Nonthyroidal Illness Research Articles

Low T3 syndrome is associated with 30-day mortality in adult patients with fulminant myocarditis.

Fulminant myocarditis (FM) is a critical disease with high early mortality. Low triiodothyronine syndrome (LT3S) was a strong predictor of poor prognosis of critical diseases. This study investigated whether LT3S was associated with 30-day mortality in FM patients. Ninety-six FM patients were divided into LT3S (n=39, 40%) and normal free triiodothyronine (FT3) (n=57, 60%) groups based on serum FT3 level. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality. Kaplan-Meier curve was used to compare 30-day mortality between two groups. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to assess the value of FT3 level for 30-day mortality prediction. Compared to normal FT3 group, LT3S group had higher incidence of ventricular arrhythmias, worse hemodynamics, worse cardiac function, more severe kidney impairment, and higher 30-day mortality (48.7% vs. 12.3%, P<0.001). In univariable analysis, LT3S (odds ratio [OR]:6.786, 95% confidence interval [CI]:2.472-18.629, P<0.001) and serum FT3 (OR:0.272, 95%CI:0.139-0.532, P<0.001) were significant strong predictors of 30-day mortality. After adjustment for confounders in multivariable analysis, LT3S (OR:3.409, 95%CI:1.019-11.413, P=0.047) and serum FT3 (OR:0.408, 95%CI:0.199-0.837, P=0.014) remained independent 30-day mortality predictors. The area under the ROC curve of FT3 level was 0.774 (cut-off: 3.58, sensitivity: 88.46%, specificity: 62.86%). In DCA, FT3 level showed good clinical-application value for 30-day mortality prediction. In FM patients, LT3S could independently predict 30-day mortality. FT3 level was a strong 30-day mortality predictor and a potentially useful risk-stratification biomarker.

Similar hypothyroid and sepsis circulating mRNA expression could be useful as a biomarker in onthyroidal illness syndrome: a pilot study.

Based on hypothetical hypothyroidism and nonthyroidal illness syndrome (NTIS) gene expression similarities, we decided to compare the patterns of expression of both as models of NTIS. The concordant profile between them may enlighten new biomarkers for NTIS challenging scenarios. We used Ion Proton System next-generation sequencing to build the hypothyroidism transcriptome. We selected two databanks in GEO2 platform datasets to find the differentially expressed genes (DEGs) in adults and children with sepsis. The ROC curve was constructed to calculate the area under the curve (AUC). The AUC, chi-square, sensitivity, specificity, accuracy, kappa and likelihood were calculated. We performed Cox regression and Kaplan-Meier analyses for the survival analysis. Concerning hypothyroidism DEGs, 70.42% were shared with sepsis survivors and 61.94% with sepsis nonsurvivors. Some of them were mitochondrial gene types (mitGenes), and 95 and 88 were related to sepsis survivors and nonsurvivors, respectively. BLOC1S1, ROMO1, SLIRP and TIMM8B mitGenes showed the capability to distinguish sepsis survivors and nonsurvivors. We matched our hypothyroidism DEGs with those in adults and children with sepsis. Additionally, we observed different patterns of hypothyroid-related genes among sepsis survivors and nonsurvivors. Finally, we demonstrated that ROMO1, SLIRP and TIMM8B could be predictive biomarkers in children´s sepsis.

Changes in thyroid function parameters 3 months after allogeneic and autologous hematopoietic stem cell transplantation in children.

Thyroid dysfunction (hypo- and hyperthyroidism) has been reported as a late effect after hematopoietic stem cell transplantation (HSCT) in children. Short-term effects of HSCT on thyroid function parameters are, however, unclear. We prospectively evaluated thyroid function parameters before and 3 months after HSCT in all children (<21 years) who underwent HSCT during a 2-year period in the Princess Máxima Center, the Netherlands. Among 72 children, none had thyroidal hypothyroidism or hyperthyroidism 3 months after HSCT. Changes in thyroid function parameters (either aberrant thyroid-stimulating hormone [TSH] or free thyroxine [FT4] concentrations) were found in 16% before and in 10% 3 months after HSCT. Reverse triiodothyronine (rT3) was found elevated in 9.3% before and in 37% 3 months after HSCT, which could be related to poor physical condition. An individual decline in FT4 concentration of ≥20% was found in 10.5% (6/57) 3 months after HSCT. In conclusion, thyroidal hypo- and hyperthyroidism are very rare 3 months after HSCT. These results indicate that surveillance for hypo- and hyperthyroidism may start later in time. The changes in thyroid function parameters found 3 months after HSCT might reflect euthyroid sick syndrome.

