Details
Category: Volume 05 Issue 12 December 2017
Hits: 1425

Title: Study of Thyroid Profile in Patients with Sepsis

Authors: A. Pal, N. Jain, M. Patidar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.46

Abstract

Background: Thyroid hormone abnormalities are frequently encountered in patients with sepsis, sepsis is important cause of death in developing countries. The aim of  study is to analyze thyroid profile in sepsis patients at admission and evaluate the prognostic role of thyroid dysfunction in sepsis patients.

Method:  In prospective observational study, thyroid hormone levels (FT3, FT4, TSH) measured in 75 in-patients with sepsis . Serum thyroid level measured by chemiluminescent assay at the time of admission. Sepsis patients further divided into survivors and non- survivors.

Observation and Results: Thyroid profile was assessed in 75 sepsis inpatients, low FT3 (56%) was the commonest abnormality observed, followed by low FT4 (10.67%) and high TSH (10.67%) followed by low TSH (8%).

-Non survivors have low mean FT3 (1.56 ± 0.77) than survivors (2.31 ± 0.65) which was statistically significant (p <0.0001). Significant positive correlation observed between serum FT3 and serum albumin (p=0.002, r=0.36)

Conclusion:  low level of FT3 has positive correlation with decrease survival in sepsis patients. FT3 may be used as predictor of mortality. Serum FT3 and serum albumin have positive correlation.

References

  1. Plank LD, Connolly AB, Hill GL. Sequential changes in the metabolic response in severely septic patients during the first 23 days after onset of peritonitis. Ann Surg 1998; 228: 146-158.
  2. Fong Y, Marono MA, Moldawer LL. The acute splanchnic and peripheral tissue metabolic response to endotoxin in humans. J Clin Invest 1990; 85: 1896-1904.
  3. Farwell AP. Sick euthyroid syndrome in the intensive care unit. In: Irwin RS, Rippe JM, (eds), Irwin and Rippe’s Intensive Care Medicine, Philadelphia, PA: Lippincott Williams & Wilkins, 2003; pp: 1205-1216.
  4. DeGroot LJ. Non-thyroidal illness syndrome is functional central hypothyroidism, and if severe, hormone replacement is appropriate in light of present knowledge. J Endocrinol Invest 2003; 26: 1163-1170.                                                                              
  5. Adler SM, Wartofsky L. The nonthyroidal illness syndrome. Endocrinol Metab Clin North Am 2007; 36: 657-672.                                                                                                   
  6. Sahana PK, Ghosh A, Mukhopadhyay P, Pandit K, Chowdhury BK, Chowdhury S. A study on endocrine changes in patients in intensive care unit. J Indian Med Assoc 2008; 106: 362-364
  7. Haas NA, Camphausen CK, Kececioglu D. Clinical review: Thyroid hormone replacement in children after cardiac surgery: is it worth a try? Crit Care 2006; 10: 213.
  8. Vasa FR, Molitch ME. Endocrine problems in the chronically ill patient. Clin Chest Med 2001; 22: 193-208                                                          
  9. Zucker AR, Chernow B, Fields AI, Hung W, Burman KD. Thyroid function in critically ill children. Clinical and lab observations 1985; 107: 552-554.                                                      
  10. Chopra IJ, Hershman JM, Pardridge WM, Nicoloff JT. Thyroid function in nonthyroidal illness. Ann Intern Med 1983; 98: 946-957.                                                        
  11. Chopra IJ, Chopra U, Smith SR, Reza M, Solomon DH. Reciprocal changes in serum concentrations of 3, 3, 5- triiodothyronine (T3) in systemic illness. J Clin Endocrinol Metab 1975; 41: 1043-1049.                       
  12. Kaptein EM, Weiner JM, Robinson WJ, Wheeler WS, Nicoloff JT. Relationship of altered thyroid hormone indices to survival in non-thyroidal illness. Clin Endocrinol 1982; 16: 565-574.
  13. Chopra IJ, Williams DE, Orgiazzi J, Solomon DH. 1975 Opposite effects of dexamethasone on serum concentrations of 3,3΄,5΄triiodothyronine (reverse T3) and 3,3΄5-triiodothyronine (T3). J Clin Endocrinol Metab 1975; 41: 911-920.                                                                                                          
  14. Chopra IJ, Huang TS, Beredo A, Solomon DH, ChuaTeco GN, Mead JF. Evidence for an inhibitor of extrathyroidal conversion of thyroxine to 3,5,3΄- triiodothyronine in sera Assessment of thyroid function in critically ill patients Biomed Res- India 2016 Volume 27 Issue 2 451 of patients with nonthyroidal illnesses. J Clin Endocrinol Metab 1985; 60: 666-672.                                                     
  15. Van der Poll T, Romijn JA, Wiersinga WM, Sauerwein HP. Tumor necrosis factor: a putative mediator of the sick euthyroid syndrome in man. J Clin Endocrinol Metab 1990; 71: 1567-1572                                      
  16. Stouthard JM, van der Poll T, Endert E. Effects of acute and chronic interleukin-6 administration on thyroid hormone metabolism in humans. J Clin Endocrinol Metab 1994; 79: 1342-1346.
  17. Corssmit EP, Heyligenberg R, Endert E, Sauerwein HP, Romijn JA. Acute effects of interferon-alpha administration on thyroid hormone metabolism in healthy men. J Clin Endocrinol Metab 1995; 80: 3140-3144.                                                                                                                       
  18. .Slag MF, Morley JE, Elson MK, Crowson TW, Nettle FQ, Shafer RB. Hypothyroxinemia in critically ill patients as a predictor of high mortality. JAMA 1981; 245: 43-45
  19. Kiran Bhat1*, Sumita Sharma1 , Kapil Sharma1 , RK Singh2: Assessment of thyroid function in critically ill patients Biomedical Research 2016; 27 (2):
  20. Mohamed Hosny RaniaRashad Doaa Atef Nashwa Abed: Predictive value of thyroid hormone assessment in septic patients in comparison with C-reactive protein. The Egyptian Journal of Critical Care Medicine Volume 3, Issues 2–3, August–December 2015
  21. Feilong Wang,#1 Wenzhi Pan,#2 Hairong Wang,#1 Shuyun Wang,1 Shuming Pan, 1 and Junbo Ge 2: Relationship between thyroid function and ICU mortality: a prospective observation study Published online 2012 Jan 19. doi: 1186/cc11151
  22. Dr. Desai Vidya Sripad, Dr.N.V.S. Chowdary, Dr.V.Sivaprabodh, Dr.Ravi Shekharal :Relationship between Free T3 and ICU Mortality: A Prospective Observation. international Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 1 ISSN 2250-3153.

Corresponding Author

M. Patidar

RMO, Department of Medicine

N.S.C.B Medical College Jabalpur