Nonthyroidal Illness Research Articles

Prognostic significance of non-thyroidal illness syndrome in sepsis

Background and objectives. Sepsis is a common diagnosis among ICU patients. Therefore, the present study aimed at assessing the prognostic significance of non-thyroidal illness syndrome (NTIS) in sepsis. Materials and methods. The study was done as a retrospective analysis on adult patients of age greater than 18 years who were admitted with sepsis to an urban tertiary care ICU at Saveetha Medical College and Hospital. Results. The study found that NTIS can manifest as a fall in T3 alone, T4 alone, or both T3 and T4. A combined fall in T3 and T4 strongly correlates with poor primary outcomes (28-day mortality) compared to a fall in either hormone alone. Advancing age in septic patients leads to a greater combined fall in T3 and T4 values and an increased mortality rate, especially among females. The overall mortality rate in this series was 55%, with severe infections and high APACHE II scores contributing to lower hormone levels and higher severity. Conclusion. NTIS should be considered an indicator of poor prognosis in septic patients, necessitating aggressive management. It underscores the importance of assessing TSH alongside T3 and T4 in critically ill patients, although treating NTIS was beyond the scope of this study.

Exploring the potential of thyroid hormone therapy: Recent advancements and controversies

This article provides an overview of the recent advancements in thyroid hormone therapy for treating hypothyroidism and other thyroid disorders. The traditional thyroid hormone replacement therapy using levothyroxine has been effective, but recent advancements have led to a more individualized approach to treatment. The article discusses the development of new formulations and dosages of thyroid hormone replacement therapy, as well as the exploration of new combination therapies using both levothyroxine and liothyronine. Additionally, recent developments in the guidelines for thyroid hormone replacement therapy have emphasized the need for individualized treatment based on the patient’s specific needs and physiology. The article also highlights recent advancements in thyroid hormone therapy for depression, cardiovascular disease, and non-thyroidal illness syndrome. Overall, the article shows that recent advancements in thyroid hormone therapy have provided clinicians with more options for treating patients with thyroid disorders, improving their lives.

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.

Effects of Levothyroxine and Liothyronine on Cirrhotic Cardiomyopathy in Rats

In liver cirrhosis, there is low T3 syndrome associated with a decrease in total triiodothyronine (T3) and free T3 concentrations and cirrhotic cardiomyopathy (CCM) with chronotropic incompetence. Thus, we aimed to investigate the effects of eliminating T3 and thyroxine (T4) deficiencies on cardiac chronotropic dysfunction. Bile duct ligation (BDL) was used to induce cirrhosis in male Wistar rats. The chronotropic responses were studied through the Power Lab system in sham/saline, sham/T3T4, BDL/saline, and BDL/T3T4 groups. The serum T3 and T4, and T3 resin uptake (T3RU) levels were assessed. The atrial T3 receptor expression was investigated through a real-time polymerase chain reaction (Real-time PCR). The chronotropic responses were decreased in the BDL/saline group and raised in the BDL/T3T4 group. The serum T3 levels decreased in the BDL/saline group compared to sham group, but increased in the BDL/T3T4 group compared to the BDL/saline group. The serum T4 level increased in the BDL/saline and decreased in the BDL/T3T4 group. The serum T3RU level decreased in the BDL/saline and increased in the BDL/T3T4 group. The T3 receptor expression in atria increased in the BDL/saline group, nonetheless, it did not change in the BDL/T3T4 group compared to the sham/saline and the BDL/saline groups. T3T4 treatment did not increase the chronotropic response in the control group but the treatment improved the chronotropic hyporesponsiveness, and serum T4 and T3 RU abnormalities in cirrhosis, however, it is not related to the atrial T3 receptor expression.

Association of Anxiety and Depressive Symptoms with Thyroid Hormone Concentrations in Patients with Primary Bone Tumors.