A STUDY OF PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM AND OVERT HYPOTHYROIDISM IN BIDAR DISTRICT, KARNATAKA

Background: Subclinical hypothyroidism and overt hypothyroidism are often overlooked afictions. The aim of the present study was to estimate the prevalence of overt and subclinical hypothyroidism among the adult population of Bidar District. Materials &amp; Methods: A prospective hospital study of 1485 subjects who were referred to Department of Biochemistry, Bidar Institute of Medical Sciences, Bidar was undertaken for assessment of thyroid functions investigated between November 2022 to April 2023. Statistical analysis was done in terms of percentage and chi-square test (x2). Results: Of the 1485 subjects (198 men and 1287 women); 593 subjects (~40%) were euthyroid, 362 subjects (27 men and 335 women) had subclinical hypothyroidism; 331 subjects (56 men and 275 women) had overt hypothyroidism; 30 subjects (6 men and 24 women) had subclinical hyperthyroidism; 162 subjects (3 men and 159 women) had overt hyperthyroidism; and 7 subjects (02 men and 5 women) had Euthyroid sick syndrome. Conclusion: Hypothyroidism appears to be common in Bidar, Karnataka. Community based mass screening for Sub clinical and overt hypothyroidism in high risk group is suggested to identify these patients and treat them.

Hypothyroidism in induction chemotherapy of children with acute lymphoblastic leukaemia: A single-centre study.

Hypothyroidism as a long-term complication in cancer survivors has been an issue, but few studies have focused on changes in thyroid hormone levels during chemotherapy for leukaemia. This retrospective study was conducted to assess the characteristics of children with acute lymphoblastic leukaemia (ALL) and hypothyroidism during induction chemotherapy and to investigate the prognostic value of hypothyroidism in ALL. Patients with a detailed thyroid hormone profile at ALL diagnosis were enrolled. Hypothyroidism was defined as low serum levels of free tetraiodothyronine (FT4) and/or free triiodothyronine (FT3). The Kaplan-Meier method was used to create survival curves, and multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). There were 276 children eligible for the study, and 184 patients (66.67%) were diagnosed with hypothyroidism, including 90 cases (48.91%) with functional central hypothyroidism and 82 cases (44.57%) with low T3 syndrome. Hypothyroidism was correlated with the dosages of L-Asparaginase (L-Asp) (P = .004) and glucocorticoids (P = .010), central nervous system (CNS) status (P = .012), number of severe infections (grade 3, 4 or 5) (P = .026) and serum albumin level (P = .032). Hypothyroidism was an independent prognostic factor for PFS in ALL children (P = .024, 95% CI: 1.1-4.1). We conclude that hypothyroidism is commonly present in ALL children during induction remission, which is related to chemotherapy drugs and severe infections. Hypothyroidism was a predictor of poor prognosis in childhood ALL.

Thyroid Function in Newly Diagnosed HIV-positive Patients.

