Thyroid function tests in patients at the emergency department compared to a prior healthy setting.

Rock Bum Kim,Yoon Young Cho,Dawon Kang,Jong Ryeal Hahm,Minji Kim,Chi Yeon Kim,Soo Kyoung Kim,Jaehoon Jung,Jung Hwa Jung

doi:10.1371/journal.pone.0202422

Rock Bum Kim, Yoon Young Cho + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0202422

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Abstract

We examined the changes in thyroid hormone levels in patients with an acute clinical condition and compared these to levels in the healthy subjects. Serum total triiodothyronine (T3), thyroid stimulating hormone (TSH), and free thyroxine (fT4) measurements were recorded from 555 patients (mean age: 55.0 years, men: 65.9%) admitted to the emergency department (ED) 1–91 months (median: 34 months) after a regular health examination (HE). Serological data were analyzed; mean change in hormone levels was stratified by emergency classification system and quintiles of changes in inflammatory marker values, such as neutrophil lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (CRP). The mean decrease in T3 levels from HE and ED samples was 10.6 ng/dL (p< 0.001). Mean decrease in T3 levels was 21.6 ng/dL among patients classified as having an infection status and 11.0 ng/dL among patients classified as having an urgency status. A decrease 3.7 ng/dL among emergency patients was observed. TSH and fT4 levels did not change across all groups. When patients were stratified into quintiles according to changes in NLR values, mean decreases in T3 were 6.21, 8.14, 14.37, 12.76, and 21.98 ng/dL and showed significant linear reduction (p<0.001). For quintiles of changed CRP values, mean decreased T3 levels were 10.57, 3.05, 4.47, 7.68, and 28.07 ng/dL. TSH and fT4 were not associated with significant changes (p = 0.100, p = 0.561, respectively). In this study, thyroid function changes in individuals with an acute condition revealed that T3 significantly decreased, more markedly in infectious diseases compared to their healthy counterparts, and decline in T3 measurements correlated with inflammatory markers. TSH and fT4 levels remained stable. It is necessary to consider the severity of acute conditions when abnormal T3 levels are detected in subjects with emergent status.

Highlights

Thyroid hormone changes are a common feature in emergency patients with no known thyroid dysfunction
Patient status was classified into infection, emergency, and urgency conditions, according to the Canadian Triage and Acuity Scale (CTAS) adult guidelines[13]
This study examined changes in thyroid hormones associated with infection, emergency, or urgency conditions among previously healthy individuals

Summary

Introduction

Thyroid hormone changes are a common feature in emergency patients with no known thyroid dysfunction. NTIS frequently occurs in patients with acute/severe illness admitted to the intensive care unit (ICU) or emergency department (ED). Several studies have reported thyroid hormone changes in patients with sepsis, burns, acute ischemic syndromes, physical trauma, and bone marrow transplantation, as well as in those who undergo major surgery, such as coronaryartery bypass surgery[2,5,6,7,8,9,10,11,12]. Because studies have reported hormonal changes in patients with specific diseases (e.g., acute myocardial infarction, sepsis), it is difficult to compare the differences in thyroid hormones level changes according to the severity of the patient’s condition or the clinical classification of patient status in the ICU or ED

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