Dangerous Dogmas in Medicine: The Nonthyroidal Illness Syndrome

Groot, Leslie J. De

doi:10.1210/jcem.84.1.5364

Cited by 353 publications

(138 citation statements)

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“…No patient was treated for low hormone concentrations. Although T 3 administration has beneficial inotropic effects after cardiopulmonary bypass surgery and reduces the need for postoperative intensive care [24,25], other evidence for benefit of thyroid hormone replacement to critically ill patients with low thyroid hormone concentra- tion is conflicting [1,2,26]. A marked decrease in TT 4 concentration is associated with a high probability of death.…”

Section: Patients With Abnormally Low Endocrine Valuesmentioning

confidence: 99%

“…Altered thyroid function in critical illness is well known -the "sick euthyroid syndrome" or "non-thyroidal illness syndrome" [1,2]. The commonest finding in moderately ill patients is reduced circulating total tri-iodothyronine (TT 3 ) concentration, while total thyroxine (TT 4 ) and free thyroxine (fT 4 ) concentrations may also be reduced in more severe disease.…”

Section: Introductionmentioning

confidence: 99%

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Endocrine measurements in survivors and non-survivors from critical illness

et al. 2002

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Section: Patients With Abnormally Low Endocrine Valuesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endocrine measurements in survivors and non-survivors from critical illness

et al. 2002

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“…Alterations of plasma thyroid hormone levels occur in infants with congenital cardiac malformations after a CPB operation and have been referred to as NTIS [2,3,4]. Whether these changes are adaptive or maladaptive is still a matter of debate [3].…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon has been described as euthyroid sick syndrome and has been interpreted as an adaptive response of the organism to minimize metabolic demands during the stress of critical illness, and more recently it has been referred to as nonthyroidal illness syndrome (NTIS), implying that these changes in thyroid hormones resemble secondary hypothyroidism and that thyroid hormone replacement should be considered [2,3,4]. The most common pattern is a decrease in total and free T3 with normal levels of T4 [3,4].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Neurodevelopmental Outcome of Children Treated with Tri-Iodothyronine after Cardiac Surgery: Follow-Up of a Double-Blind, Randomized, Placebo-Controlled Study

Mittnacht

Choukair²,

Kneppo³

et al. 2015

Horm Res Paediatr

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Background: Transient thyroid dysfunction occurs in children after cardiopulmonary bypass (CPB). We demonstrated significant benefits of acute postoperative tri-iodothyronine (T3) treatment for recovery and myocardial function. Now we report the long-term neurodevelopment of these children. Methods: Twenty-eight children (70% of the original study population) could be recruited for a follow-up examination (median age 10.7 years, range 10-19.6 years) retaining the double-blind, randomized, placebo-controlled protocol. Cognitive function and motor development were tested, as were growth and thyroid and cardiac functions. Results: The median full-scale intelligence quotient of all children was within the reference range and similar in the placebo and T3 groups. Tests for motor and cognitive functions, growth, and thyroid and cardiac functions revealed concurrent results. Conclusions: Overall intellectual development is preserved in adolescents treated with CPB in infancy irrespectively of low postoperative thyroid hormone concentrations. While acute postoperative T3 treatment in children after CPB improves recovery, no significant long-term effects on neurodevelopment could be detected. We therefore speculate that transient postoperative thyroid dysfunction by means of nonthyroidal illness syndrome is predominantly mediated by extranuclear, nongenomic mechanisms and thus acutely affects the cardiovascular system but not the development of the central nervous system mediated by genomic mechanisms.

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“…The euthyroid sick syndrome, also called low T3 syndrome or nonthyroidal illness syndrome (NTIS), is observed in many acute and chronic non-thyroidal conditions [11,12]. This syndrome is characterised by decreased circulating levels of triiodothyronine (total and free T3), due to deficient peripheral T4 deiodination, as well as normal or low T4 and TSH levels.…”

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confidence: 99%