As of 2019, the highest prevalence of human immunodeficiency virus (HIV) in India is seen in the Northeastern states. Endocrine and metabolic disturbances can occur in HIV infection. Thyroid dysfunction is one of the common endocrinopathies. In HIV infection, thyroid function abnormalities are seen in about 4-35% of adult patients. Thyroid function abnormalities range from overt hypothyroidism, subclinical hypothyroidism, and sick euthyroid syndrome to overt hyperthyroidism. Among them, subclinical hypothyroidism is the commonest abnormality. To our knowledge, there have been no studies from Northeastern India done in this regard. To study the thyroid function in newly diagnosed cases of HIV infection attending anti-retroviral therapy (ART) center, Assam Medical College. To estimate the prevalence and types of thyroid dysfunction in newly diagnosed HIV-infected individuals. To study thyroid dysfunctions with respect to age, sex, and cluster of differentiation (CD) 4 count. Hospital-based observational study was done at a tertiary care centre of upper Assam on newly diagnosed HIV-positive patients who were not started on antiretroviral therapy and who attended the ART centre, Assam Medical College during the period of our study. History, examinations and laboratory investigations, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and CD4 count, are done in all such patients, and only those who fulfilled the inclusion and exclusion criteria of our study are taken as study participants, and their findings tabulated. A total of 95 newly diagnosed HIV-positive patients fulfilling the inclusion and exclusion criteria of our study were taken. In our study, a total of 36.84% of the patients had thyroid dysfunction. We got subclinical hypothyroidism, overt hypothyroidism, sick euthyroid syndrome, and overt hyperthyroidism as the types of thyroid dysfunction. Among all the types of thyroid dysfunction, subclinical hypothyroidism was the commonest abnormality in our study. Under sick euthyroid syndrome, we got only low FT3 as the biochemical abnormality. Thyroid dysfunctions were more common in females (42.3%) than males (35.8%) and were more common in the age group of 30-39 years. In the present study, among patients with thyroid dysfunction, it was seen that 51.43% of the patients had a CD4 cell count in the range 101-200 cells/mm3, whereas only 11.43% of patients had a CD4 cell count in the range &lt;50 cells/mm3 and no patient had a CD4 cell count &gt;500 cells/mm3 . In our study, we found that thyroid dysfunctions were common in newly diagnosed HIV-positive patients, the prevalence of which was much higher in the general population. Thyroid dysfunction was present in all the stages of the HIV disease.

Clinical features and prognosis of patients hospitalized with heart failure and low T3 syndrome

Objective: To investigate the association between triiodothyronine (T3) and inflammatory factors, and its potential effect on long-term outcomes in hospitalized patients with heart failure (HF). Methods: A total of 2 475 patients with HF admitted in Heart Failure Care Unit were consecutively enrolled in this retrospective cohort study from December 2006 to June 2018. Patients were divided into low T3 syndrome group (n=610, 24.6%) and normal thyroid function group (n=1 865, 75.4%). The median follow-up time was 2.9 (1.0, 5.0) years. A total of 1 048 all-cause deaths were recorded at the final follow-up. The effects of free T3 (FT3) and high-sensitivity C-reactive protein (hsCRP) on the risk of all-cause death were evaluated by Cox regression analysis and Kaplan-Meier analysis. Results: The age of the total population was 19-95 (57±16) years, 1 823 cases (73.7%) were male. Compared to those with normal thyroid function, albumin [(36.5±5.4) vs. (40.7±4.7) g/L], hemoglobin [(129.4±25.1) vs. (140.6±20.6) g/L], total cholesterol [3.6 (3.0, 4.4) vs. 4.2 (3.5, 4.9) mmol/L] (all P<0.001) were lower, Whereas age [(60.5±16.0) vs. (55.2±15.4) years], creatinine [105.0 (83.6, 137.0) vs. 87.8 (75.6, 106.3) mmol/L], log N-terminal B-type natriuretic peptide [(8.2±1.3) vs. (7.2±1.4) ng/L] were higher in LT3S patients (all P<0.001). In Kaplan-Meier survival analysis, patients with lower FT3 and higher hsCRP had significantly lower cumulative survival (P<0.001), lower FT3 combined with higher hsCRP subgroup had the highest risk of all-cause death (Ptrend<0.001). In multivariate Cox regression analysis, LT3S was an independent predictor of all-cause mortality (HR=1.40, 95%CI 1.16-1.69, P<0.001). Conclusion: LT3S is an independent predictor of poor prognosis in patients with heart failure. FT3 combined with hsCRP improve the predictive value of all-cause death in hospitalized patients with heart failure.

