High prevalence of non-thyroidal illness syndrome in patients at long-term care facilities

Lado-Abeal, Joaquín; Díaz, C; Berdine, Gilbert; Iwuji, Kenneth; Araújo‐Vilar, David; Lampon-Fernandez, Natalia; Wang, Min; Lojo, S.; Rodriguez-Perez, Alfonso; Rivas, Ana Marcella

doi:10.1007/s12020-020-02321-5

Cited by 4 publications

(5 citation statements)

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“…NTIS has been reported in the context of infection, sepsis, trauma, burns, Extended author information available on the last page of the article myocardial infarction, and malignancy [10][11][12][13]. This condition has also been described in fasting states in otherwise healthy individuals [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Several changes in thyroid hormones (TH) occur during severe acute illness and are collectively referred to as non-thyroidal illness syndrome (NTIS) [10]. NTIS has been reported in the context of infection, sepsis, trauma, burns, Extended author information available on the last page of the article myocardial infarction, and malignancy [10][11][12][13]. This condition has also been described in fasting states in otherwise healthy individuals [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…In NTIS, this drop in T3 and thyroxine (T4) levels is usually not accompanied by a concomitant rise in serum thyroid-stimulating hormone (TSH). Instead, serum TSH may even decrease due to inhibition of the hypothalamic-pituitary-thyroid (HPT) axis [10,11]. NTIS can be thought of as an adaptive response and represents the body's attempt to decrease energy expenditure [10].…”

Section: Introductionmentioning

confidence: 99%

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Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children

Calcaterra

Biganzoli

Dilillo

et al. 2021

J Endocrinol Invest

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Purpose COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. Methods We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019–January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. Results Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8–13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. Conclusions A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children’s health and help delineate long term follow-up management and prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children

Calcaterra

Biganzoli

Dilillo

et al. 2021

J Endocrinol Invest

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“…A study from China found that approximately 27.52% of patients with COVID-19 had non-thyroidal illness syndrome (NTI) [1], which is characterized by a decrease in triiodothyronine (T3) levels and/or a decrease in thyroxin (T4) levels without an increase in thyroid-stimulating hormone (TSH) levels [2,3]. NTI typically occurs in patients admitted to intensive care units (ICUs) and is closely associated with the disease condition and prognosis [3,4]. The abovementioned study found that patients with NTI had up to 2.5-fold increased ratio for severe COVID-19 [1].…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of low TSH concentration in patients with COVID-19 presenting with non-thyroidal illness syndrome

et al. 2021

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Background Low free triiodothyronine (FT3) levels are related to a poor prognosis deterioration in patients with COVID-19 presenting with non-thyroidal illness syndrome (NTI). This study was designed to explore whether free thyroxin (FT4) or thyroid stimulating hormone (TSH) levels affected the mortality of patients with COVID-19 presenting with NTI. Methods Patients with COVID-19 complicated with NTI who were treated at our hospital were included in this retrospective study. Patients were divided into low TSH and normal TSH groups, as well as low and normal-high FT4 group, according to the reference range of TSH or FT4 levels. The 90-day mortality and critical illness rates were compared among patients with low and normal TSH levels, as well as among patients with low FT4 levels and normal-high FT4 levels; in addition, differences in demographic and laboratory data were compared. A Kaplan-Meier analysis and Cox proportional hazards models were used to assess the associations of TSH and FT4 levels with mortality. Results One hundred fifty patients with low FT3 levels and without a history of thyroid disease were included, 68% of whom had normal FT4 and TSH levels. Critical illness rates (74.07% VS 37.40%, P = 0.001) and mortality rates (51.85% VS 22.76%, P = 0.002) were significantly higher in the low TSH group than in the normal TSH group. Although no significant difference in the critical illness rate was found (P = 0.296), the mortality rate was significantly higher in the low FT4 group (P = 0.038). Low TSH levels were independently related to 90-day mortality (hazard ratio = 2.78, 95% CI:1.42–5.552, P = 0.003). Conclusions Low FT4 and TSH concentrations were associated with mortality in patients with COVID-19 presenting with NTI; moreover, low TSH levels were an independent risk factor for mortality in these patients.

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“…Studies investigating neuroendocrine function after recovery from critical illness outside the setting of TBI or brain surgery are scarce if not absent. It has been shown that former ICU patients who were transferred to long-term care facilities still reveal the typical non-thyroidal illness syndrome, which is not unexpected given that such patients have not fully recovered [ 29 ]. However, information on the thyroid axis in fully recovered former ICU patients was hitherto lacking.…”

Section: Discussionmentioning

confidence: 99%

Persisting neuroendocrine abnormalities and their association with physical impairment 5 years after critical illness

et al. 2021

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Background Critical illness is hallmarked by neuroendocrine alterations throughout ICU stay. We investigated whether the neuroendocrine axes recover after ICU discharge and whether any residual abnormalities associate with physical functional impairments assessed 5 years after critical illness. Methods In this preplanned secondary analysis of the EPaNIC randomized controlled trial, we compared serum concentrations of hormones and binding proteins of the thyroid axis, the somatotropic axis and the adrenal axis in 436 adult patients who participated in the prospective 5-year clinical follow-up and who provided a blood sample with those in 50 demographically matched controls. We investigated independent associations between any long-term hormonal abnormalities and physical functional impairments (handgrip strength, 6-min walk distance, and physical health-related quality-of-life) with use of multivariable linear regression analyses. Results At 5-year follow-up, patients and controls had comparable serum concentrations of thyroid-stimulating hormone, thyroxine (T4), triiodothyronine (T3) and thyroxine-binding globulin, whereas patients had higher reverse T3 (rT3, p = 0.0002) and lower T3/rT3 (p = 0.0012) than controls. Patients had comparable concentrations of growth hormone, insulin-like growth factor-I (IGF-I) and IGF-binding protein 1 (IGFBP1), but higher IGFBP3 (p = 0.030) than controls. Total and free cortisol, cortisol-binding globulin and albumin concentrations were comparable for patients and controls. A lower T3/rT3 was independently associated with lower handgrip strength and shorter 6-min walk distance (p ≤ 0.036), and a higher IGFBP3 was independently associated with higher handgrip strength (p = 0.031). Conclusions Five years after ICU admission, most hormones and binding proteins of the thyroid, somatotropic and adrenal axes had recovered. The residual long-term abnormality within the thyroid axis was identified as risk factor for long-term physical impairment, whereas that within the somatotropic axis may be a compensatory protective response. Whether targeting of the residual abnormality in the thyroid axis may improve long-term physical outcome of the patients remains to be investigated. Trial registration ClinicalTrials.gov: NCT00512122, registered on July 31, 2007 (https://www.clinicaltrials.gov/ct2/show/NCT00512122). Graphical Abstract

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High prevalence of non-thyroidal illness syndrome in patients at long-term care facilities

Cited by 4 publications

References 37 publications

Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children

Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children

Prognostic significance of low TSH concentration in patients with COVID-19 presenting with non-thyroidal illness syndrome

Persisting neuroendocrine abnormalities and their association with physical impairment 5 years after critical illness

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