Timely identification and intervention of psychological disorders bear significant import in ameliorating the ensuing therapeutic trajectories in primary bone tumor patients. Moreover, perturbations in thyroxine and thyroid-stimulating hormone (TSH) levels have been linked to manifestations of depressive and anxiety-related symptoms. However, the precise interplay governing the nexus of anxiety, depression, and the levels of thyroxine and TSH within the context of primary bone tumor patients remains presently unexplored. The objective of this study is to investigate the potential correlation between the hypothalamus- pituitary-thyroxine (HPT) axis and the depressive as well as anxious states observed in patients afflicted with bone tumors. Patients with primary bone tumors were required to accept the assessments of anxiety and depressive symptoms as well as thyroid axis hormone concentrations. The depressive and anxiety symptoms were assessed using the Hamilton Depression Rating Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) score. During each follow-up, peripheral venous blood samples were collected for subsequent analysis using radioimmunoassay methods to measure serum- free T3, free T4, and TSH levels, with the calculated free T3 to free T4 ratio indicating peripheral free T4 to free T3 conversion. Tests for trend were conducted to assess thyroid axis hormone concentrations, HAMA scores, and HAMD scores, while the correlation between HAMA or HAMD scores and thyroid axis hormone concentrations was examined through univariate regression analyses. The study included 30 primary bone tumor patients. Initial high HAMA and HAMD scores decreased over a year after surgery (P < 0.05), reflecting diminishing anxiety and depression. TSH levels reduced postoperatively, contrasting with increased free-T3 and free-T4 levels (p < 0.01). Multivariate analysis affirmed that positive correlations were noted between TSH and anxiety/depression scores, while free-T3 correlated negatively, adjusted for demographic factors (p < 0.05). No significant associations emerged between HAMA/HAMD scores and free-T4 or free-T3 to free-T4 ratio (p > 0.05). The early identification of the low T3 syndrome could prove instrumental in both intervening and preventing adverse emotional states associated with primary bone tumors.

Non-thyroidal Illness in Children with Congestive Heart Failure

To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure (CHF). This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity, derived from the Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24 hours of hospitalization and evaluated for free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), N-terminal pro-brain natriuretic peptide (NT pro-BNP) and reverse T3. A total of 80 (64 acyanotic CHD) children of median (interquartile range) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%) of whom 27 had low fT3 levels. The proportion of NTI was highest in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41) (p=0.018). Ten (27%) patients with NTI died compared to 2 (4.7%) without NTI with unadjusted odds ratio (OR) [95% confidence interval (CI)] 7.593 (1.54, 37.38); p=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR: 1.41, 95% CI: 1.03, 1.92; p=0.032). Linear regression for fT3 identified a significant relationship with log NT-BNP [beta -3.541, (95% CI: -1.387, -0.388)] and with TSH [beta 2.652 (95% CI: 0.054, 0.383)]. The cutoff (area under the curve, 95% CI) that predicted mortality were fT4 <14.5 pmol/L (0.737, 0.60, 0.88), fT3/rT3 index <1.86 pg/ng (0.284, 0.129, 0.438) and NT pro-BNP >3725 pg/mL (0.702; 0.53, 0.88). NTI was present in a significant proportion of children with CHD and CHF. fT3 level was significantly associated with NTBNP levels and thus severity of CHF.

Is thyroid function testing necessary in all cases of new onset atrial fibrillation diagnosed in the emergency department? - a real-life study

Abstract Background Atrial fibrillation/flutter (AF) is the most frequent cardiac arrhythmia worldwide. It increases the risk for comorbidities and prompt management is thus important. One established risk factor for AF development is hyperthyroidism, and concomitant disease significantly impacts morbidity in these patients. Therefore, thyroid function testing is recommended in new-onset AF (NOAF) by the European Society of Cardiology. There are few studies examining the prevalence of previously undiagnosed hyperthyroidism in cases of NOAF, especially if diagnosed in the emergency department (ED). Furthermore, previous studies often relied upon thyroid stimulating hormone (TSH) levels to identify cases of hyperthyroidism, this approach is susceptible for diagnostic errors since TSH profiles can overlap in conditions like hyperthyroidism, non-thyroid illness, and central hypothyroidism (of which only the former is associated with AF). Because of this, it's essential to incorporate additional biomarkers for a more precise differentiation. Purpose We aim to evaluate the prevalence of previously undiagnosed hyperthyroidism in a real-life NOAF population admitted to and diagnosed in the ED with a 2.5-years follow-up. Furthermore, we aim to interpret thyroid dysfunctions in relation to TSH as well as free thyroid hormone levels and other relevant biomarkers. Methods This retrospective registry-based cohort study included all patients attending the ED at a medium-sized hospital in Sweden during 2018 and 2020. Inclusion criteria: main diagnosis of AF (ICD I48) and ≥18 years old. Exclusion criteria: multiple visits, previous AF, abnormal thyroid function within the previous 2 years, and current thyroid hormone substitution. Results Patients from a total of 1020 ED visits were screened for eligibility. After exclusion, 325 patients with NOAF were included in the analysis. Of those, 106 (33%) and 232 (71%) had undergone thyroid function testing in the ED and by the end of the 2.5-years follow-up, respectively. We found no cases of hyperthyroidism in the ED and only two cases (1% prevalence) during the 2.5-years follow-up. Conclusions In this real-life cohort we found modest thyroid testing rates in the ED, however, a majority of patients underwent testing during follow-up. Despite this, we found no cases of hyperthyroidism in the ED and only two cases during follow-up, this is considerably lower than previously reported and may raise a question whether all patients should undergo thyroid testing, or if thyroid testing should be directed towards those with a suspected thyroid disease.