Abstract #1408160: Double Whammy: Graves' Hyperthyroidism with Superimposed Non-Thyroidal Illness Syndrome (NTIS)

Abstract #1408160: Double Whammy: Graves' Hyperthyroidism with Superimposed Non-Thyroidal Illness Syndrome (NTIS)

Thyroid Dysfunction in Chronic Kidney Disease: A Study from North Kerala

Introduction: Chronic kidney disease (CKD) is a leading cause of morbidity and mortality Worldwide. The understanding of metabolic and hormonal abnormalities in milder forms of renal dysfunction is expanding, but the knowledge of thyroid dysfunction in people with CKD is still limited. The growth, differentiation, and regulation of physiological mechanisms in all tissues, including the kidney, depend on thyroid hormones. They are essential for maintaining the balance of electrolytes and water. Prevalence of hypothyroidism in end stage renal disease (ESRD) has been estimated to be in the range of 0 to 9%. Patients with ESRD also have a higher prevalence of goitre. Although there are several indicators that can predict both overall mortality and the severity of renal impairment, thyroid dysfunction is one of the major ones. In order to improve the outcome, it is wise for the internist and treating physician to be aware of thyroid dysfunction. The importance of knowing the prevalence of thyroid dysfunction in CKD patients also lies in the fact that it adds to the already high cardiovascular mortality risk in this patient group.&#x0D; Objectives&#x0D; &#x0D; To find the proportion of thyroid dysfunction in patients with chronic kidney disease.&#x0D; To study the correlation between thyroid dysfunction and severity of renal diseases.&#x0D; &#x0D; Methodology&#x0D; A single center cross sectional study conducted in Departments of General Medicine and Nephrology in a tertiary care hospital in Calicut, Kerala. In the study period of 12 months, among patients admitted in Medical Ward after applying inclusion and exclusion criteria, 100 patients were included in the study. Patients who fulfilled the criteria for CKD and who are on conservative management and haemodialysis were taken up for the study. Thyroid profile was done in all patients who fulfilled the criteria. The prevalence of thyroid dysfunction in chronic kidney disease was described and analyzed in terms of percentages and averages. One way ANOVA test was used to analyze various parameters like T3, T4, Blood urea and Serum creatinine in relation to various grades of renal failure.&#x0D; Results&#x0D; Low T3 levels were seen in 65% and subclinical hypothyroidism was seen in 17% of the study subjects. Low T4 was seen in only 6% of the study subjects. There was no significant association observed between CKD stages and T3, T4, TSH values categorized as low, high and normal.&#x0D; Conclusion&#x0D; Low T3 syndrome was the commonest abnormality detected. This may be viewed as protective mechanism to conserve protein in chronic kidney disease patients. Subclinical hypothyroidism was the second most common abnormality detected and the number of patients with subclinical hypothyroidism progressively increased with the severity of chronic kidney disease. As subclinical hypothyroidism is associated with increased cardiovascular mortality in CKD patients, adult patients with CKD should be routinely screened for subclinical hypothyroidism and further studies are required concentrating on improving clinical and biochemical criteria to diagnose thyroid dysfunction in CKD.

LOW TRIIODOTHYRONINE (T3) SYNDROME IN ACUTE HEART FAILURE AND ASSOCIATION WITH SHORT-TERM OUTCOME

Introduction: Heart failure (HF) is a clinical syndrome caused by structural and/or functional cardiac abnormality that causes decreased cardiac output and/or elevated intracardiac pressures. The prognosis of cardiac diseases may be negatively impacted by low-T3 states and was independently linked to higher all-cause mortality in hospitalized HF patients. Objectives: The objectives of the study were to find an association between low T3 syndrome and short-term outcome in patients admitted with acute HF. Methods: 176 patients diagnosed as acute HF fulfilling inclusion criteria were enrolled. Serum fT3, fT4, and thyroid-stimulating hormone were measured. Patients were followed up and length of hospital stay, need for inotropes, mechanical ventilation, and intensive care unit (ICU) facility were compared with thyroid function tests. End points were discharge or death. Data were entered into structured pro forma and analyzed. Results: There was a statistically significant association between need for ICU/high dependency unit (HDU) facility care and T3 status (χ2=27.82; p&lt;0.001). There was a statistically significant association between the need for mechanical ventilation with the levels of T3 (χ2=16.14; p&lt;0.001). There is a statistically significant difference in mean T3 among the patients who expired and patients who were discharged (2.31±0.74 vs. 1.71±0.66; p=0.019). Conclusion: Low T3 correlated with a higher rate of ICU/HDU admissions (53.5% vs. 14.7%, p&lt;0.001) and an increased need for invasive mechanical ventilation (35.6% vs. 9.3%, p&lt;0.001). Low T3 syndrome is frequently found in patients with acute HF and is associated with a poor short-term outcome in terms of need for intensive care and mechanical ventilation.

