Variable Thyrotropin Response to Thyrotropin-releasing Hormone after Small Decreases in Plasma Free Thyroid Hormone Concentrations in Patients with Nonthyroidal Diseases

Maturlo, Susan J.; Rosenbaum, Robert; Pan, Chao; Surks, Martin I.

doi:10.1172/jci109875

Cited by 67 publications

(12 citation statements)

References 29 publications

(43 reference statements)

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“…The pathogenetic mechanism remains to be elucidated. A possible cause could be the presence of functional central hypothyroidism in severe NTI (5,13,14). This could lead to understimulation of the thyroid gland resulting in involutional changes as described above.…”

Section: Discussionmentioning

confidence: 99%

Thyroid morphology in lethal non-thyroidal illness: a post-mortem study

Jongh

Jöbsis²,

Elte³

2001

European Journal of Endocrinology

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Objective: Non-thyroidal illness (NTI) is associated with alterations in thyroid hormone metabolism. Whether morphological changes of the thyroid gland accompany NTI is unknown. The aim of the present study was to describe thyroid morphology in patients with lethal non-thyroidal disease. Design: In an autopsy study 267 cases have been examined. Methods: Clinical data were obtained from medical records. Subjects were patients with chronic disease (group A), intensive care patients (group B) or persons who had died suddenly without preexisting illnesses (group C). Patients (n 93) who did not fit into one of these categories and subjects with pre-existing thyroid disorders were excluded. Thyroid histology was assessed semi-quantitatively: grade I ,25%, grade II 25±50% or grade III .75% occupation of the thyroid gland by follicles with a diameter ,200 mm. Results: Mean thyroid weight was 19.9 g in group A (n 75Y age 19±96 (median 75) years, 48 males); 25.7 g in group B (n 64Y age 24±93 (median 69) years, 43 males); and 26.0 g in group C (n 35Y age 31±89 (median 69) years, 22 males) (P , 0X0005Y A vs B/C). Grade I thyroid histology was present in 6 out of 75 patients with chronic illness, in 3 out of 64 intensive care patients and in 33 out of 35 sudden-death subjects. Grade III thyroid histology occurred in 30 out of 75 chronically ill patients, in 17 out of 64 intensive care patients and in 0 out of 35 sudden-death subjects (P , 0X0005Y C vs A/B). Conclusions: NTI is associated with reduced thyroid follicular size that is accompanied by lower thyroid weight in chronically ill patients but not significantly in intensive care patients.

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Section: Discussionmentioning

confidence: 99%

Thyroid morphology in lethal non-thyroidal illness: a post-mortem study

Jongh

Jöbsis²,

Elte³

2001

European Journal of Endocrinology

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“…Further more, patients with chronic renal failure have been known to exhibit a blunted and delayed TSH response to TRH [13]. Maturlo et al [22] have examined this relationship in considerable detail in NTI patients. Their studies showed an inappropriate response of TSH to TRH in about one half of systematically ill patients treated with iodide to affect decrements in serum TT4 and TT3.…”

Section: Discussionmentioning

confidence: 99%

Serum Thyroid Hormone Levels in Patients on Continuous Ambulatory Peritoneal Dialysis and Regular Hemodialysis

Thysen¹,

Gatz²,

Freeman³

et al. 1983

Nephron

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In vitro thyroid function tests were performed on clinically euthyroid patients undergoing regular hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The mean serum total thyroxine (TT4) and total triiodothyronine (TT3) values measured before HD were significantly subnormal. Similarly, CAPD subjects had reduced TT3 concentrations with low normal TT4 levels. Free thyroxine measurements, estimated by two different methods were aberrant in CAPD patients. Low normal reverse triiodothyronine (rT3) values were found in HD, in contrast to high normal rT3 levels in CAPD. Thyroid stimulating hormone determinations were normal, corresponding with the euthyroid status in both patient groups.

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“…Increased serum levels of interleukin-6 have been observed in b-thalassemia (T Alexandrides, P Matsuka & A Vagenakis, unpublished observations). However, patients with the euthyroid sick syndrome are not susceptible to the inhibitory effects of iodide despite the fact that serum cytokines are increased in the majority of these patients (28,29).…”

Section: Discussionmentioning

confidence: 99%

Increased sensitivity to the inhibitory effect of excess iodide on thyroid function in patients with beta-thalassemia major and iron overload and the subsequent development of hypothyroidism

Alexandrides¹,

Georgopoulos²,

Yarmenitis

et al. 2000

European Journal of Endocrinology

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Objective: Patients with b-thalassemia frequently develop primary hypothyroidism and other endocrine disorders due to iron overload. We studied whether administration of excess iodide to patients with apparently normal thyroid function could uncover an underlying thyroid disease. Design and methods: Twenty-®ve patients, 10 prepubertal (mean age 11 6 3 years) and 15 adults (mean age 23 6 5 years) with normal thyroid hormone and TSH levels, a normal response of TSH to TRH and negative thyroid peroxidase antibodies received 20 mg iodide three times daily for three weeks, and thyroid hormone and TSH levels were measured weekly during, and for three weeks after, iodide administration and every 3 months thereafter for the next 5 years. Results: During iodide administration there was a signi®cant decrease in thyroid hormone concentrations which remained within normal levels, and a signi®cant increase in TSH concentrations which in 14 out of 25 (56%) patients reached the hypothyroid level. Baseline TSH values were higher in those patients who developed subclinical hypothyroidism (2.31 6 0.71 mU/l vs 1.34 6 0.64 mU/l, P 0.0016). Subclinical hypothyroidism developed in 70% of prepubertal and in 47% of adult patients. Serum ferritin was elevated in all patients. Nine of the fourteen patients (64.3%) who developed subclinical hypothyroidism during iodide administration developed hypothyroidism during the 5-year follow-up compared with only one of the eleven patients with a normal response to iodide (P 0.004). Conclusions:Patients with b-thalassemia should not be exposed to excess iodide due to increased sensitivity to its inhibitory effects on thyroid function. The susceptible individuals frequently develop permanent hypothyroidism in the following years.

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Variable Thyrotropin Response to Thyrotropin-releasing Hormone after Small Decreases in Plasma Free Thyroid Hormone Concentrations in Patients with Nonthyroidal Diseases

Abstract: A B S T R A C T Although a normal serum thyrotropin (TSH)

Cited by 67 publications

References 29 publications

Thyroid morphology in lethal non-thyroidal illness: a post-mortem study

Thyroid morphology in lethal non-thyroidal illness: a post-mortem study

Serum Thyroid Hormone Levels in Patients on Continuous Ambulatory Peritoneal Dialysis and Regular Hemodialysis

Increased sensitivity to the inhibitory effect of excess iodide on thyroid function in patients with beta-thalassemia major and iron overload and the subsequent development of hypothyroidism

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