Thyroid function in critically ill patients

Fliers, Eric; Bianco, Antonio C.; Langouche, Lies; Boelen, Anita

doi:10.1016/s2213-8587(15)00225-9

Cited by 335 publications

(345 citation statements)

References 92 publications

(104 reference statements)

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“…This condition, known as nonthyroidal illness, is typically characterized by normal serum TSH levels combined with low serum triiodothyronine and FT4 levels. 35 In contrast, we found an association of higher rather than lower FT4 levels with an increased risk of atherosclerotic manifestations. Additionally, nonthyroidal illness occurs mainly in critically ill patients, whereas our population consists of relatively healthy community-dwelling adults.…”

Section: Discussioncontrasting

confidence: 74%

Thyroid Function and the Risk of Atherosclerotic Cardiovascular Morbidity and Mortality

Bano¹,

Chaker²,

Mattace-Raso³

et al. 2017

Circulation Research

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Rationale: Thyroid hormones have been linked with various proatherogenic and antiatherogenic processes. However, the relationship of thyroid function with manifestations of atherosclerosis remains unclear. Objective: To investigate the association of thyroid function with atherosclerosis throughout its spectrum; that is, subclinical atherosclerosis, incident atherosclerotic cardiovascular (ASCV) events, and ASCV mortality. Methods and Results: This population-based study was embedded within the Rotterdam Study. The risk of atherosclerosis was evaluated by measuring (1) presence of subclinical atherosclerosis, assessed by coronary artery calcification score >100 AU; (2) ASCV events, defined as fatal and nonfatal myocardial infarction, other coronary heart disease mortality, or stroke; (3) ASCV mortality, defined as death because of coronary heart disease and cerebrovascular or other atherosclerotic diseases. Associations of thyroid-stimulating hormone and free thyroxine with the outcomes were assessed through logistic regression and Cox proportional hazard models, adjusted for potential confounders, including cardiovascular risk factors. A total of 9420 community-dwelling participants (mean age±SD, 64.8±9.7 years) were included. During a median follow-up of 8.8 years (interquartile range, 4.5–11.8 years), 934 incident ASCV events and 612 ASCV deaths occurred. Free thyroxine levels were positively associated with high coronary artery calcification score (odds ratio, 2.28; 95% confidence interval, 1.30–4.02) and incident ASCV events (hazard ratio, 1.87; confidence interval, 1.34–2.59). The risk of ASCV mortality increased in a linear manner with higher free thyroxine levels (hazard ratio, 2.41; confidence interval, 1.68–3.47 per 1 ng/dL) and lower thyroid-stimulating hormone levels (hazard ratio, 0.92; confidence interval, 0.84–1.00 per 1 logTSH). Results remained similar or became stronger among euthyroid participants. Conclusions: Free thyroxine levels in middle-aged and elderly subjects were positively associated with atherosclerosis throughout the whole disease spectrum, independent of cardiovascular risk factors.

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Section: Discussioncontrasting

confidence: 74%

Thyroid Function and the Risk of Atherosclerotic Cardiovascular Morbidity and Mortality

Bano¹,

Chaker²,

Mattace-Raso³

et al. 2017

Circulation Research

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“…In the Netherlands, CH screening is primarily based on thyroxine (T4) screening with supplementary thyrotropin (TSH) and thyroxine-binding globulin measurements aimed at identifying not only children with primary hypothyroidism but also children with central hypothyroidism [2]. However, interpretation of the screening results can be complicated by factors that can transiently reduce thyroid hormone concentrations, such as prematurity [3], drug use [4], cardiac surgery [5], and critical illness [6]. This condition of disturbed thyroid hormone concentrations (low T4 and low triiodothyronine, increased reverse triiodothyronine, and normal or low TSH) during critical illness is referred to as nonthyroidal illness syndrome (NTIS) or euthyroid sick syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…This condition of disturbed thyroid hormone concentrations (low T4 and low triiodothyronine, increased reverse triiodothyronine, and normal or low TSH) during critical illness is referred to as nonthyroidal illness syndrome (NTIS) or euthyroid sick syndrome. It is important to distinguish between CH and NTIS because CH therapy should be initiated as soon as possible, whereas treatment for NTIS is not recommended [6]. In previous studies critically ill neonates have had lower thyroid hormone concentrations than healthy neonates [7,8,9], and this has been associated with a prolonged hospital stay and a higher mortality [7,9].…”

