Thyroid-Hormone Levels and Prognosis in Patients With Serious Non-Thyroidal Illness

McLarty, D.G.; Ratcliffe, W. A.; Mccoll, K. E. L.; Stone, Daniel; Ratcliffe, J G

doi:10.1016/s0140-6736(75)90980-0

Cited by 60 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, also increased variability in T3 (e.g., both increases and decreases in concentration) resulted in elevated hazards albeit statistically not significant, leading us to hypothesize that T3 fluctuations may link to adverse outcomes. This finding accords with a previous study in critically ill patients (29), in which a fast decline in T3 and T4 (without a concomitant rise in TSH levels) was observed prior to death. Our longitudinal analysis, by including two observations 3 months apart in the same individual, represents a step forward by virtue of observing the subject-specific temporal order of events.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Meuwese

Dekker

Lindholm

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Conflicting evidence exists with regard to the association of thyroid hormones and mortality in dialysis patients. This study assesses the association between basal and trimestral variation of thyroid stimulating hormone, triiodothyronine, and thyroxine and mortality.Design, setting, participants, & measurements In 210 prevalent hemodialysis patients, serum triiodothyronine, thyroxine, thyroid stimulating hormone, and interleukin-6 were measured 3 months apart. Cardiovascular and non-cardiovascular deaths were registered during follow-up. Based on fluctuations along tertiles of distribution, four trimestral patterns were defined for each thyroid hormone: persistently low, decrease, increase, and persistently high. The association of baseline levels and trimestral variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models.Results During follow-up, 103 deaths occurred. Thyroid stimulating hormone levels did not associate with mortality. Patients with relatively low basal triiodothyronine concentrations had higher hazards of dying than patients with high levels. Longitudinally, patients with persistently low levels of triiodothyronine during the 3-month period had higher mortality hazards than those having persistently high levels. These associations were mainly attributable to cardiovascular-related mortality. The association between thyroxine and mortality was not altered after adjustment for triiodothyronine.Conclusions Hemodialysis patients with reduced triiodothyronine or thyroxine levels bear an increased mortality risk, especially due to cardiovascular causes. This was true when considering both baseline measurements and trimestral variation patterns. Our longitudinal design adds observational evidence supporting the hypothesis that the link may underlie a causal effect.

show abstract

Section: Discussionsupporting

confidence: 93%

“…Although this is the first study to report so in a dialysis population, the findings are in line with previous evidence in non-renal patients with nonthyroidal illness (29,30). An interesting aspect of our analysis is that the strength of the association between low T4 levels and mortality was not fully affected by adjustment for T3.…”

Section: Discussionsupporting

confidence: 91%

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Meuwese

Dekker

Lindholm

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…As ex pected from clinical studies [7][8][9], there was a fall in circulating T3 levels in the control ani mals. Restoring the T 3 levels was associated with a greater recovery of function, and the extent of this recovery was dose dependent.…”

Section: Discussionmentioning

confidence: 87%

“…Studies by Larty ct al. [7] and Westgren et al [8] have shown low T3 levels in oatients who have experienced a myocardial infarction. Recently, Hamilton et al [9] have shown that there was a depletion of T3 in advanced heart failure and that the extent of this depletion was the best predictor of sur vival.…”

Section: Introductionmentioning

confidence: 96%

Facilitated Recovery of Cardiac Performance by Triiodothyronine following a Transient Ischemic Insult

Yokoyama

Novitzky²,

Deal³

et al. 1992

Cardiology

View full text Add to dashboard Cite

Reperfusion following a transient ischemic insult has been shown to result in a delayed recovery of myocardial function. A reduction in plasma triiodothyronine (T₃) has been reported in these acute cardiovascular challenges. To test whether the replacement of T₃ can facilitate the recovery of myocardial function following a transient regional ischemia, we investigated cardiac performance for 3 h after a 15-min, left anterior descending coronary artery occlusion in a canine model. Three groups of dogs were studied: I – control (n = 10); II -receiving T₃ (0.25 µg/kg i.v. and 0.25 µg/kg/h for 3 h, n = 9), and III – receiving T₃ (0.25 µg/kg i.v. and 0.5 µg/kg/h for 3 h, n = 9). Three hours following reperfusion, the T3 level in blood was significantly decreased in group I. Concomitantly, local segmental shortening was reduced from preocclusion control levels in group I (15.2 to 5.1%, p < 0.05), but recovered in both treated groups. The endsystolic elastance (Ees) and the external work (EW) efficiency (EW/PVA) in group I were depressed from preocclusion control (Ees = 95.5 ± 0.8%; EW/PVA = 90.2 ± 1.8%, both p < 0.05), the effective arterial elastance (Ea) and ventriculoarterial coupling (Ea/Ees) in group I were still elevated from preocclusion control (Ea = 122.5 ± 5.1%; Ea/Ees =128.3 ± 5.3%, both p < 0.05). But these measures of global cardiac performance in the treated groups recovered following reperfusion, and the extent of recovery was dose dependent. These data suggest that T₃ facilitates recovery of the stunned myocardium by improvement in local and global contractile function, in ventriculoarterial coupling, and in the energy efficiency.

show abstract

“…lated to the severity of illness [4]. Our pre vious work [5] revealed that hemorrhagic shock in dogs and humans is associated with profound decreases in the plasma concentra tion not only of T3 but also of T4.…”

mentioning

confidence: 99%

Beneficial Effect of Thyroidectomy in Canine Hemorrhagic Shock

1987

View full text Add to dashboard Cite

To further evaluate the relationship between plasma thyroid hormone concentrations and mortality in shock, 10 thyroidectomized and 9 normal dogs were bled rapidly to a mean arterial pressure of 40 mm Hg. After 60 min of hypotension, the reservoir line was clamped for 30 min. The shed blood was then reinfused. Thyroidectomy produced a hypodynamic, hypometabolic state. During shock, these animals exhibited fewer major hemodynamic derangements than the control group. Only one thyroidectomized dog died, whereas 5 of 9 control animals died (p < 0.05). Thus, circulating thyroid hormones are not determinants of survival in canine hemorrhagic shock. We hypothesize that thyroidectomy, perhaps by modulating catecholamine metabolism or stimulating liberation of thyrotropin releasing hormone, promotes salutary hemodynamic-metabolic effects during circulatory collapse and enhances survival.

show abstract

Thyroid-Hormone Levels and Prognosis in Patients With Serious Non-Thyroidal Illness

Cited by 60 publications

References 0 publications

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Facilitated Recovery of Cardiac Performance by Triiodothyronine following a Transient Ischemic Insult

Beneficial Effect of Thyroidectomy in Canine Hemorrhagic Shock

Contact Info

Product

Resources

About