Serum levels of thyroid hormones and thyroid stimulating hormone in patients with biliogenic and hyperlipidaemic acute pancreatitis: Difference and value in predicting disease severity

Abstract

ObjectivesTo compare retrospectively serum levels of thyroid hormones (THs) and thyroid stimulating hormone (TSH) between patients with biliogenic acute pancreatitis (BAP) and those with hyperlipidaemic acute pancreatitis (HLAP), in order to assess their value for predicting the severity of acute pancreatitis (AP).MethodsPatients with AP were divided into BAP and HLAP groups, then further divided into either a mild AP (MAP) group or a moderately severe AP (MSAP) group. Routine blood parameters were measured. Free tri-iodothyronine (FT3), free thyroxine (FT4) and TSH levels were measured.ResultsSeventy-six patients with AP were enrolled in the study. FT3 and TSH levels were significantly higher in patients with MAP than in patients with MSAP. FT4 and TSH levels were significantly lower in the HLAP group than in the BAP group. TSH levels in both MAP and MSAP patients were significantly lower in the HLAP group than in the BAP group. TSH was inversely correlated with triglyceride levels in patients with HLAP. FT3 was a risk factor for MSAP in patients with AP and also demonstrated moderate accuracy in predicting AP severity.ConclusionsTHs and TSH decrease with the severity of AP, especially in patients with HLAP. FT3 may be a useful biomarker for the early assessment of the severity of AP.

Low FT3 is a valuable predictor of severe acute pancreatitis in the emergency department

“…We also found that serum FT3 levels offered significantly more predictive accuracy than the levels of T3, T4, FT4 or TSH. Our finding was different from those of a previous study that focused only on thyroid hormone and TSH levels in patients with biliary and hyperlipidemic AP . The possible reasons for the difference in findings between these two studies may be the larger sample size and greater number of AP subtypes in our study compared with the previous one (172 vs 76).…”

“…We found that MSAP and SAP might represent early reductions in FT3 levels, while TSH levels remained normal, which is consistent with some of the findings in a previous study . Furthermore, compared with CRP and traditional scoring systems (Ranson and APACHE II scores), we found that FT3 was a predictor of AP severity with a better sensitivity (88.2%), specificity (53.1%) and PPV (85.0%), indicating that thyroid function may respond early in the disease course or serve as a type of self‐regulating mechanism for changes in energy consumption, sometimes due to concomitant obligatory fasting and inflammation under critical conditions.…”

“…Although no gold standard for determining the severity of AP at the early stage has been identified over the last few decades, researchers have made great progress in clinical practice, such as identifying serum biomarkers (e.g., amylase, lipase, CRP, interleukin‐6, interleukin‐8, and tumor necrosis factor‐alpha), imaging tools (e.g., CT, MRI or MRCP), and grading models (e.g., Ranson score, bedside index of severity in acute pancreatitis score, APACHE II score, and the CT severity index) . However, limited attention has been paid to the early and subsequently dynamic changes in endocrine, metabolite and nutritional factors during the disease progression of AP . In addition, some of the existing scoring systems are quite complex or time‐consuming for the rapid assessment of severity, with results often taking as long as 48 h after patient admission to the emergency department, leading to delays in intervention.…”

“…We hypothesize that serum thyroid hormone levels may be influenced by AP and can be reversed by appropriate treatment. In the present study we included a relatively large sample size and almost all etiologies (rather than only biliary and hyperlipidemic) and obtained all blood samples during a shorter period (at admission or after overnight fasting, compared with those collected within 48 h after admission in previous studies) . To assess the thyroid hormone function in patients with AP, to explore the predictive value of low T3 syndrome for AP severity and its outcomes based on the abundant clinical data in our emergency department and to identify a reliable new biomarker that can predict AP severity more accurately, which will aid in determining therapeutic strategies and improving the outcomes of AP patients.…”

The Frequency of Thyroid Dysfunctions among Patients of Diabetes Mellitus Presenting in Tertiary Care Hospital of a Developing Country

“…Various studies have reported a significant association between Diabetes and thyroid disorders [5]. On the one hand, studies have also reported the significance of thyroid hormones' contribution to regulating carbohydrate metabolism and pancreatic function; in the same vein, studies are also showing the paramount significance of DM in regulating the thyroid function tests [6,7]. The Thyroid hormones and pancreatic hormones like insulin antagonize each other, and excess and deficit of any one of them can lead to functional derangement of the other [8].…”