Thyroid test abnormalities in traumatic brain Injury: Correlation with neurologic impairment and sympathetic nervous system activation

Woolf, Paul D.; Lee, Louyse A.; Hamill, Robert W.; McDonald, Joseph V.

doi:10.1016/0002-9343(88)90414-7

Cited by 68 publications

(39 citation statements)

References 35 publications

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“…Our data corroborate previous findings, demonstrating altered thyroid hormone metabolism in TBI patients [13,14,17,18]. Only one patient did not present with a low T 3 syndrome.…”

Section: Discussionsupporting

confidence: 92%

“…A relationship between IL-10 levels and low T 3 syndrome was also absent in another clinical study [12]. The lack of such correlations may also be due to an independent pathophysiology of low T 3 syndrome occurring after TBI, since some authors described unchanged values of reverse T 3 [17]. However, several other reports found increased concentrations of reverse T 3 suggesting altered hepatic thyroxin deiodinase type 1 activity similar to other patient groups [13,15,18].…”

Section: Discussionmentioning

confidence: 85%

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Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

et al. 2005

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European Journal of Trauma Ab stractPurpose: To clarify the association between disturbed thyroid hormone metabolism (low T 3 syndrome) and release of cytokines and markers of cell-mediated immune response. Material and Methods: Concentrations of cytokines as well as of thyroid hormones were determined in 32 patients suffering from severe traumatic brain injury: interleukin-(IL-)1, IL-6, IL-10, tumor necrosis factor, transforming growth factor-(TGF-)β, soluble interleukin-2 receptor (sIL-2R), neopterin, and β 2 -microglobulin (β2m) in serum and cerebrospinal fluid; triiodothyronine (T 3 ), free T 3 , thyroxine (T 4 ), free T 4 , thyrotropin, thyroxine-binding globulin, and albumin in serum. Additionally, clinical parameters were assessed: Glasgow Coma Score, CT scan, intracranial pressure, Glasgow Outcome Score, and occurrence of pneumonia. Results: Among 31 patients with a low T 3 syndrome, those with additional low serum T 4 levels (n = 13) showed a prolonged suppression of serum β2m, neopterin, and sIL-2R, and a higher secondary increase of serum β2m, neopterin, and TGF-β, as well as lower T 3 levels (all p < 0.05). These patients also had a longer stay in the intensive care unit (34 ± 6 days vs. 22 ± 12 days; p = 0.008). Increased levels of β2m correlated with a preceding decrease of thyrotropin (cerebrospinal fluid: r = -0.53; p = 0.004; serum: r = -0.41; p = 0.029). Associations of thyroid hormone metabolism with either other cytokines or with clinical parameters were not detected. Conclusion:These results show that low T3 syndrome is a very common pathophysiological feature after severe traumatic brain injury. The association of a low T 3 syndrome in combination with low serum T 4 levels, with an altered time course of markers of cell-mediated immunity led the authors to hypothesize that a disturbed thyroid hormone metabolism may be interrelated with a prolonged cellular immune dysfunction after traumatic brain injury.

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“…Our data corroborate previous findings, demonstrating altered thyroid hormone metabolism in TBI patients [13,14,17,18]. Only one patient did not present with a low T 3 syndrome.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 85%

Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

et al. 2005

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“…Kinetic studies showed that the daily production rate (PR) of T 3 is decreased, while its clearance is unchanged in NTI (3). The reduction in serum TT 3 concentration is usually accompanied by an increase in serum reverse T 3 (rT 3 ) concentration (1), although the latter is normal in patients with chronic renal failure (4), AIDS (5), or traumatic brain injury (6). PR of rT 3 is unchanged, but its clearance is reduced (3).…”

Section: Introductionmentioning

confidence: 99%

Role of cytokines in the pathogenesis of the euthyroid sick syndrome

Bartalena

Bogazzi

Brogioni

et al. 1998

European Journal of Endocrinology

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“…Other workers have demonstrated low TSH and T3 concentrations after TBI, which seem to be adaptive changes rather than pituitary failure (22). Some studies have linked hypothyroidism to poor outcome from TBI (22,31), though this association is not universally shared (26) and remains unproven.…”

Section: Anterior Pituitarymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

Garrahy

Sherlock

Thompson

2017

European Journal of Endocrinology

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Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognised acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life threatening. Although hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation. Patients who survive SAH may also develop hypopituitarism, though it is less common than after TBI. The growth hormone axis is most frequently affected. There is also accumulating evidence that survivors of intracranial malignancy, who have required cranial irradiation, may develop hypopituitarism. The time course of the development of hormone deficits is varied, and predictors of pituitary dysfunction are unreliable. Furthermore, diagnosis of GH and ACTH deficiency require dynamic testing that can be resource intensive. Thus the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services. However, diagnosis and management of pituitary dysfunction can be rewarding. Appropriate hormone replacement can improve quality of life, prevent complications such as muscle atrophy, infection and osteoporosis and improve engagement with physiotherapy and rehabilitation.

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Thyroid test abnormalities in traumatic brain Injury: Correlation with neurologic impairment and sympathetic nervous system activation

Cited by 68 publications

References 35 publications

Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

Role of cytokines in the pathogenesis of the euthyroid sick syndrome

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

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