzen und zahlreichen weiteren unterschiedlichen Krankheitsbildern postuliert 167 563 598 599 , mit der Folge verunsicherter Patient*innen, die sich im Internet „informiert“ haben. Auch werden Schimmelpilze mit „Darmpilzen“ (kommensale Besiedlung mit Candida albicans ) fälschlicherweise mitunter gleichgesetzt.…”

The Roles of Autoimmunity and Biotoxicosis in Sick Building Syndrome as a “Starting Point” for Irreversible Dampness and Mold Hypersensitivity Syndrome

“…Exposure to the metabolite products of indoor air molds can cause the development of autoimmune thyroidal disease and type I diabetes mellitus [34]. There are some, although scarce, reports that DMHS is related to non-thyroid illness [35]. Dennis et al [36] published that patients exposed to indoor air molds had low T3 and/or T4 values and a low value of adrenocorticotrophic hormone (ACTH).…”