Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

Abstract

Object A low triiodothyronine (T3) state is highly prevalent and is associated with a poor prognosis in critically ill patients. The authors investigated, in patients undergoing brain tumor surgery, the direct association of a perioperative low T3 syndrome with clinical outcomes and also with symptoms of depression and anxiety. Methods Ninety consecutive patients (71% women, median age 55 years), on admission for brain tumor surgery, were evaluated for sociodemographic and clinical characteristics. Their thyroid function profile was assessed on the morning of brain tumor surgery and on the morning after brain tumor surgery. Patients with free T3 concentrations of 3.1 pmol/L or less were considered to have low T3 syndrome. The patients were evaluated for symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) before and after surgery and for clinical outcomes using the Glasgow Outcome Scale (GOS) at discharge. Results After brain tumor surgery, free T3 concentrations decreased (p < 0.001) and the proportion of patients with low T3 levels increased from 38% to 54% (p = 0.02). Lower preoperative (rho = 0.30, p = 0.004) and postoperative (rho = 0.33, p = 0.002) free T3 concentrations correlated with low GOS scores at discharge. Preoperative low T3 syndrome (OR 5.49, 95% CI 1.27–23.69, p = 0.02) and postoperative low T3 syndrome (OR 8.73, 95% CI 1.49–51.21, p = 0.02) both increased risk for unfavorable clinical outcomes (GOS scores < 5) at discharge, after adjusting for age, sex, histological diagnosis of brain tumor, preoperative functional impairment, previous treatment for brain tumor, and depressive symptoms. Preoperative low T3 syndrome increased the risk for preoperative (HADS-depression subscale score ≥ 11; OR 4.12, 95% CI 1.16–14.58, p = 0.03) but not postoperative depressive symptoms independently from sociodemographic and clinical factors. Conclusions Low T3 syndrome is a strong independent predictor of unfavorable clinical outcomes and depressive symptoms, and its diagnosis and preoperative management should be considered in patients undergoing neurosurgery for the treatment of brain tumors.

Preoperative low tri-iodothyronine concentration is associated with worse health status and shorter five year survival of primary brain tumor patients

“…These findings agree with previous data showing 8-fold greater risk for poor discharge outcomes in brain tumor patients with reduced free triiodothyronine concentrations [15]. An association of lower triiodothyronine concentrations with worse hospital discharge outcomes was previously reported in stroke [21] aneurysmal SAH [22] patients.…”

“…The prevalence of the Low triiodothyronine syndrome was the highest in high-grade glioma patients. In a previous study of 90 patients with primary and metastatic brain tumors, we found that 38% of patients had reduced triiodothyronine concentrations before surgery, and that the prevalence of the Low triiodothyronine syndrome increased to 54% after surgery [15]. Greater prevalence rate of the Low triiodothyronine syndrome in the present study can be explained by the greater number of patients with malignant gliomas (21% vs. 13%) included in the present cohort.…”

“…In previous studies, lower triiodothyronine concentrations were associated with worse health-related quality of life [18], and with greater depressive and anxiety symptom severity [15] of brain tumor patients independently from histological diagnosis, patients’ age, gender and functional status. These findings suggest that thyroid impairment should be suspected in brain tumor patients presenting with cognitive, mental and functional complaints.…”

“…However, the clinical significance of the Low triiodothyronine syndrome in brain tumor patients remains understudied [13–16]. In 90 patients with various histological diagnoses of brain tumors we have documented that 54% of patients had the Low triiodothyronine syndrome that was associated with an 8-fold increase in risk for unfavorable discharge outcomes and with greater depressive and anxiety symptom severity [15]. However there are no studies investigating long-term prognostic value of the Low triiodothyronine syndrome in primary brain tumor patients.…”

Reliability and validity of the SF-36 Health Survey Questionnaire in patients with brain tumors: a cross-sectional study

“…Moderate-severe depressive symptoms were associated with worse HRQoL across all SF-36 dimensions. Mood symptoms and disorders are common [25–27] and were document as independent predictors of worse HRQoL of brain tumor patients [3, 26]. Functional dependence was associated with worse HRQoL in all but mental health domains suggesting that functional status should be considered important for HRQoL of brain tumor patients.…”