Nonthyroidal Illness Syndrome Group Research Articles

Total triiodothyronine level associated with disease severity for patients with emergent status

Thyroid hormones are metabolic indicators to evaluate the physical condition of emergency hospitalized patients, while the relationship between total triiodothyronine and the severity of emergency inpatients is still unclear. To explore the thyroid function levels of inpatients in emergency ward and the status of combined Nonthyroidal illness syndrome (NTIS), and to emphasize the importance of thyroid hormone examination for non-endocrinology inpatients. According to thyroid function of inpatients in emergency ward, they were divided into NTIS group and non-NTIS group, the hematological characteristics and TH levels of each group were analyzed. Based on clinical diagnoses, the hospitalized patients were divided into three major groups, namely infection group, non-infection group and impaired organ function group. Among them, infection group was further divided into sepsis group, lung infection group and local infection group, altogether five groups. The thyroid function levels and low values in each group were evaluated, and the correlation between hormone levels and inflammatory factors, nutritional indicators and the relationship with the risk of death was discussed. The inpatient rate in emergency ward complicated with NTIS was 62.29%, T3 was the most sensitive index of NTIS, followed by FT3. Compared to non-NTIS group, the NTIS group had an increased risk of death. The sepsis group and impaired organ function group had the highest rates of complicated NTIS, reaching 83.33% and 78.12% respectively. Spearman's correlation analysis implied T3/T4/FT3 levels were positively correlated with ALb and PLT (except T4), and negatively correlated with CRP, D-Dimer, IL-6 and Fer. The Receiver Operating Curve (ROC) and Area under the curve (AUC) showed T3 levels alone were strongly associated with the risk of death (AUC 0.750; 95% CI 0.673–0.828; P < 0.001). T3 is the most sensitive indicator for emergency patients, followed by FT3. The decrease of T3 level has a good predictive value for mortality risk. Thyroid function should be monitored in critically ill patients.

Low free T3 level may predict the severity of acute pancreatitis

ABSTRACT Objectives To demonstrate that deterioration in thyroid function tests can serve as an indicator of severity and prognosis in acute pancreatitis despite a healthy thyroid gland. Methods This study is a retrospective, single-center study. Patients diagnosed with acute pancreatitis between May 2020 and June 2021 were evaluated. Acute pancreatitis was diagnosed and classified according to the 2012 revised Atlanta criteria. Patients were categorized into Non-Thyroidal Illness Syndrome and euthyroid groups and compared in terms of biochemical parameters and scoring systems such as Ranson, Glasgow, Balthazar and BISAP scores. Results A total of 152 patients were included in the study. Eighty-three patients (54%) were euthyroid, with free triiodothyronine (T3), free thyroxine (T4), and Thyroid-stimulating hormone (TSH) levels within normal limits. Sixty-nine patients (46%) had Non-Thyroidal Illness Syndrome with low serum free T3 levels and low/normal TSH levels. As expected, free T3 was significantly lower in the Non-Thyroidal Illness Syndrome group than in the euthyroid group (1.5 ± 0.04 vs 2.6 ± 0.04, respectively, p < 0.0001). In the Non-Thyroidal Illness Syndrome group, Ranson score (3.35 ± 0.2 vs 2.11 ± 0.18 p < 0.0001), Glasgow (2.4 ± 0.2 vs 1.3 ± 0.1, p < 0.0001), Atlanta (p = 0.007), and Balthazar (2.1 ± 0.1 vs 1.4 ± 0.1, p = 0.001) scores were significantly higher than euthyroid group. Conclusion Non-Thyroidal Illness Syndrome provides insight into the prognosis of acute pancreatitis. Free T3 values are a significant parameter that may indicate the prognosis of acute pancreatitis. We believe that free T3 could be incorporated into an ideal scoring system in a disease such as acute pancreatitis, where early determination of prognosis is known to significantly reduce mortality.

Analysis of clinical features and 7-year all-cause mortality in older male patients with non-thyroidal illness syndrome on general wards.

Older patients with non-thyroidal illness syndrome (NTIS) have a poor prognosis. However, there are few studies on the association of NTIS and mortality among older inpatients on general wards. In a 7-year retrospective observational study, we aimed to investigate the clinical features of NTIS and the association of NTIS and all-cause mortality in older inpatients. A total of 959 older male inpatients whose average age was 86.3 ± 8.1years were enrolled and divided into the NTIS group and non-NTIS group. Cox models were performed to explore the association of thyroid hormone level and mortality. Patients had more respiratory disease and chronic kidney disease in the NTIS than in the non-NTIS group, especially in primary nursing care, respiratory failure and haemodialysis patients; serum total protein, albumin, prealbumin, haemoglobin, uric acid and high-density lipoprotein cholesterol levels were lower, and urea nitrogen and fasting blood glucose levels were higher, in the NTIS than in the non-NTIS group. Patients in the NTIS group had a lower survival rate over 7years follow-up (P < 0.01). A lower free T3 level was associated with all-cause mortality with a HR of 1.50 (1.36, 1.66). Lower free T4 level was associated with reduced all-cause mortality with a HR of 0.91 (0.88, 0.94) even after adjusting for confounding factors (P < 0.01). Among older male inpatients, the survival rate was lower in the NTIS group. A reduced free T3 level with low albumin and Hb levels was associated with all-cause mortality; moreover, a higher free T4 in the normal range may be a strong predictor for long-term mortality risk in hospitalised older male patients.