#1080 Low-T3 syndrome: “endemic” in hemodialysis patients?

Abstract Background and Aims In hemodialysis patients, low-T3 syndrome is more prevalent than in the general population and was found to be associated with malnutrition and inflammation. Although evidence suggest that low free T3 (fT3) levels predict cardiovascular and all-cause mortality, low-T3 syndrome is usually not treated. The aim of this single-center retrospective observational study was to determine the prevalence of thyroid axis derangements and examine the relationship between thyroid hormones and biochemical and clinical variables in our hemodialysis (HD) patients cohort. Method Patients on thrice-weekly maintenance HD for at least 6 months were enrolled. Patients taking amiodarone, levothyroxine or methimazole were excluded. Data about age, sex, ethnicity, hemodialysis vintage, type of dialysis (bicarbonate dialysis/online hemodiafiltration/acetate-free-biofiltration/hemofiltration with endogenous reinfusion/expanded hemodialysis) were obtained from medical records and values of fT3, fT4, TSH, albumin, LDL, hemoglobin—routinely checked for every patient during hemodialysis sessions—were acquired. Continuous variables are expressed as median and IQR or mean ± SD and categorical variables as absolute value or percentage. The normality of data distribution was tested by Sapiro-Wilk test. Correlations were studied with Pearson and Spearman. T-test and Mann-Whitney U test were performed to compare continuous and categorical variables. Statistical significance was reached with p &amp;lt; 0.05. Results A total of 57 patients on thrice-weekly maintenance HD were enrolled. Most of them were male (70.2%), Caucasians (89.5%), with a mean age of 69 ± 14 years and with a median dialytic vintage of 63 [29; 113] months. Hypertension was the most frequent comorbidity and more than half of the patients was either affected by ischemic, hypertensive or dilatative cardiomyopathy. Most of the patients underwent bicarbonate hemodialysis (42.1%) and overall 57.9% of the study population was treated by convective techniques. Hemoglobin, albumin, LDL cholesterol, fT3 and fT4 values was normally distributed, while those of TSH and PCR were not. A very high prevalence of low-T3 syndrome (75%) was found, 5 patients showed subclinical hypothyroidism and only in a minority of patients thyroid function tests were normal (12%) (Fig. 1). A significant negative correlation between fT3 and age (p = 0.041) and a positive one between TSH and dialytic vintage (p = 0.017) were found (Table 1). In addition, a significant positive correlation between albumin and fT3 was detected, supporting the known association between low T3 and malnutrition. Interestingly, PCR negatively correlated with fT3 and positively with fT4. Patients treated by diffusive techniques showed no statistically significant difference of thyroid hormone levels compared to convective therapies (Table 1). Conclusion Low-T3 syndrome affects the great majority of patients in our hemodialysis population, with a prevalence even higher than that provided by literature. Our investigations confirm that older patients seem to show lower fT3 levels and a longer hemodialysis vintage may correlate with higher TSH levels. The association with inflammation was also confirmed. Considering the known impact on cardiovascular and all-cause mortality already demonstrated, it is important to routinely check thyroid hormones in HD. In addition, further studies should be performed in order to establish the possible impact of the therapeutic correction of this hormonal derangement on hemodialysis patients’ mortality and cardiovascular outcomes.

