The nonthyroidal illness syndrome in the non-critically ill patient

Παππά, Θεοδώρα; Vagenakis, Apostolos G.; Alevizaki, Maria

doi:10.1111/j.1365-2362.2010.02395.x

Cited by 75 publications

(69 citation statements)

References 76 publications

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“…Whether the thyroid hormone abnormalities found in the euthyroid sick syndrome are a physiologic adaptation or a pathologic change is a topic that is still debated (35,46,60,86,87). Multiple studies have shown that there is a positive correlation between low serum T3 or high serum rT3 levels and poor prognosis.…”

Section: Treatment Of the Euthyroid Sick Syndromementioning

confidence: 98%

“…Despite poor prognosis seen in these critically ill patients with the euthyroid sick syndrome or increased short-term mortality risk in elderly hospitalized patients (4), treatment with thyroid hormone in patients in medical ICU showed no benefit on outcome (9,86,93).…”

Section: General Medical or Intensive Care Unit Patientsmentioning

confidence: 99%

“…Abnormal serum thyroid hormone parameters have been well described in patients with acute illness but without prior history of thyroid disease since the 1970s (9,14,35,46,60,86,106). The most common alterations in thyroid hormone parameters seen in these cases include low triiodothyronine (T3) levels, normal thyroid stimulating hormone (TSH) levels, and increased reverse triiodothyronine (rT3) levels.…”

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Euthyroid Sick Syndrome

Lee

Farwell

2016

Comprehensive Physiology

130

116

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In this review, we discuss the characteristics, pathophysiology, and therapeutic implications of the euthyroid sick syndrome. Multiple mechanisms have been identified to contribute to the development of euthyroid sick syndrome, including alterations in the iodothyronine deiodinases, thyroid-stimulating hormone secretion, thyroid hormone binding to plasma protein, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. The euthyroid sick syndrome appears to be a complex mix of physiologic adaptation and pathologic response to acute illness. The underlying cause for these alterations has not yet been elucidated. Treatment of the euthyroid sick syndrome with thyroid hormone to restore normal serum thyroid hormone levels in an effort to improve disease prognosis and outcomes continues to be a focus of many clinical studies, although currently available data do not provide evidence of a clear benefit of treatment.

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Section: Treatment Of the Euthyroid Sick Syndromementioning

confidence: 98%

Section: General Medical or Intensive Care Unit Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Euthyroid Sick Syndrome

Lee

Farwell

2016

Comprehensive Physiology

130

116

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“…Low T3 syndrome has been found in several critical disorders. Moreover, accumulating evidence suggests that fT3 could be a valuable parameter in evaluating the prognosis of patients with illness requiring admission to the ICU, acute cerebrovascular disorders, NMOSD, and even noncritical illness [12,[22][23][24]. The detection of several thyroid hormones simultaneously or individually can predict a poor outcome in children with central nervous system infections [25].…”

Section: Discussionmentioning

confidence: 99%

Thyroid Function and Autoimmune Indications in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Ma¹,

Yin²,

Zeng³

et al. 2018

Neuroimmunomodulation

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Objective: Previous studies have shown that functional abnormalities of the thyroid are associated with the pathogenesis of several neurological diseases. However, their relationship in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis remains to be defined. Methods: Forty-three patients with anti-NMDAR encephalitis were examined for thyroid function and autoimmune indications, in comparison with 225 healthy controls (CTL). Patients were further classified into 2 subgroups based on their free tri-iodothyronine (fT3) levels. Moreover, fT3 levels were also investigated after at least three months of follow-up. The clinical characteristics of the patients and CTL were described in detail. Results: Serum levels of fT3 and thyroid-stimulating hormone (TSH) were found to be relatively lower in patients with anti-NMDAR encephalitis than in CTL (both p < 0.001). Low T3 syndrome also occurred more frequently in anti- NMDAR encephalitis (25.6 vs. 0.4%, p < 0.001). However, no statistical differences were detected between patients and CTL in terms of the positive rate of thyroid antibodies and other types of thyroid dysfunction. Patients with low T3 levels tended to have a longer hospital stay (p = 0.006), a higher rate of abnormal brain magnetic resonance imaging (MRI) findings (p = 0.033), a higher frequency of consciousness declination (p = 0.029), and a higher modified Rankin scale (mRS) score during hospitalization. Low fT3 levels were also associated with abnormal MRI findings, a decline in consciousness, and the mRS score on admission. In addition, fT3 seemed to gradually return to normal levels upon improvement of the mRS score (r = –0.649, p = 0.002). Conclusions: Low T3 syndrome often copresents in anti-NMDAR encephalitis and indicates a longer hospitalization, abnormal MRI findings, consciousness declination, and a higher clinical severity. However, fT3 levels do not seem to influence the prognosis of anti-NMDAR encephalitis.

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“…Pappa et al thought that there is no clear evidence of benefit from thyroid hormone replacement and well-designed studies that confirming its efficacy, thyroxine supplementation should not be recommended for the treatment of NTIS. 16 While De Groot et al hold that ESS is a manifestation of hypothalamicpituitary dysfunction and should be treated with appropriate replacement therapies. 17 In this study, we hope to explore the efficacy and safety of thyroid hormone replacement therapy for nephrotic syndrome (NS) patients associated with ESS.…”

Section: Introductionmentioning

confidence: 99%

Thyroid hormone replacement for nephrotic syndrome patients with euthyroid sick syndrome: a meta-analysis

Liu

Yan

2014

Renal Failure

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Objective: To assess the efficacy of thyroid hormone replacement therapy for nephrotic syndrome (NS) patients associated with euthyroid sick syndrome (ESS). Materials and methods: The Cochrane library, ISI, Ovid, PubMed, Chinese Biomedicine Database were searched, and reference list of relevant articles were selected. Randomized controlled trials (RCTs) or quasiRCTs with thyroid hormone replacement on NS patients associated with ESS were included in this analysis. Results: Six trials (329 participants) were included. Meta-analysis showed that thyroid hormone replacement therapy can significantly increase the completely remission rate [OR ¼ 3.04, 95% confidence interval (CI): 3.04-1.88, p50.00001] and total response rate (OR ¼ 4.63, 95% CI: 2.46-8.71, p50.00001) of NS patients associated with ESS. No side effect was observed during the follow-up period. There was no obvious publication bias in the meteanalysis studies. Conclusions: Thyroid hormone replacement therapy significantly increases the remission of ESS in patients with NS.

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The nonthyroidal illness syndrome in the non-critically ill patient

Cited by 75 publications

References 76 publications

Euthyroid Sick Syndrome

Euthyroid Sick Syndrome

Thyroid Function and Autoimmune Indications in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Thyroid hormone replacement for nephrotic syndrome patients with euthyroid sick syndrome: a meta-analysis

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