Abstract
The present study was aimed at examining thyroid hormones and other clinical factors to improve the accuracy of outcome prediction among critically ill patients undergoing early neurological rehabilitation. Patients consecutively admitted to an intensive or intermediate care unit were screened for eligibility. Serum levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were collected during the first three days after admission. The Glasgow Outcome Scale (GOS) was defined as the primary outcome measure. Thyroid hormone levels and other clinical factors were entered into a binary logistic regression model to predict a good outcome at the end of early rehabilitative treatment. 395 patients (268 males) with a median age of 62 years (IQR = 52 − 76) and a median disease duration of 19 days (IQR = 13 − 28) were included in the study. Most patients (80%) had decreased fT3 values. Patients with low fT3 were admitted earlier to the rehabilitation facility and had more severe impairment upon admission compared to patients with fT3 values within the normal range. Both decreased fT3 and TSH levels were associated with an unfavorable outcome (GOS ≤ 3), but only TSH proved to be an independent predictor in multivariate analyses (OR = 1.11; 95%CI = 1.02 − 1.22). These data suggest that decreased fT3 and TSH levels upon admission may predict an unfavorable outcome at the end of early rehabilitative treatment. Thus, thyroid hormone levels are not only important during acute treatment but also in prolonged critical illness.
Highlights
IntroductionAlterations of thyroid hormones in the absence of primary thyroid dysfunctions are known as “nonthyroidal illness syndrome” (NTIS) [1]
Critical illness is associated with profound changes in the endocrine metabolism
Most patients had impaired consciousness upon admission, with 177 patients being in the unresponsive wakefulness syndrome (UWS) and 132 patients in the minimally conscious state (MCS)
Summary
Alterations of thyroid hormones in the absence of primary thyroid dysfunctions are known as “nonthyroidal illness syndrome” (NTIS) [1]. These changes include low serum levels of triiodothyronine (T3), low or normal levels of thyroxine (T4), and low or normal levels of thyroid-stimulating hormone (TSH) [2]. Some studies found no or opposite associations between thyroid hormones levels and outcome [10, 11]. This could be due to the fact that the studies did not consistently include disease severity or preexisting risk factors. Some studies show that clinical or subclinical TSH dysfunction may be associated with functional outcome [12, 13], while others have failed to reproduce this finding [14]
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