#1246 The impact of severe nephrotic syndrome on thyroid function

Abstract Background and Aims Nephrotic syndrome (NS) is a clinical condition characterized by massive urinary loss of proteins, mostly albumin, but also hormones and their carrier proteins among others. The most frequently reported hormonal complication is thyroid dysfunction. The study aimed to assess the frequency of thyroid dysfunction in NS and its association with carrier protein levels and indicators of disease severity. Method A case-control study was conducted involving patients with newly diagnosed or relapsed severe NS, defined as proteinuria &amp;gt; 3.5 g/day and serum albumin ≤ 2.5 g/dL (NS group), and patients without proteinuria (control group). The evaluation included thyroid hormone profiles, serum levels of carrier proteins (prealbumin – PAB, and thyroid-binding globulin – TBG), and markers reflecting the course of NS. Results Forty-two nephrotic and 40 matched non-proteinuric patients were enrolled. The NS group comprised 67% males with a mean age of 49 years and an average proteinuria of 8.9 g/day (Table 1). The leading cause of NS was minimal change disease (22 patients), followed by membranous nephropathy (11 patients). The other causes included: amyloidosis (3 patients: AL – 2 cases, A – 1 case), focal segmental glomerulosclerosis (2 patients) and lupus nephritis (1 case). In 5 cases, no histological diagnosis was made. Thyroid dysfunction secondary to NS was observed in the majority of patients, occurring 18-times more frequently than in the control group (67% vs 10%, OR = 18, 95% CI: 5.3-60.7). Euthyroid sick syndrome was the most commonly seen in NS (15 cases, 36%), followed by overt (8 cases, 19%) and subclinical hypothyroidism (5 cases, 12%). According to the current guidelines, levothyroxine supplementation was required in 11 patients (26% of the NS group, 36% of those with thyroid dysfunction). Serum TSH correlated inversely with PAB (R = −0.63, p &amp;lt; 0.001), and positively with TBG (R = 0.39, p = 0.010), while no relationships were found between carrier proteins and free hormones (fT3 or fT4). The only indicator of NS severity related to thyroid function was serum albumin. It correlated, however, only with TSH (R = −0.41, p = 0.007), not with free hormones. Additionally, neither histological type, nor clinical course of NS distinguished between euthyroidism, euthyroid sick syndrome, or hypothyroidism (Table 2). Conclusion Thyroid dysfunction is a common complication of severe NS. Although euthyroid sick syndrome predominates, the proportion of patients with hypothyroidism who may potentially require levothyroxine replacement therapy remains substantial.

Low T3 syndrome is associated with the severity of myelin oligodendrocyte glycoprotein antibody-associated disease exacerbation.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune inflammatory disease of the central nervous system, (CNS) different from multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). While numerous studies have delved into the involvement of thyroid antibodies (ATAbs) and thyroid function in NMOSD and MS. The objective of this study is to explore the clinical significance of thyroid dysfunction and ATAbs abnormalities in adult patients with MOGAD. 36 adult inpatients diagnosed with MOGAD and 47 sex- and age-matched healthy controls were enrolled. Patients were divided into two groups based on the presence or absence of low T3 syndrome. Demographics, clinical characteristics, and results of auxiliary examinations were compared across the subgroups. Moreover, an analysis was conducted to explore the correlations between thyroid hormone levels and Expanded Disability Status Scale (EDSS) scores. Thyroid dysfunction was notably more frequent in MOGAD patients than healthy controls (p < 0.0001), particularly low T3 syndrome (p=0.03). Furthermore, subgroup analyses revealed that the low T3 syndrome group exhibited higher EDSS scores and a higher proportion of individuals with EDSS scores > 3, in comparison to the non-low T3 syndrome group (p = 0.014, p = 0.046). However, no significant differences were observed in demographic characteristics, annual relapse rates, clinical phenotypes, laboratory and MRI results, and EEG abnormalities between the two groups. Additional Spearman's analysis showed significantly negative correlations between the TT3 and FT3 levels with EDSS scores (r = -0.367, p = 0.028; r = -0.377, p = 0.024). Typical brain lesions and paralateral ventricle lesions were significantly rare in patients with positive ATAbs compared to those with negative ATAbs (p = 0.0001, p = 0.03), although the incidence of ATAbs abnormalities did not differ significantly between MOGAD patients and healthy controls. Overall, this study confirmed thyroid dysfunction, especially low T3 syndrome, is frequent in adult MOGAD patients. Patients with low T3 syndrome exhibited elevated EDSS scores and a significantly higher incidence of unfavorable condition. additionally, the correlation analysis model manifests that FT3 and TT3 levels were negatively correlated with EDSS scores. These evidences indicate that low T3 syndrome is associated with the severity of MOGAD exacerbation.

