Nonthyroidal illnesses syndrome in full-term newborns with sepsis

Abstract

Objective: To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods: We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results: 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions: This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34

Neonatal Screening Program of Congenital Hypothyroidism: How Can We (Still) Improve?

“…aminophylline, heparin, amiodarone). In nonthyroidal illness (also called sick euthyroid syndrome) babies are described to have low serum T3 levels, normal to low TT4, elevated reverse T3 and normal TSH [34,35]. Therefore, babies on medication should repeat the screening [24,37,38], a procedure not widely accomplished for Portuguese babies, as observed here.…”

“…Babies seriously ill, using dopamine, caffeine and corticosteroids are likely to present impaired thyroid function [15,28,30]. Dopamine inhibits TSH and T4 secretion [28, [31][32][33]; caffeine may increase the expression of the gene encoding for TSH [30]; corticosteroids may lead to reduction of T3 and TSH levels and elevation of reverse T3 [33,34]; many other drugs may affect thyroid function (e.g. aminophylline, heparin, amiodarone).…”

The Relationship Between Congenital Hypothyroidism and Neonatal Sepsis in Premature Infants

“…Sonuç olarak, birçok klinik çalışmada kritik hastalıklar ve özellikle sepsiste tiroid hormonlarının baskılanması ve hipotirodi olan ratlarda sepsis şiddeti daha yüksek olması aslında tiroid hormonlarının kritik hastalarda önemli işleve sahip olduğunu göstermektedir (10,18,20) . Çalışmamızda, KH, sepsis için risk oluşturmadığı sonucu bulunmuştur.…”

Serum cortisol and thyroid hormone concentrations and survival in foals born from mares with experimentally induced ascending placentitis

“…In human neonates, disorders such as sepsis suppress the hypothalamic‐pituitary‐thyroid axis (HPTA), reducing thyroxine (T 4 ), and triiodothyronine (T 3 ) concentrations, leading to a condition known as nonthyroidal illness syndrome (NTIS) 5,6 . The reduction in thyroid hormone (TH) concentrations possibly represents a physiological adaption to reduce metabolic activity to allow energy reallocation to respond to disease 5 .…”