The Value of Decreased Thyroid Hormone for Predicting Mortality in Adult Septic Patients: A Systematic Review and Meta-Analysis

Kim, Jae Guk; Shin, Hyungoo; Kim, Wonhee; Lim, Taeho; Jang, Bo‐Hyoung; Cho, Youngsuk; Choi, Kyu-Sun; Ahn, Chiwon; Lee, Juncheol; Na, MinKyun

doi:10.1038/s41598-018-32543-7

Cited by 26 publications

(26 citation statements)

References 45 publications

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“…Thyroid hormone dysfunction could affect the outcome, and increase mortality in patients with a critical illness [26][27][28][29]. Like the most severe manifestations of SARS, COVID-19 can be complicated by sepsis, multiorgan failure and acute respiratory distress syndrome (ARDS) [30].…”

Section: Thyroid Acute Respiratory Distress Syndrome and Nonthyroidamentioning

confidence: 99%

Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)

Speer¹,

Somogyi²

2021

Endocr J

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We have reviewed the available literature on thyroid diseases and coronavirus disease 2019 (COVID-19), and data from the previous coronavirus pandemic, the severe acute respiratory syndrome (SARS) epidemic. We learned that both SARS and COVID-19 patients had thyroid abnormalities. In the limited number of SARS cases, where it was examined, decreased serum T3, T4 and TSH levels were detected. In a study of survivors of SARS approximately 7% of the patients had hypothyroidism. In the previous evaluation evidence was found that pituitary function was also affected in SARS. Others suggested a hypothalamic-pituitary-adrenal axis dysfunction. One result published recently indicates that a primary injury to the thyroid gland itself may play a key role in the pathogenesis of thyroid disorders in COVID-19 patients, too. Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19. Angiotensin-converting enzyme 2 is a membrane-bound enzyme, which is also expressed in the thyroid gland and the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses it for docking, entering as well as replication. Based on the available results obtained in the SARS-CoV-2 pandemic, beside others, we suggest that it is necessary to monitor thyroid hormones in COVID-19.

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Section: Thyroid Acute Respiratory Distress Syndrome and Nonthyroidamentioning

confidence: 99%

Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)

Speer¹,

Somogyi²

2021

Endocr J

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“…9,10,17 In both human and dogs with NTIS, the finding of low serum T 4 or fT 4 concentrations, together with high TSH concentrations, complicates evaluation of thyroid function and increases the risk for misdiagnosis of primary hypothyroidism. [1][2][3]11,18 In both humans 3,[19][20][21][22][23] and dogs 10,12 with NTIS, development of low serum T 4 and T 3 concentrations increases the likelihood of death, a finding that might be useful as a prognostic indicator. Furthermore, in both humans and dogs, finding of low serum TSH concentrations has predicted mortality.…”

Section: Introductionmentioning

confidence: 99%

Serum thyroxine and thyrotropin concentrations decrease with severity of nonthyroidal illness in cats and predict 30‐day survival outcome

Peterson

Davignon

Shaw

et al. 2020

Veterinary Internal Medicne

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Background: In cats, nonthyroidal illness affects serum thyroid hormone concentrations. Serum thyroxine (T 4) and triiodothyronine (T 3) concentrations commonly decrease, whereas free T 4 (fT 4) concentrations vary unpredictably. Limited information exists regarding effects on serum thyrotropin (thyroid-stimulating hormone [TSH]) concentrations in cats with nonthyroidal illness syndrome (NTIS). Objectives: To characterize alterations in thyroid function that develop in cats with NTIS and to correlate these alterations with severity and outcome of the nonthyroidal illness. Animals: Two hundred and twenty-two cats with NTIS and 380 clinically normal cats of similar age and sex. Methods: Prospective, cross-sectional study. All cats had serum T 4 , T 3 , free T 4 , and TSH concentrations measured. Cats were grouped based on illness severity and 30-day survival. Results: Cats with NTIS had lower serum T 4 and T 3 concentrations than did normal cats (P < .001). Serum fT 4 and TSH concentrations did not differ between groups. Serum T 4 , T 3 , and fT 4 concentrations progressively decreased with increasing disease severity (P < .001). The 56 cats that died had lower T 4 , T 3 , and TSH concentrations than did the 166 survivors, with no difference in fT 4 concentration. Multivariable logistic regression modeling indicated that serum T 4 and TSH concentrations both predicted survival (P < .02). Conclusions and Clinical Importance: Cats with NTIS commonly develop low serum T 4 , T 3 , and TSH concentrations, the prevalence and extent of which increases with disease severity. Clinicians should consider evaluating thyroid function in cats with severe NTIS, because doing so could help determine probability of successful treatment responses before investing considerable time, effort, and finances in addressing the underlying disease.

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“…There is evidence suggesting that low T3 syndrome is a strong predictor of cardiac death because of its potential associations with exacerbation of cardiac disease [31,32]. Similar associations between TH levels and mortality were observed in patients with sepsis, as TH levels affect the function and activity of neutrophils and other immune cells [33]. We can conclude that there are multifactorial causes of associations between lower serum FT3 levels and prognosis of higher mortality in AIS; thus, TH status both reflects and affects different organ dysfunctions.…”

Section: Parametermentioning

confidence: 72%

Nonthyroidal Illness Syndrome in Ischaemic Stroke Patients is Associated with Increased Mortality

Taroza

Rastenytė

Podlipskytė

et al. 2019

Exp Clin Endocrinol Diabetes

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Background Results of studies on associations between triiodothyronine serum levels and mortality after acute ischemic stroke (AIS) are inconsistent. Therefore, the aim of this prospective study was to evaluate links between serum levels of thyroid axis associated hormones and all-cause mortality during 1 year after AIS. Methods and results This study involved 255 patients with AIS. Patients were divided into two groups: those who survived 1 year after their index stroke and those who not, and by quartiles of free triiodothyronine (FT3) and ΔFT3 (difference between basal FT3 and repeated FT3 on discharge) hormone serum concentrations. To assess serum levels of thyroid stimulating hormone (TSH), FT3 and free tetraiodothyronine (FT4), venous blood was taken from all included patients on admission to hospital. On discharge, blood tests were repeated for 178 (69.8%) patients. Study endpoints were overall mortality within 30, 90 and 365 days after AIS. Results Compared with the survivals, those who died had significantly lower mean FT3, FT3/FT4 ratio in all periods and lower median TSH within 30 days. Higher FT3 serum levels versus lower, even after adjustment for included important variables, remained significant for lower odds of death within 365 days after AIS (OR=0.57; 95% CI: 0.33–0.97, p=0.04), but added insignificant additional predictive value to the NIHSS score or age. Kaplan–Meier survival curves demonstrated that the first FT3 quartile was significantly associated with increased mortality compared with all other quartiles within 365 days after AIS. With ΔFT3 quartiles no such association was found. Conclusions. Higher FT3 levels on admission versus lower are significantly associated with lower mortality within 365 days after AIS. FT3 serum levels changes over time didn’t show any association with mortality within first year.

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The Value of Decreased Thyroid Hormone for Predicting Mortality in Adult Septic Patients: A Systematic Review and Meta-Analysis

Cited by 26 publications

References 45 publications

Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)

Thyroid complications of SARS and coronavirus disease 2019 (COVID-19)

Serum thyroxine and thyrotropin concentrations decrease with severity of nonthyroidal illness in cats and predict 30‐day survival outcome

Nonthyroidal Illness Syndrome in Ischaemic Stroke Patients is Associated with Increased Mortality

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