Prevalencia y significación pronóstica del síndrome del enfermo eutiroideo en patología crítica

Bayarri, Vicente Miguel; Pallé, S. Borrás; Llácer, Blesila Murcia; Chinesta, S. Sancho; López, Antonio; Izquierdo, Eva; Bermúdez, Brígido Pérez; Mijares, Antonio Hernández

doi:10.1016/s0014-2565(01)70916-2

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…Very sick patients may show a dramatic fall in total T3 and T4 levels; this state is called the low-T4 syndrome or SES type 2 (SES-2) and has a poor prognosis [9]. Patients with low or undetectable TSH show increased morbidity and mortality [10,11]. Additionally, the response of TSH to thyroid releasing hormone (TRH) is impaired in SES.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the function of hypothalamo-pituitary-thyroid axis in children with central nervous system infections

et al. 2011

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BackgroundIt is well known that certain non-thyroidal critical illness may lead to euthyroid sick syndrome(ESS). There are little reports about the change of thyroid hormone in the children's central nervous system (CNS) infections.ResultsThe results of serum TT3, TT4 and TSH in these children were compared with those in 20 cases of healthy adults and 20 cases of adults with primary hypothyroidism. Serum T3 and T4 were decreased in 34/78 children with CNS infections, T3 and T4 were much lower than those of healthy adult (p < 0.05), but still higher than that of the primary hypothyroidism (p < 0.05), and TSH levels were not significant differences among children with CNS infections and children with non-CNS infections (p > 0.05).Low T3 and T4 levels in serum and cerebrospinal fluid(CSF)were predominant in children with serious infections of CNS, 31/34 (percent 91.17) cases of serious CNS infection had low serum TT3 and/or TT4. The low T3 with low T4 was seen in 14/34 children of severe CNS infections, 3 of them died. The levels of CSF T3 (X ± SD = 0.39 ± 0.47 ng/ml) and T4 (x ± SD = 1.02 ± 1.27 ug/dl) in the serious CNS infections were lower than that of non-CNS infections T3 (x ± SD = 0.93 ± 1.23 ng/ml), and T4 (x ± SD = 2.42 ± 1.70 ug/dl), 7 died children were all in the subjects of low T3 and/or low T4.In 22 children with non-CNS infections, serum T3 and T4 levels were lower than that of healthy adult, but have not significant difference(p > 0.05).ConclusionsThese results suggest that detection of TT3, TT4 and TSH in serum and/or CSF simultaneous or alone in analyses would be valuable in correctly judging thyroid function and evaluating the prognosis of the children with infections of CNS. Measuring a little amount of blood (1 ml)or CSF required for this method is a simple, convenient and accurate method.

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Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the function of hypothalamo-pituitary-thyroid axis in children with central nervous system infections

et al. 2011

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Complicaciones Médicas De Los Trastornos De La Conducta Alimentaria

Gabler

Olguin

Rodríguez

2017

Revista Médica Clínica Las Condes

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2006

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Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory response, resulting in increased postoperative morbidity and mortality. Under these circumstances, a typical pattern of thyroid abnormalities is seen in the absence of primary disease, defined as sick euthyroid syndrome (SES). The presence of postoperative SES mainly in small children and neonates exposed to long bypass times and the pharmacological profile of thyroid hormones and their effects on the cardiovascular physiology make supplementation therapy an attractive treatment option to improve postoperative morbidity and mortality. Many studies have been performed with conflicting results. In this article, we review the important literature on the development of SES in paediatric postoperative cardiac patients, analyse the existing information on thyroid hormone replacement therapy in this patient group and try to summarize the findings for a recommendation. IntroductionDuring systemic illness, especially after cardiac surgery using cardiopulmonary bypass (CBP), abnormalities in the circulating thyroid hormone levels are found in the absence of primary thyroid disease; this is collectively called the sick euthyroid syndrome (SES). Some argue that it is unclear if the clinical picture of SES is an adaptive process, a marker of the severity of illness or even if treatment is warranted in these patients.The many effects of thyroid hormones on the cardiovascular system have been described in detail elsewhere [1][2][3]. The biological actions of thyroid hormones on the cardiovascular system make these hormones attractive as a potential treatment option in the management of patients after cardiac surgery.We review the actual literature on the development of SES in children after cardiac surgery and discuss the relevant literature on hormone replacement. Finally, a critical appraisal of the potential effects of hormone replacement and the studies performed is sought. Sick euthyroid syndromeIt is well known that several severe diseases can cause abnormalities in the circulating thyroid hormone levels in the absence of primary thyroid disease (i.e., non-thyroidal illness or SES) [4].The most common pattern is a decrease in total and unbound triiodothyronin (T3) with normal levels of thyroid stimulating hormone (TSH) and thyroxin (T4). This is classified as SES type 1 (SES-1) or low-T3 syndrome. The de-ionidation from T4 to T3 via peripheral (hepatic) enzymes (inhibition of 5′-deionidase, a selenoenzyme [5,6]) is impaired, leading to a decrease of T3 and an increase in reverse T3 that is biologically inactive [7]. Inflammatory cytokines have been linked to the development of SES [8] and the levels of cytokines seem to influence the severity of SES [9,10]. Elevated serum levels of steroids as part of a stress response may influence the de-ionidase activity and TSH and T3 response in SES [8,[11][12][13]. Additionally, tissue-specific thyroid hormone bioactivity is reduced during cellular hypoxia and contributes to the low T(...

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Prevalencia y significación pronóstica del síndrome del enfermo eutiroideo en patología crítica

Cited by 4 publications

References 16 publications

Clinical evaluation of the function of hypothalamo-pituitary-thyroid axis in children with central nervous system infections

Clinical evaluation of the function of hypothalamo-pituitary-thyroid axis in children with central nervous system infections

Complicaciones Médicas De Los Trastornos De La Conducta Alimentaria

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