Non-Thyroidal Illness Syndrome is a Manifestation of Hypothalamic-Pituitary Dysfunction, and in View of Current Evidence, Should be Treated with Appropriate Replacement Therapies

Groot, Leslie J. De

doi:10.1016/j.ccc.2005.10.001

Cited by 166 publications

(132 citation statements)

References 131 publications

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“…Critical illness in humans is characterized by multiple and complex alterations in the thyroid axis [6,7]. As the severity of illness progresses, there is a reduction not only of serum triiodothyronine (T3), but also thyroxine (T4) and thyrotropin (TSH) concentrations [8]. Low concentrations of T4 and TSH have been shown to indicate prolonged illness and a poor prognosis in human critical care [9,10], especially in neonates undergoing open heart surgery [11] and in children with bacterial sepsis and septic shock [12].…”

Section: Introductionmentioning

confidence: 99%

Serum thyrotropin, thyroxine and free thyroxine concentrations as predictors of mortality in critically ill puppies with parvovirus infection: a model for human paediatric critical illness?

Schoeman

Herrtage

2008

Microbes and Infection

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This prospective case-controlled study investigated the role of the pituitaryethyroidal axis in the prediction of mortality in dogs. Serum thyrotropin, thyroxine and free thyroxine were measured at admission and daily until death or discharge in dogs ill with parvoviral diarrhoea. Serum thyroxine and free thyroxine in ill dogs were significantly lower than in controls and also significantly lower in nonsurvivors than in survivors on days 1-4. Serum thyrotropin at admission in ill dogs was similar to controls, but was significantly higher in nonsurvivors than in survivors. Thyrotropin concentrations became significantly lower in nonsurvivors vs survivors by day 4.

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Section: Introductionmentioning

confidence: 99%

Serum thyrotropin, thyroxine and free thyroxine concentrations as predictors of mortality in critically ill puppies with parvovirus infection: a model for human paediatric critical illness?

Schoeman

Herrtage

2008

Microbes and Infection

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“…Data concerning the potential role of deiodinases in the pathogenesis of NTIS are inconsistent. The generally accepted view has been that extrathyroidal conversion of T4 to T3 is diminished in patients with illnesses due to a decrease in both hepatic/renal D1 activity and skeletal muscle D2 activity (32)(33)(34). It was suggested that, together, these modifications in deiodinase expression could be a major factor involved in causing the low T3 concentration that is associated with NTIS.…”

Section: Discussionmentioning

confidence: 99%

Is there a link between polycystic ovary syndrome and non-thyroidal illness syndrome?

Karaköse¹,

Çakal²,

Topaloğlu³

et al. 2013

J Turkish German Gynecol Assoc

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Objective:The aim of this study was to determine the frequency of non-thyroidal illness syndrome (NTIS) in patients with polycystic ovary syndrome (PCOS). Material and Methods:During a 6-month period, 52 patients with PCOS were recruited for this cross-sectional study. The control group included 68 age-matched female volunteers. Serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroperoxidase antibody (anti-TPO Ab), and anti-thyroglobulin antibody (anti-Tg Ab) were measured. Results:The TSH level in the PCOS patients and controls did not differ significantly (1.9±1.2 µIU/mL vs. 1.8±0.9 µIU/mL, p>0.05). Serum fT3 and fT4 levels in the controls were significantly lower than those in the PCOS patients (fT3: 2.7±0.3 pg/mL vs. 2.9±0.3 pg/mL, p=0.02; fT4: 1.0±0.1 ng/dL vs. 1.1±0.1 ng/dL, p=0.03). The Hs-CRP (high-sensitivity C-reactive protein) level in the PCOS patients was significantly higher than in the controls (3.5±4.9 mg/L vs. 1.7±2.7 mg/L, p=0.03). A statistically significant relationship was observed between Hs-CRP and fT4 (r=0.245, p=0.015). However, NTIS was not observed in either group. Conclusion:Thyroid function abnormalities could be observed in PCOS; however, NTIS was not noted in the present study despite the inflammatory state of the PCOS patients. (J Turkish-German Gynecol Assoc 2013; 14: 216-20) Key words: Polycystic ovary syndrome, non-thyroidal illness syndrome, inflammation, hormones Received: 05 September, 2013 Accepted: 22 September, 2013 Amaç: Bu çalışmanın amacı, polikistik over sendromu (PKOS) olan hastalarda tiroid dışı hastalık sendromunun (NTIS) sıklığını tespit etmektir. Gereç ve Original Investigation 216 IntroductionPolycystic ovary syndrome (PCOS) is probably the most common endocrinopathy in women of reproductive age, and is characterised by anovulation, hyperandrogenaemia, and frequently insulin resistance (IR). It is associated with an increased risk of type 2 diabetes mellitus (T2DM) (1-3).The serum plasminogen activator inhibitor-1 (PAI-1) (4), C-reactive protein (CRP) (5, 6), advanced glycation end-products (AGEs) (7) and endothelin-1 (8) levels are all elevated in PCOS patients. These markers are known to contribute to atherogenesis and chronic inflammation (9-12).The first study to examine low-grade chronic inflammation in women with PCOS via the measurement of CRP was conducted in 2001 (13). The researchers reported that the CRP concentration was elevated in women with PCOS. PCOS patients were reported to exhibit higher mean serum tumour necrosis factor-a (TNF-a) (14), soluble intracellular adhesionmolecule-1 (sICAM-1), and sE-selectin levels (15). During many chronic illnesses, some aspects of thyroid hormone metabolism may change, which is collectively known as non-thyroidal illness syndrome (NTIS). Non-thyroidal illness is characterised by a decrease in the serum T3 level and it is thought that decreased extrathyroidal conversion of T4 to Is there a link between polycystic ovary syndrome and non-thyroidal illness sy...

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“…13 Levels of TSH, T4, and T3 are reduced, consistent with the nonthyroidal illness syndrome (NTIS), which has recently been considered a form of central hypothyroidism that may require treatment. 23 Hypogonadotropic hypogonadism is also a feature of PACI that may further enhance catabolism and poor nitrogen retention.…”

Section: Prolonged Acute Critical Illnessmentioning

confidence: 99%

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Schulman

Mechanick²

2012

Respir Care

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Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic interventions are extrapolated from clinical critical care research, scientific theory, and years of CCI patient care experience. Intensive metabolic support (IMS) is a multi-targeted approach consisting of tight glycemic control with intensive insulin therapy, early and adequate nutrition therapy, nutritional pharmacology, management of metabolic bone disease, and meticulous attention to other endocrine/metabolic derangements. Ideally, IMS should be under the supervision of a metabolic support consultative team. Further research specifically focused on the CCI population is needed to validate this current approach.

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Non-Thyroidal Illness Syndrome is a Manifestation of Hypothalamic-Pituitary Dysfunction, and in View of Current Evidence, Should be Treated with Appropriate Replacement Therapies

Cited by 166 publications

References 131 publications

Serum thyrotropin, thyroxine and free thyroxine concentrations as predictors of mortality in critically ill puppies with parvovirus infection: a model for human paediatric critical illness?

Serum thyrotropin, thyroxine and free thyroxine concentrations as predictors of mortality in critically ill puppies with parvovirus infection: a model for human paediatric critical illness?

Is there a link between polycystic ovary syndrome and non-thyroidal illness syndrome?

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

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