Nonthyroidal Illness Syndrome and Prolonged Mechanical Ventilation in Patients Admitted to the ICU

Thyroid hormone levels as a predictor of mortality in intensive care patients: A comparative prospective study

“…In studies by Economidou et al [1] and Ray et al [3] it has been reported that a progressive hourly decrease in T3 levels can be seen in ICU patients. In a similar study, Melver et al observed that total T3 levels were lower in patients undergoing surgery as well as in patients with burns, acute coronary syndrome, cancer, renal, respiratory, prolonged mechanical ventilation, hepatic disorders, pregnancy or during the postpartum period and premature infants [1,[20][21][22].…”

Thyroid function in critically ill patients

“…On the other hand, patients with extended critical illness show clear symptoms and signs that resemble those noted in patients with hypothyroidism including impaired con sciousness, myocardial function, hypothermia, neuropathy, muscle weakness, atrophy of the skin, and hair loss, which together might impede recovery. 13,14 Although the hypothesis that NTIS in patients in the ICU could be maladaptive has been extensively discussed, 9 surprisingly few clinical studies (some being randomised controlled trials [RCTs]) aimed at modulating NTIS to improve clinical outcome have been reported. With some clinical intervention studies, irrespective of their design, the risk–benefit ratio might seem favourable with most patients showing a benefit and only a few showing harm (table), but this ratio has not been formally analysed when only RCTs with clinically relevant outcome measures, such as mortality or morbidity, are taken into account.…”

Non-Thyroidal Illness in the ICU: A Syndrome with Different Faces

“…Indeed, patients admitted to the ICU who ultimately do not survive critical illness present with much lower plasma concentrations of T4, T3, and TSH, and with higher plasma concentrations of rT3 than do survivors (11). In addition, patients suffering from prolonged critical illness present with symptoms and signs that could theoretically be eplained by a degree of hypothyroidism (12). These include unexplained impaired consciousness, suppressed myocardial function, hypothermia, diaphragm dysfunction, and failure to be weaned from the ventilator, neuropathy and weakness, kidney failure, atrophy of the skin, and hair loss.…”