Euthyroid sick syndrome in severe sars-cov-2 disease

Euthyroid sick syndrome in severe sars-cov-2 disease

Clinical value of reverse triiodothyronine in the identification of euthyroid sick syndrome and prediction of mortality in critically ill patients

Clinical value of reverse triiodothyronine in the identification of euthyroid sick syndrome and prediction of mortality in critically ill patients

Prevalence of thyroid dysfunctions and thyroid autoantibodies in Thai patients with systemic lupus erythematosus: An age- and sex-matched controlled study.

To determine the prevalence of thyroid dysfunctions and thyroid autoantibodies in Thai systemic lupus erythematosus (SLE) patients, and compare them with age- and sex-matched healthy controls (HCs). Associations between thyroid dysfunctions and SLE disease activity, and associated factors for thyroid dysfunctions in SLE also were determined. One hundred SLE patients, without apparent clinical thyroid disease, attended the Rheumatology Clinic between November 2021 and October 2022, were enrolled into this study. HCs were matched to SLE cases by age and sex (ratio of 1:1). Clinical manifestations, SLE disease activity and medication received were collected in all SLE patients. Thyroid function tests and thyroid autoantibodies (anti-thyroglobulin: anti-TG and anti-thyroid peroxidase: anti-TPO) were collected from all participants. When compared with HCs, SLE patients had higher prevalence of thyroid dysfunctions, hypothyroidism and euthyroid sick syndrome (28% vs. 7%, p < .001, and 12% vs. 2%, p = .010, and 6% vs. 0%, p = .013, respectively). Prevalence of isolated hypothyroxinemia was higher numerically in SLE patients (9% vs. 3%, p = .074). Prevalence of anti-TG or anti-TPO was no different between SLE patients and HCs (16% vs. 18%, p = .707). There was no association between SLE disease activity and abnormal thyroid functions or thyroid autoantibodies. Family history of thyroid disease and prednisolone use (>10 mg/day) were associated factors for thyroid abnormalities with adjusted OR (95% CI) of 6.13 (1.58-23.75), p = .009 and 4.00 (1.37-11.70), p = .011, respectively. Thyroid dysfunctions were more prevalent in SLE patients. Family history of thyroid disease and prednisolone use (>10 mg/day) were independent associated factors of thyroid abnormalities.

Thyroid hormone changes in critical surgical illness: a narrative review

The systemic response to stress caused by a critical surgical illness is characterized by a series of events that precede metabolic and neuroendocrine dysregulation. However, the relevance of theclassically described 'stress response' is now highly questionable in an era where profound physiological deconditioning is common in critically ill, surgical and non-surgical patients. Common assessment techniques do not accurately reflect the integrity of the hypothalamic-pituitary-thyroid axis in the course of a critical chronic disease state. The clinical presentation ismostly masked by symptoms of the underlying critical illness when plasma thyroid hormone concentrations are altered. The frequent development of multimorbidity in critically ill patients is the reason for the need for a more detailed analysis of the neuroendocrine model of activation. Basic scientific studies suggest that low levels of circulating thyroid hormones in the acute phase are an adaptive process, but the chronic condition could directly cause organ damage. Here, we review factors that have emerged to challenge the conventional model of euthyroid sick syndrome (ESS) in the surgically critically ill as an adaptive process, and suggest that the stage of the critical illness is an important consideration in the critically ill. Examining the stressresponse in the critically ill presents opportunities to improve outcomes through improved understanding of the neuroendocrine aspects.

Changes in biomarkers of the redox status in whole blood and red blood cell lysates in canine hypothyroidism

Hypothyroidism is the most commonly diagnosed endocrine disease in dogs. The objective of this study was to evaluate the changes in the redox status in canine hypothyroidism using whole blood (WB) and red blood cell (RBCs) lysates. For this purpose, a panel of five antioxidants and five oxidants biomarkers was measured in WB and RBCs lysates of 30 dogs with hypothyroidism, 26 dogs with non-thyroidal illnesses and 15 healthy dogs. The antioxidants measured were cupric reducing antioxidant capacity (CUPRAC), ferric reducing ability of plasma (FRAP), Trolox equivalent antioxidant capacity (TEAC), thiol and paraoxonase type-1 (PON-1). Oxidants measured include the total oxidant status (TOS), peroxide-activity (POX-Act), reactive oxygen-derived metabolites (d-ROMs), advanced oxidation protein products (AOPP) and thiobarbituric acid reactive substances (TBARS). WB showed a significant decrease of the antioxidants CUPRAC, TEAC and thiol, and also an increase in TBARS and a decrease in AOPP in dogs with hypothyroidism compared to healthy dogs. Meanwhile, RBCs lysates showed a significant increase in FRAP and PON-1 in dogs with hypothyroidism. The changes in the redox biomarkers in this study show that WB in canine hypothyroidism had a higher number of changes in biomarkers of the redox status than RBCs lysates, making it a promising sample type for the evaluation of the redox status in this disease. In addition, WB is easier and simpler to process than RBCs lysates and unlike serum, it does not have any hemolysis interference.