Nonthyroidal Illness Syndrome in Patients With Short-Bowel Syndrome.

Nonthyroidal illness syndrome (NTIS) is prevalent in critical illness and is associated with poor outcomes. However, only few studies have focused on the relationship between NTIS and short-bowel syndrome (SBS). The aim of this study was to investigate the prevalence, etiology, and prognosis of NTIS and its correlation with clinical variables in adult patients with SBS. Sixty-one eligible adults diagnosed with SBS, from December 2016 to December 2018, were retrospectively identified from a prospectively maintained database. Demographic and clinical characteristics (including thyroid hormones and nutrition variables) were evaluated for each participant. The prevalence of NTIS in adults with SBS was 52.5%. Patients with NTIS tended to have a longer duration of hospital stay and poor survival, but the results were not significant. A decreased, standard thyroid-stimulating hormone index and sum activity of deiodinases and an increased secretory capacity by the thyroid were observed in the NTIS group. Receiver operating characteristic curve analysis showed that insulin-like growth factor-1 (IGF-1) had better performance for distinguishing NTIS from patients with euthyroidism, with an area under the curve of 0.862 (cutoff, 101.0; sensitivity, 0.813; and specificity, 0.800). NTIS is a common complication in adult patients with SBS. Patients with NTIS tend to have a worse nutrition status and poor prognosis. A potential pituitary thyrotroph dysfunction and hypodeiodination condition may play a role in the pathophysiology of NTIS in SBS. Furthermore, IGF-1 is a meaningful predictor for distinguishing NTIS from euthyroid.

Prognostic Value of Thyroid Hormone FT3 in General Patients Admitted to the Intensive Care Unit.

Low plasma triiodothyronine (T3) concentration indicates nonthyroidal illness syndrome (NTIS), which might be associated with a poor outcome in patients in the intensive care unit (ICU). This study evaluated the relationship between NTIS and prognostic indicators in patients admitted to the ICU and examined the fT3 cut-off points that could be associated with 28-day mortality. This prospective observational study included patients admitted to the ICU of The Third Hospital of Hebei Medical University from February to November 2018. The baseline variables and the occurrence of low free T3 (FT3) were collected. The patients were divided into the NTIS (FT3 < 3.28) and non-NTIS groups. Among 305 patients, 118 (38.7%) were in the NTIS group. FT3 (P < 0.001) and FT4 (P = 0.001) were lower, while the 28-day mortality rate (P < 0.001) and hospitalization expenses in ICU (P = 0.001) were higher in the NTIS group. The univariable analyses identified NTIS, FT3, free thyroxine/FT3, APACHEII, sequential organ failure score, duration of mechanical ventilation, creatinine, oxygenation index, white blood cells, albumin, age, and brain natriuretic peptide as being associated with 28-day mortality (all P < 0.05). The cut-off value of FT3 for 28-day mortality was 2.88 pmol/L. The 28-day mortality rate and hospitalization expenses in the ICU were higher in patients with NTIS. NTIS was independently associated with 28-day mortality.

Triiodothyronine levels were positively correlated with opening of collateral circulation in cerebral infarction patients with large artery atherosclerosis.

IntroductionNon-thyroidal illness syndrome (NTIS) is one of the signs for poor prognosis of cerebral infarction (CI), but its risk factors had never been explored. In this study, we analyzed the potential effect of collateral circulation on prognosis prediction of triiodothyronine for large artery atherosclerosis cerebral infarction (LAA-CI) patients.Material and methodsClinical data of CI patients between 2012 and 2014 were collected. Imaging inspection was used for determining TOAST classification and evaluating collateral circulation. One-year follow-up was conducted for mRS score by telephone.ResultsT3 level in the NTIS group (p = 0.001) was significantly decreased while TSH level (p < 0.001) was increased. Patients in the NTIS group had a poorer prognosis (p = 0.008) and the main reason was the high mortality (p = 0.002). NTIS predicted poor collateral circulation (p = 0.026) and good collateral circulation tended to be less likely concomitant with NTIS (p = 0.001). Logistic regression analysis showed that triiodothyronine concentrations (OR = 4.760, 95% CI: 1.981–11.456, p < 0.001) were positively correlated with but advanced age (OR = 0.756, 95% CI: 0.645–0.886, p = 0.001) negatively with opening of collateral circulation.ConclusionsPoor opening of collateral circulation was likely to mediate the prediction of NTIS for prognosis of LAA-CI patients.

