727: LONGITUDINAL STUDY OF THYROID PROFILE IN CHILDREN DURING SEPTIC SHOCK AND ITS IMPACT ON OUTCOMES

Abstract

Introduction: Non-thyroidal illness syndrome (NTIS) is common in septic shock. Data on thyroid profile in pediatric patients from low- and middle-income countries (LMICs) are scarce, where undernutrition is common. Longitudinal behaviour of thyroid hormones during initial 7 days of septic shock and its association with clinical outcome in children from LMICs was studied. Methods: This prospective observational study was conducted in pediatric emergency room and pediatric intensive care unit in a tertiary care centre of a low-middle income country. Sixty-two patients (age, 6mo-12yrs) with fluid refractory septic shock at admission or developing it within 24hrs of admission were enrolled. Exclusions were history of CPR, chronic illness, endocrine disorders, and recent radio-contrast study. Serum levels of Thyroid Stimulating Hormone (TSH), T4 and T3 were measured on Day 1, 3 and 7. Correlation between thyroid hormones and severity of organ dysfunctions, outcomes and nutritional status were analysed. Results: TSH was low in 20% patients, which remained unaltered during 7 days. T4 and T3 levels were low in the majority (Day 1: 84% and 72%; Day 7: 68% and 59% respectively). Non-Survivors (n=24) have significantly lower TSH and T4 levels during 7 days compared to survivors (n=38) (p=0.045 and p=0.004 respectively). Non-survivors had significantly lower T3 on day 1 (p< 0.001), however it increased significantly over 7 days (p=0.05) to become similar to that among survivors. TSH, T4 and T3 levels were negatively correlated with admission pSOFA, maximum pSOFA and PRISM-III scores (p< 0.05). Children with VIS >40 had significantly lower T3 levels on day 1 and 3 (p=0.008 and p=0.034 respectively). Time to shock reversal was negatively correlated with T3 levels on day 3 (rho=-0.43, p=0.008). Children requiring ventilation had lower thyroid hormones on day 1 and 3. Their levels were positively correlated with ventilator-free days and acute care area free days. Nutritional status did not affect thyroid profile. Conclusions: Children with more severe disease had lower levels of all thyroid hormones on day 1 and 3. Non-survivors had significantly lower thyroid hormones on day 1, which mostly failed to increase during initial 7 days as compare to survivors. Nutritional status did not affect thyroid profile.