Total thyroxine, triiodothyronine, and thyrotropin concentrations during acute nonthyroidal illness and recovery in dogs.

Acute illness can result in changes in serum total thyroxine (tT4), total triiodothyronine (tT3), and thyrotropin (TSH) concentrations in euthyroid dogs defined as nonthyroidal illness syndrome, but longitudinal evaluation of these hormones during the recovery phase is lacking. To longitudinally evaluate serum tT4, tT3, and TSH concentrations during the acute phase and recovery from acute illness in dogs. Nineteen euthyroid client-owned dogs hospitalized for acute illness at a veterinary teaching hospital. Prospective longitudinal study. Serum tT4, tT3, and TSH concentrations were measured at the admission (T0), at last day of hospitalization (T1), and during the recovery phase at 3, 7, 14, and 21 days after the discharge (T2, T3, T4, and T5), respectively. tT4 and tT3 were below the reference interval (RI) at T0 in 3 (16%) and 18 (95%) dogs, respectively; tT4 normalized in all dogs early in the recovery phase, while low tT3 persisted at the end of the study in 16 (83%) dogs. Median TSH concentrations were increased at T5 compared with T1 (0.19 ng/mL [range 0.03-0.65] vs 0.11 ng/mL [range (0.05-0.26)], mean difference = 0.09 ng/mL; P = .03). Five (26%) dogs had TSH above the RI at least at 1 time point during the recovery phase. None of the dogs had concurrent low tT4 and high TSH during the study. In euthyroid dogs acute illness can interfere with evaluation of thyroid function up to 21 days during the recovery phase. Thyroid testing should be avoided or postponed in these dogs.

Thyroid dysfunction in nonvalvular atrial fibrillation and clinical outcomes.

Thyroid dysfunction's effects on those who have been diagnosed with atrial fibrillation have not been well investigated. We looked at how thyroid function among patients with pre-existing atrial fibrillation related to thromboembolic risk and clinical outcomes. We gathered the medical information of patients diagnosed with nonvalvular atrial fibrillation (NVAF) between 2016 and 2020 at Dongguan People's Hospital. We then assessed the correlation between thyroid dysfunction and thrombotic risk (CHA2DS2-VASc) as well as the occurrence of clinical composite endpoint (all-cause death, heart failure, systemic embolism and hemorrhage events). Of 1329 patients were admitted, 82.6% were euthyroid, 7.4% had subclinical hyperthyroidism, 4.2% had subclinical hypothyroidism, and 6.7% had low triiodothyronine (T3) syndrome. Lower levels of total triiodothyronine (TT3) were linked to an increased risk of thromboembolism (P < 0.005). During a median follow-up period of 1.84 years, there were 608 clinical composite endpoint occurrences. In the adjusted model, Low T3 syndrome was linked to a higher risk of the clinical composite endpoint (HR, 1.68; 95% CI, 1.20-2.37; P < 0.05) in comparison to euthyroidism. Specifically, low T3 syndrome was linked to a higher risk of heart failure (HR, 1.52; 95%CI, 1.01-2.30; P < 0.05) and all-cause death (HR, 3.34; 95% CI, 1.76-6.36; P < 0.001). Low T3 syndrome are linked to an increased risk of heart failure and all-cause death in individuals with NVAF. And Patients with NVAF and low TT3 levels have a higher risk of thromboembolism.

Does an episode of diabetic ketoacidosis affect thyroid function tests in pediatric patients?