MON-588 Characteristics of Overt Thyrotoxicosis When TSH Is Measured in All Patients in Nonsurgical Departments

Introduction: Thyroid dysfunction in patients in non-surgical departments is common and often caused by nonthyroidal illness syndrome (NTIS) and medications. The aim of this study was to characterize overt thyrotoxicosis when TSH is measured routinely in medical departments. Methods: This is a retrospective study of adult patients from medical departments, who were admitted to our medical center for any reason. TSH level was measured on admission routinely in all patients, FT3 and FT4 levels were measured in patients with low TSH. In order to characterize the patients with overt thyrotoxicosis, three groups were defined and compared: 1) T4 group: overt thyrotoxicosis with high FT4 included a random sample of patients who had low TSH and only high FT4 levels. 2) T3 group: overt thyrotoxicosis with high FT3 included all patients with low TSH and high FT3 levels (with and without high FT4 levels). 3. NTIS group: Included a random sample of patients with low TSH and FT3 levels and FT4 levels below the middle of the normal range. Results: TSH levels were measured on admission in 77,147 inpatients and 82 (0.11%) patients met the criteria for T3 group. The T4 and the NTIS groups included a random sample of 123 patients and 119 patients respectively. The T4 group was 5.1 times more prevalent than the T3 group. The T3 group had much more elevated FT3 level compared to FT4 elevation in T4 group, 85.4% of the patients in T4 group had FT4 level less than 1.25 times the upper normal level. In addition, the T4 group had low FT3 levels, 79.7% of patients had FT3 levels in the lower half of the norm and less. Compared to the T3 group, the T4 group was older, had less supraventricular arrhythmia, more systemic or inhaled corticosteroids treatment and higher CRP levels (all p<0.001). Compared to the NTIS group, the T4 group had more levothyroxine treatment (p<0.001), more amiodarone treatment (p=0.04) and more women (p=0.009). There were no differences between the T4 and NTIS groups in age, CRP levels, systemic or inhaled corticosteroids treatment and supraventricular arrhythmia. The proportion of patients treated with anti-thyroid drugs was higher in the T3 group than in NTIS and FT4 groups (p <0.001; p= 0.087, 2-sided, p=0.052 1-sided respectively). The NTIS group and the T4 group had no correlation between FT4 and FT3 levels but the T3 group had a borderline positive correlation (r=0.208, p=0.061). T3 group had no correlation between CRP and FT3 levels but T4 and NTIS groups had a negative correlation (r =-0.366, p <0.001; r=-0.270, p=0.03 respectively). Conclusion: When TSH level is measured routinely in non surgical departments, more than 80% of cases that met overt thyrotoxicosis definition were caused by solitary increase in FT4 levels. This T4 group was a result of acute disease and treatment with levothyroxine, corticosteroids, and amiodarone, and in contrast to the T3 group, was rarely related to endogenous excess of thyroid hormones.

Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis.

Aim:This study was performed to investigate the association of non-thyroidal illness syndrome (NTIS) with 28-day mortality in adults with sepsis.Methods:We performed a prospective observational analysis of adult patients with sepsis. Patients' demographic data, comorbidities, the blood test results including thyroid hormone analysis at admission, Acute Physiologic and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score were compared between 28-day survivors and non-survivors. Further patients were divided into 3 groups; non-NTIS, NTIS group A (low total tri-iodothyronine (T3) and NTIS group B (low T3 with low thyroxine (T4). Multivariate Cox proportional hazards regression analysis was performed to determine the risk factors for mortality.Results:A total of 360 patients were included, and overall mortality was 30%. The mortality of non-NTIS patients was 13.4%; group A, 50.1%, and group B 69.1% (P < .001). The median T3 (IQR) in non-survivors and survivors was 0.74 (0.56–1.17) and1.58 (0.91–2.13) and median free T3 (IQR) 2.40 (1.13-3.01) and 4.03 (3.03-7.13) respectively (P < .001). In Cox proportional hazards analysis, NTIS group A (hazard ratio, 1.66; 95% confidence interval [CI], 1.00-2.76) and group B (hazard ratio, 2.57; 95% CI, 1.53-4.34). The area under the receiver-operating curve of NTIS groups was 0.68 (95% CI, 0.63-0.72).Conclusion:The T3 and free T3 were significantly lower in non-survivors compared with that in survivors and that a combination of low T3 with low T4 was associated with greater mortality than low T3 alone. A lower free T3 is independently associated with 28-day mortality.