Section: Introductionmentioning

confidence: 99%

Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation

et al. 2016

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Background: Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation (ECMO). Objectives: To determine the incidence of aberrant CH screening results in ECMO-treated neonates, to identify possible determinants, and to follow up patients with abnormal thyroid hormone concentrations. Methods: In this retrospective cohort study, we included 168 ECMO-treated neonates admitted from 2004 to 2014 and screened by protocol and divided them into the following 3 groups: group 1 (screened during ECMO, n = 107), group 2 (screened shortly before ECMO, n = 26), and group 3 (screened shortly after ECMO, n = 35). Results: CH screening results were aberrant in 67.3% (72/107) of the neonates screened during ECMO, in 73.1% (19/26) of the neonates screened before ECMO, and in 31.4% (11/35) of the neonates screened after ECMO (p < 0.001). Of the neonates with an aberrant screening result, all but 2 (i.e. 98%) had a low thyroxine concentration with a normal thyrotropin concentration at screening, as is seen in NTIS. None was diagnosed with CH. Mortality did not significantly differ between neonates with an aberrant screening result (32.4%) and neonates with a normal screening result (22.7%; p = 0.18). Screening before ECMO (OR 5.92; 95% CI 1.93-18.20), screening during ECMO (OR 4.49; 95% CI 1.98-10.19), and a higher Pediatric Logistic Organ Dysfunction-2 score (OR 1.31; 95% CI 1.04-1.66) were associated with an aberrant screening result. Conclusions: Aberrant CH screening results were found in most ECMO-treated neonates screened before or during ECMO, which is likely due to NTIS. Follow-up of thyroid hormone concentrations is best started after recovery from critical illness. Our results suggest that thyroxine therapy is not required during ECMO.

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“…Poor outcomes may result from this aggravating of the disease condition. 26 A Dutch study showed that low thyroid hormone in critically ill patients can cause death. 27 Also, a study in Turkey reported that the levels of T3, T4, FT3 and FT4 were lower in children with septic shock, compared to sepsis-related mortality of patients with sepsis.…”

Section: Resultsmentioning

confidence: 99%

Triiodothyronine levels and mortality in children with sepsis and septic shock

Destariani

Lubis

Deliana

et al. 2018

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Background Sepsis is the most common cause of death in infants and children. It can cause hormonal imbalances, such as euthyroid sick syndrome (ESS), which may increase the risk of death. Objective To evaluate a possible correlation between the level of triiodothyronine (T3) and mortality in children with sepsis and septic shock. Methods An observational cohort study was conducted on 80 children with sepsis and septic shock from October 2015 until January 2016 in Haji Adam Malik General Hospital, Medan, North Sumatera. Subjects underwent PELOD score and T3 examination on the first day admitted in Haji Adam Malik General Hospital. Chi-square test was used to analyze for a correlation between the T3 values and mortality. Results Of the 80 consecutive subjects, 39 (48.75%) had low T3 level on the first day. Of these 39 children, 36 (92.3%) died. Subjects with low T3 level had a 6.31 times higher risk of mortality (PR 6.31; 95%CI 2.99 to 13.28; P<0.001). Of the 31 subjects with high PELOD score, 23 (74.2%) had decreased T3 (PR=2.27; 95%CI 1.45 to 3.57; P<0.001). Conclusion Low T3 levels have significant relationship with mortality in children with sepsis and septic shock.

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Thyroid function in critically ill patients

Cited by 335 publications

References 92 publications

Thyroid Function and the Risk of Atherosclerotic Cardiovascular Morbidity and Mortality

Thyroid Function and the Risk of Atherosclerotic Cardiovascular Morbidity and Mortality

Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation

Triiodothyronine levels and mortality in children with sepsis and septic shock

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