Low T3 syndrome as a predictor of poor prognosis in chronic lymphocytic leukemia

Abstract

Low triiodothyronine (T3) state is associated with poor prognosis in critical acute and prolonged illness. However, the information on thyroid dysfunction and cancer is limited. The aim of our study was to evaluate the prognostic value of low T3 syndrome in chronic lymphocytic leukemia (CLL). Two hundred and fifty-eight patients with detailed thyroid hormone profile at CLL diagnosis were enrolled. Low T3 syndrome was defined by low free T3 (FT3) level accompanied by normal-to-low free tetraiodothyronine (FT4) and thyroid-stimulating hormone (TSH) levels. A propensity score-matched method was performed to balance the baseline characteristics. Multivariate Cox regression analyses screened the independent prognostic factors related to time-to-first-treatment (TTFT) and cancer-specific survival (CSS). Area under the curve (AUC) assessed the predictive accuracy of CLL-International Prognostic Index (IPI) together with low T3 syndrome. The results showed that 37 (14.34%) patients had low T3 syndrome, which was significantly associated with unfavorable TTFT and CSS in the propensity-matched cohort, and it was an independent prognostic indicator for both TTFT and CSS. Serum FT3 level was positively related to protein metabolism and anemia, and inversely related to inflammatory state. Patients with only low FT3 demonstrated better survival than those with synchronously low FT3 and FT4, while those with synchronously low FT3, FT4 and TSH had the worst clinical outcome. Low T3 syndrome together with CLL-IPI had larger AUCs compared with CLL-IPI alone in TTFT and CSS prediction. In conclusion, low T3 syndrome may be a good candidate for predicting prognosis in future clinical practice of CLL.

Low triiodothyronine syndrome is associated with hemorrhagic transformation in patients with acute ischaemic stroke

“…According to the manufacturer’s instructions, the reference intervals for our laboratory were as follows: T3, 1.34–2.73 nmol/L; serum free T3, 3.80-6.00 pmol/L; total thyroxine (T4), 78.38–157.40 nmol/L; serum free T4, 7.86–14.41 pmol/L; TSH, 0.34–5.60 mIU/L. Low T3 syndrome was defined as T3 levels below the lower limit of the reference interval (T3 < 1.34 nmol/L) accompanied by low or normal serum T4 and TSH levels [49–51].…”

Thyroid Hormones and Cancer: A Comprehensive Review of Preclinical and Clinical Studies

“…Changes include a decrease in T3 levels, increase in rT3 and inconstant alterations in circulating T4 levels (212). The association of NTIS with cancer was documented in various tumor types including breast cancer (232), gastrointestinal cancers (232), lung cancer (233–235), central nervous system tumors (236), multiple myeloma (237), chronic lymphocytic leukemia (238), and diffuse large cell lymphoma (239).…”

“…NTIS was also a predictor of poor post-operative outcomes in patients undergoing brain tumor surgery (240). In a study of patients with chronic lymphocytic leukemia (238), NTIS was associated with significantly shorter time to first treatment (2 vs. 11 months, p < 0.001) and cancer-specific survival (median survival 51 months vs. not reached) compared to patients with normal T3. In another study by the same group, of 188 patients with diffuse large B cell lymphoma, low T3 was associated with worse PFS (median survival 17 vs. 22 months) and overall survival (median survival 17 vs. 23 months) in the rituximab era (239).…”

Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors

“…In addition, the age of the ESS group in this study is higher than that of the non-ESS group. The univariate regression analysis shows no correlation between ESS and age; therefore, the correlation between these factors requires further investigation ( 23 – 25 ).…”