The aim of our study was to investigate the changes in thyroid hormone levels during and after acute metabolic disorder in patients with diabetic ketoacidosis (DKA). Eighty five patients diagnosed with DKA were included in the study. Patients with control thyroid function test (TFT) values at admission (the first blood sample) and 1month later were included in the study. Thyroid function tests obtained during diabetic ketoacidosis and at the first month follow-up were compared. Euthyroidism and euthyroid sick syndrome were defined and grouped according to current guidelines. The mild and moderate groups, according to DKA classification, were combined and compared with the severe group. A significant increase was observed between the first admission and the control TFT values 1month later. However, there was no significant difference found in TFT between mild/moderate and severe groups taken at the time of DKA. Difference between two groups, euthyroid sick syndrome and euthyroid, was examined and the result that was different from the literature was the difference between TSH levels. We found that low FT4 levels were associated with higher HgbA1c, although the correlation was weak. Thyroid hormone levels may not reflect a thyroid disease during severe DKA attack. Therefore, it is unnecessary to check thyroid function tests.

Low Free Thyroxine (FT4) in critically ill juvenile systemic lupus erythematosus: a diagnostic approach

Introduction: Thyroid dysfunction was frequent in systemic lupus erythematosus (SLE) patients, which may present as euthyroid, hypothyroid, or hyperthyroid states. Critical conditions have a higher chance of euthyroid sick syndrome due to alterations in the hypothalamic-pituitary-thyroid (HPA) axis. Renal impairment was associated with an increased risk of low FT4 due to proteinuria followed by thyroid loss. Case Description: We reported one patient, a 15-year-old girl, who complained of shortness of breath and revealed acute respiratory distress syndrome, valve regurgitation, and pericardial effusion. She also felt joint pain over the leg and odor urination. Further evaluation showed non-scaring alopecia, pyuria, proteinuria &gt;0.5 gram/24 hours, urinary cast, and acute kidney injury stage failure. ANA (IF) pattern: scattered with titer 1:100, ANA profile indicated Smith (Sm) antigen (+) and C3 108.3 mg/d, which fulfilled Systemic Lupus International Collaborating Clinics (SLICC) 2015 and European League Against Rheumatism (EULAR) 2019 criteria for SLE. On the fourth day of treatment, the patient had acute confusion, hypothermia, and sinus bradycardia, while the investigation of FT4 hormone was 0.45 ng/dL, TSH 2.39 uIu/ml, which revealed euthyroid sick syndrome. After treatment with a high dose of methylprednisolone, cyclophosphamide, rituximab, levothyroxine, a phosphodiesterase inhibitor, and a diuretic, she deteriorated and passed away. Conclusion: The higher prevalence of thyroid dysfunction in juvenile SLE patients necessitates further attention. Lupus nephritis, increased creatinine level, detection of Smith (Sm) antigen, and critical condition were also at higher risk of low FT4 in juvenile SLE patients. This condition may have a worsened prognosis with prompt diagnosis and treatment.

Thyroiditis and COVID-19: focus on pediatric age. A narrative review.

In light of the growing concern over the possible link between SARS-CoV2 infection and autoimmune diseases, we conducted a review to investigate the impact of the pandemic outbreak on thyroid diseases. We carried out a narrative review of all pediatric cases described in the literature, mainly focusing on the possible association of COVID-19 with the incidence of autoimmune and post-infective thyroid diseases (namely Hashimoto's Thyroiditis (HT), Grave's Disease (GD) and Sub-Acute Thyroiditis (SAT)). We also felt it was necessary to provide a brief review of Non-thyroidal Illness Syndrome (NTIS) and Multisystem Inflammatory Syndrome in Children (MIS-C) because of their overlap with thyroiditis. There is currently no conclusive evidence linking SARS-CoV-2 infection with an increased incidence of autoimmune thyroiditis (AT) in pediatric age. However, SAT may be a mild complication of SARS-CoV-2 infection, as is the case with other viral infections. SAT typically resolves on its own and does not require treatment. NTIS may be associated with inflammatory complications, such as MIS-C, and admission to intensive care. It may also be considered a prognostic risk factor for severe disease. The hypothesized pathogenetic mechanisms of thyroid damage in COVID-19 include direct damage due to the significant expression of angiotensin-converting enzyme 2 (ACE2) in the thyroid gland, which is a ligand for the virus, and indirect damage due to immune dysregulation, such as the overproduction of IL-6, which is thought to be part of the pathogenesis of thyroiditis. However, due to the limited evidence available, further prospective longitudinal studies are required to clarify the relationship between COVID-19 and thyroid disease in children and adolescents, as well as to investigate any potential long-term consequences.