Diagnosis and treatment of low T3 syndrome in neurocritical patients

Chen, Yi-Hao; Chang, Jianbo; Yin, Rui; Wen, Junxian; Ma, Baitao; Zuo, Wei; Zhang, Xiao; Wei, Junji

doi:10.1111/jcpt.13162

Cited by 10 publications

(9 citation statements)

References 37 publications

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Section: Discussionmentioning

confidence: 99%

“…T3 mainly participates in the catabolic pathways of the body, and the decline in T3 levels observed in severe disease serves to protect the body by conserving energy ( 10 , 23 ). Low-T3 syndrome can thus be viewed as a useful adaptation in the acute phase of critical illness ( 5 , 19 , 23 ). Therefore, it is controversial whether thyroid hormone supplementation should be administered in the acute phase of severe disease accompanied by low-T3 syndrome ( 20 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

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Thyroid Function and Low Free Triiodothyronine in Chinese Patients With Autoimmune Encephalitis

Qiao

Zhang

et al. 2022

Front. Immunol.

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Background and ObjectivesLow free triiodothyronine (FT3) is usually associated with worse functional outcome in critical illness; however, the information on thyroid dysfunction and autoimmune encephalitis (AE) is limited. This study aims to evaluate the clinical prognostic value of thyroid function and low-T3 syndrome in patients with multiple subtypes of AE. MethodsIn this retrospective study, we identified the hospital records of 319 candidate patients with AE admitted between January 2016 and December 2020. We then extracted the clinical features and outcomes. Modified Rankin scale (mRS) scores were used to evaluate the patients’ neurological function. The serum levels of FT3, free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were measured upon admission. Normal thyroid stimulating hormone level with FT3 below the lower limit of the reference interval (2.63 nmol/L) was defined as low-T3 syndrome.ResultsA total of 237 AE cases remained after screening. Among these, 57.81% (137/237) were men and the average age at onset was 41 y (interquartile range, 12–61 y). We found that 83.54% (198/237) of the patients had a good prognosis, and 16.46% (39/237) had a poor prognosis. Abnormal thyroid function was observed in 30.80% of these patients, with a relatively greater prevalence in the group with a poor prognosis (p < 0.001). The serum FT3 levels in the poor-prognosis group were significantly lower than those in the good-prognosis group (p < 0.001). Low-T3 syndrome occurred in 15.19% of AE cases and was more frequent in patients with poor prognosis (p < 0.001).ConclusionsAbnormal thyroid function in AE is frequent, and serum FT3 levels in patients with poor prognosis are significantly lower than in those with good prognosis. Low-T3 syndrome could be a potential candidate for predicting the prognosis of AE following future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thyroid Function and Low Free Triiodothyronine in Chinese Patients With Autoimmune Encephalitis

Qiao

Zhang

et al. 2022

Front. Immunol.

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“…Hormone replacement therapy (HRT) is suggested as part of the early management of critically ill patients. Several studies have also found that HRT can improve survival rates in neurocritical and BI patients (25,26). However, understanding the degree and timing of intervention remains crucial.…”

Section: Discussionmentioning

confidence: 99%

Critically ill patients: histopathological evidence of thyroid dysfunction

Saha

Chattopadhyay

Dutta

et al. 2023

Preprint

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Background: Critical illness is characterized by severe biphasic physical and metabolic stress as a result of systemic inflammatory response syndrome and multiple organ dysfunction syndrome, and is frequently associated with non-thyroidal illness. The purpose of this study is to better understand the cytomorphological basis of NTI by performing histopathological examinations of the thyroid gland on autopsies of patients who died from critical illness. Methods: Histopathological examination of the thyroid gland of 58 critically ill patients was performed in our hospital. The cases included 24 cases of burn injury, 24 cases of traumatic brain injury, and 10 cases of cerebral stroke. Thyroid samples obtained during a medicolegal autopsy were preserved in 10% formol saline and stained with hematoxylin and eosin. The sections were visualized under light microscopy. Results: Out of the 58 cases examined, 21 patients showed normal thyroid findings, and the rest of the cases had unusual thyroid findings in the histopathological study. The principal finding was the distortion of thyroid follicular architecture. Other findings include mononuclear cell infiltration, clumping of thyroglobulin, and exhaustion of thyroid follicles. Conclusion: Critical illness produces metabolically damaging effects on the thyroid gland, which functionally corresponds to the state of low T3 syndrome. These effects worsen over time and warrant intervention through hormone replacement therapy.

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“…In a randomised, placebo‐controlled study, it found that short‐term replacement therapy enhanced ventricular performance and neuroendocrine profile in patients with low T3 syndrome and chronic heart failure 24 . A retrospective analysis showed that replacement therapy for low T3 syndrome patients could significantly improve the survival rates of neurocritical patients 26 . Besides, the endocrinologist Degroot proposed that low T3 syndrome is functional central hypothyroidism in some severe cases, and if severe, hormone replacement is appropriate 27 .…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism in induction chemotherapy of children with acute lymphoblastic leukaemia: A single‐centre study

Han

Qiu

et al. 2023

Intl Journal of Cancer

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Hypothyroidism as a long-term complication in cancer survivors has been an issue, but few studies have focused on changes in thyroid hormone levels during chemotherapy for leukaemia. This retrospective study was conducted to assess the characteristics of children with acute lymphoblastic leukaemia (ALL) and hypothyroidism during induction chemotherapy and to investigate the prognostic value of hypothyroidism in ALL. Patients with a detailed thyroid hormone profile at ALL diagnosis were enrolled. Hypothyroidism was defined as low serum levels of free tetraiodothyronine (FT4) and/or free triiodothyronine (FT3). The Kaplan-Meier method was used to create survival curves, and multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). There were 276 children eligible for the study, and 184 patients (66.67%) were diagnosed with hypothyroidism, including 90 cases (48.91%) with functional central hypothyroidism and 82 cases (44.57%) with low T3 syndrome. Hypothyroidism was correlated with the dosages of L-Asparaginase (L-Asp) (P = .004) and glucocorticoids (P = .010), central nervous system (CNS) status (P = .012), number of severe infections (grade 3, 4 or 5) (P = .026) and serum albumin level (P = .032).Hypothyroidism was an independent prognostic factor for PFS in ALL children (P = .024, 95% CI: 1.1-4.1). We conclude that hypothyroidism is commonly present in ALL children during induction remission, which is related to chemotherapy drugs and severe infections. Hypothyroidism was a predictor of poor prognosis in childhood ALL.

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Diagnosis and treatment of low T3 syndrome in neurocritical patients

Cited by 10 publications

References 37 publications

Thyroid Function and Low Free Triiodothyronine in Chinese Patients With Autoimmune Encephalitis

Thyroid Function and Low Free Triiodothyronine in Chinese Patients With Autoimmune Encephalitis

Critically ill patients: histopathological evidence of thyroid dysfunction

Hypothyroidism in induction chemotherapy of children with acute lymphoblastic leukaemia: A single‐centre study

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