Reduced Active Thyroid Hormone Levels in Acute Illness

Burger, Albert; Suter, Peter M.; Nicod, Pascal; Vallotton, Michel B.; Vagenakis, Apostolos G.; Braverman, Lewis E.

doi:10.1016/s0140-6736(76)92774-4

Cited by 170 publications

(51 citation statements)

References 16 publications

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“…This impression is further supported by others, where low T3 levels have been recorded in a variety of other non-thyroidal conditions. These conditions include fasting (Spaulding, 1976); disseminated malignancy (Carter, 1977); and many other acute and chronic illnesses (Burger, 1976).…”

Section: Discussionmentioning

confidence: 99%

Thyroid hypofunction in spinal cord injury patients

et al. 1980

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Abstract. Our experience in the screening and detection of hypothyroidism in 225 spinal injury patients is described. Clinical features compatible with hypothyroidism are frequently encountered in these patients and require thyroid function testing to exclude or confirm thyroid hypofunction. Two cases of hypothyroidism, equivocal on clinical grounds alone, were first detected by a low value in screening tests for serum thyroxine levels and subsequently confirmed by a high serum TSH level. Low serum triiodiothyronine level is frequently found in apparently euthyroid patients with tetra plegia and is necessarily not an indicator of clinical hypothyroidism in these patients.

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Section: Discussionmentioning

confidence: 99%

Thyroid hypofunction in spinal cord injury patients

et al. 1980

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“…In the acutely ill group the reference range for serum TBG is lower than that of the euthyroid group, a finding reflected by the lowered Ts-uptake values. This group often presents a serious diagnostic problem, and patients are often wrongly placed in the borderline hypothyroid or hypothyroid groups (Burger et al, 1976;McLarty et al, 1976;Naeije et al, 1976;Piroska and FOldes, 1976). T3 and TSH assays and, in some instances, a TRH stimulation test (to diagnose secondary hypothyroidism) are necessary before a correct diagnosis can be established.…”

Section: T:tbgv T:t-uptakementioning

confidence: 99%

An Evaluation of Serum Thyroxine Binding Globulin as a Routine Test of Thyroid Function

McDowell

1979

Ann Clin Biochem

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SUMMARY Serum thyroxine binding globulin (TBG) values were correlated with other thyroid function test results and with the clinical condition in 680 patients. The estimation of serum TBG was helpful in the evaluation of thyroid status only in those patients who were either acutely ill, were taking the contraceptive pill, or were pregnant. Further, the derived index, thyroxine: TBG ratio, proved to be a better diagnostic index than the thyroxine: tri-iodothyronine uptake ratio and in many cases would have avoided the use of more expensive and time-consuming tests.The assays commonly used to detect thyroid dysfunction are a combination of serum thyroxine (T4), tri-iodothyronine uptake (T3-uptake), and free thyroxine index (FT!) as first-line tests, with serum T3, thyroid stimulating hormone (TSH), and the thyrotrophin releasing hormone (TRH) stimulation test to augment the diagnosis. With these tests it is possible to confirm the thyroid status of the majority of patients (Pain and Duncan, 1976;Evered et al., 1978).In a proportion of patients, especially those who are on antidepressant therapy, are taking the contraceptive pill, are pregnant, have severe nonthyroidal disease, or are elderly, the above tests become more difficult to interpret because of abnormal levels of the thyroid hormone binding proteins (Oppenheimer, 1968). The derived index, FIT, was initially reported to compensate for abnormal levels of the thyroxine-binding proteins (Howorth and MacLagen, 1969), but it has become increasingly recognised that this is not always correct, and reliance on this index may lead to a false diagnosis of thyroid status (Premachandra et al., 1976). A direct assay of thyroxine binding globulin (TBG) in serum was first described by Freeman and Pearson in 1969, soon followed by the first radioimmunoassay (Levy et al., 1970). It was the purpose of this study to investigate the relationships of TBG to the other thyroid parameters and to ascertain whether its routine use aids the differentiation of the thyroid disorders. Patients and methodsThyroid status was determined using assays of serum 'Present address: Department of Chemical Pathology, Hope Hospital, Eccles Old Road, Salford M6 8HD T4, T 3-uptake, and FT!, followed by assays of serum T3, TSH, or a TRH-stimulation test where appropriate. Details of age, sex, therapy, and clinical diagnosis were recorded at the same time. The patients were then classified as follows:1 Acutely ill: patients having severe non-thyroidal diseases (eg, congestive cardiac failure, myocardial infarction, severe diabetes, carcinoma, renal failure).2 Contraceptive pill users: women between the ages of 16 and 40 years who are currently taking any form of oral contraceptive (for periods greater than six months).3 Pregnant: women between the ages of 16 and 40 years and at between 20 and 40 weeks' of pregnancy.4 Borderline hypothyroid: patients having either one result in the hypothyroid range or all results outside 75 % of normal limits.5 Hypothyroid: patients having all results in the hypothyro...

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“…Studies in several laboratories have also shown that reverse T3 is a normal component of human serum (5)(6)(7)(8)(9)(10)(11). Marked elevations of serum reverse T3, as compared with normal adult levels, have been found in the cord blood of newborn humans (with high concentrations also present in amniotic fluid) and in adult serum in various disease states, including hepatic cirrhosis, chronic renal failure, acute febrile disease, and protein and calorie malnutrition (5)(6)(7)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Elevations of reverse T, are frequently accompanied by a decrease in serum T3 (7,10). 3,3'-diiodo-Lthyronine (3,3'T2) is also a constituent of the serum iodothyronines, and its main source seems to be extrathyroidal (12).…”

Section: Introductionmentioning

confidence: 99%

Thyroid Hormonelike Actions of 3,3′,5′-l-Triiodothyronine and 3,3′-Diiodothyronine

Papavasiliou¹,

Martial²,

Latham³

et al. 1977

J. Clin. Invest.

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A B S T R A C T L-Thyroxine is converted to 3,5,3'-Ltriiodothyronine (T3) as well as to 3,3',5'-L-triiodothyronine (reverse T3). One product of further deiodination is 3,3'-diiodothyronine (3,3'T2). The serum levels of reverse T3 and 3,3'T2 change considerably in various physiological and disease states. We previously found that reverse T3 and 3,3'T2 bind to the solubilized hepatic nuclear "receptors" for thyroid hormones. This led us to study binding and actions of these metabolites in cultured rat pituitary cells in which glucose consumption and growth hormone production are regulated by T3 and Lthyroxine.Reverse T3 and 3,3'T2 stimulated growth hormone production and glucose consumption and inhibited nuclear binding of radioactive T3. Either metabolite produced maximal effects that equaled those of T3, and neither inhibited the T3 response. Further, additive effects were observed when reverse T3 was combined with submaximal concentrations of T3.In serum-free and serum-containing media, concentrations of 3,3'T2 50-to 70-and 10-to 100-fold greater, respectively, than those of T3 were required for equivalent stimulations and for inhibition of nuclear binding by T3.

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Reduced Active Thyroid Hormone Levels in Acute Illness

Cited by 170 publications

References 16 publications

Thyroid hypofunction in spinal cord injury patients

Thyroid hypofunction in spinal cord injury patients

An Evaluation of Serum Thyroxine Binding Globulin as a Routine Test of Thyroid Function

Thyroid Hormonelike Actions of 3,3′,5′-l-Triiodothyronine and 3,3′-Diiodothyronine

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