Study on non-thyroidal illness syndrome in patients with coronary artery disease

Objective To determine the prognostic significance of non-thyroidal illness syndrome(NTIS)and FT3 on long-term all-cause and cardiovascular mortality in patients with coronary artery disease(CAD). Methods A total of 1 354 patients underwent coronary angiograhy and participated in the study. After screening, 984 patients with CAD were enrolled finally and divided into NTIS group and euthyroid group. The admitted patients were also classified into Tertile 1-3 groups based on FT3 value. The relationship of long-term all-cause and cardiovascular mortality with FT3 was investigated by multivariate Cox regression analysis. Results 129 out of 984 patients had NTIS. As FT3 value decreased, both long-term all-cause mortality(Tertile 1 group 9.6%, Tertile 2 group 11.5%, Tertile 3 group 20.9%, P<0.01)and cardiovascular mortality(Tertile 1 group 4.5%, Tertile 2 group 7.2%, Tertile 3 group 11.0%, P<0.01)gradually increased. After adjusting for all factors, FT3(HR=0.614, 95%CI 0.439-0.859)was independently associated with long-term all-cause mortality. FT3(HR=0.605, 95%CI 0.370-0.986)was also a risk factor for cardiovascular mortality. Conclusion NTIS exists in patients with CAD without myocardial infarction. FT3 reduction is an independent risk factor for long-term all-cause and cardiovascular mortality in patients with CAD. (Chin J Endocrinol Metab, 2015, 31: 47-51) Key words: Non-thyroidal illness syndrome; Coronary artery disease; Long-term mortality

Nonthyroidal illness syndrome in enterocutaneous fistulas

BackgroundThe aim of this study was to investigate the incidence, etiology, clinical outcomes, and prognosis of nonthyroidal illness syndrome (NTIS) in patients with enterocutaneous fistulas. MethodsWe prospectively collected 226 patients with enterocutaneous fistulas. Demographics, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment scores, C-reactive protein, body mass index, albumin, and thyroidal hormones were evaluated for each patient. ResultsThe incidence of NTIS was 57.5% in patients with enterocutaneous fistulas. Age and the APACHE II and Sequential Organ Failure Assessment scores were significantly higher, whereas albumin was lower in the NTIS group compared with those in the euthyroid group. A decreased sum activity of deiodinases and a reduced ratio of total thyroxin/free thyroxin and total triiodothyronine/free triiodothyronine were observed in the NTIS group. Patients with NTIS suffered longer durations in the intensive care unit and higher possibilities of mechanical ventilation. The cumulative survival rate was significantly lower in the NTIS group. ConclusionsNTIS was common, and patients with NTIS displayed worse clinical outcome and prognosis. A hypodeiodination condition and a potential thyroid hormone–binding dysfunction may play a role in the etiology of NTIS. A low serum albumin concentration and a high APACHE II score were risk factors of NTIS in enterocutaneous fistulas.

Nonthyroidal Illness Syndrome

This study was designed to investigate the clinical features of nonthyroidal illness syndrome (NTIS) compared with euthyroid patients in Crohn's disease (CD), to explore the etiology of NTIS in CD, to evaluate the clinical outcomes of NTIS patients, and to inspect the correlation of clinical variables and NTIS, and their ability of differentiating NTIS from euthyroid patients. NTIS has been described for more than 30 years. However, only few studies focused on the relationship between NTIS and CD. The incidence, underlying pathogenesis, clinical outcomes, and correlation with other inflammatory disease severity and nutritional variables of NTIS in CD have not been completely established. Prospectively, 44 CD patients were enrolled. Medical records and various laboratory values (including thyroidal, nutritional, and inflammatory variables) were collected in all participants. The incidence of NTIS in CD was 36.4%. Albumin, Acute Physiology and Chronic Health Evaluation II score, and Crohn's Disease Activity Index score in NTIS group were statistically different from those in euthyroid group. A decreased sum activity of deiodinases and a reduced ratio of TT4/FT4 were observed in NTIS group. Duration of hospitalization was significantly longer for NTIS patients than euthyroid patients. Albumin was confirmed as a protective factor of NTIS in CD. Receiver operating characteristic curve analysis demonstrated the differentiating capacity of albumin, suggesting 37.6 g/L as optimal cut-off value with sensitivity and specificity of 81.3% and 79.2%, respectively. NTIS was a common complication in CD. NTIS patients showed worse nutrition status and clinical outcome, and more critical disease activity and severity compared with euthyroid patients. A hypodeiodination condition and a potential thyroid-hormone-binding dysfunction may play a role in the etiology of NTIS in CD. Albumin was a meaningful protective and distinguishing marker of NTIS in CD.