ASSOCIATION OF THYROID HORMONE LEVELS AND CHRONIC KIDNEY DISEASE

Introduction- Normal thyroid hormone metabolism, breakdown, and excretion depend heavily on the kidney. We sought to assess the serum thyroid hormone levels in CKD patients in the current investigation because there is little data on the association between thyroid hormone levels and CKD. Methods- This cross-sectional and time bound study was conducted in department of General Medicine and Nephrology in NIMS&amp;R Hospital, Jaipur for 18 months. Results- Number of patients with low serum T3 levels increased proportionately with decreasing eGFR levels. Serum T4 and TSH levels were not signicantly related to worsening renal function. Conclusion- Low T3 syndrome was the commonest and subclinical hypothyroidism was the second most common thyroid abnormality detected. Hypothyroidism and severity of CKD did not correlate with each other.

Euthyroid Sick Syndrome Is Predictive of Illness Severity in Pediatric Sepsis

Euthyroid Sick Syndrome Is Predictive of Illness Severity in Pediatric Sepsis

A OBSERVATIONAL STUDY OF THYROID DYSFUNCTION IN THE PATIENTS OF CHRONIC KIDNEY DISEASE IN TERTIARY CARE HOSPITAL

Introduction: The pathophysiological processes that make up chronic kidney disease are diverse, and they are all characterised by glomerular ltration rate declines and reduced kidney function. To determine the level of thyroi Aims and objectives: d hormones in CKD patients and to estimate the prevalence of thyroid dysfunction and correlate between thyroid dysfunction with severity of renal disease. This is a Methodology: hospital based cross sectional study conducted in Department of Medicine (Medicine wards, Nephrology unit and OPD) in Tertiary Care Hospital, on 150 patients with or without CKD. Low T3 syndrome, Sub-clinical hypothyroidism and Hypot Results: hyroidism was found in 21.33%, 13.33% and 42.66% cases respectively. High T4 was found in 2.66% patients and high T3 was found in 2.66% patients. Early Conclusion: diagnosis and treatment of these thyroid abnormalities may change the course of the condition and lower the morbidity rate in CKD patients.

Non-thyroidal Illness Syndrome (NTIS) is no independent predictor for mortality in ICU patients

BackgroundLow T3-(/T4-) syndrome, also known as non-thyroidal Illness Syndrome (NTIS) describes a decrease in free serum thyroid hormones without a concomitant increase in TSH, frequently observed in critically ill patients. However, whether NTIS is only a metabolic adaption to stress in critically ill or plays a crucial role as an independent risk factor for ICU mortality, remains unknown. Our study aimed to evaluate NTIS as an independent risk factor for increased ICU mortality.MethodsAll patients admitted to the interdisciplinary intensive care unit (ICU) at the University Hospital of Leipzig between 2008 and 2014 were retrospectively analyzed for thyroidal function. Baseline data, information on additional thyroid function tests, disease progression, hospital and ICU length of stay (LOS) and patient outcome were retrospectively analyzed from the hospitals digital information system. For statistical evaluation, univariate analysis, matched pairs analysis and multivariate logistic regression were conducted.ResultsOne thousand, seven hundred ninety patients were enrolled in the study, of which 665 showed NTIS. Univariate analysis revealed a positive association of NTIS with ICU- and hospital-LOS, need for mechanical ventilation, incidence of sepsis, acute respiratory distress syndrome, acute liver failure and increased ICU mortality. Results of matched pair analysis confirmed these findings. In multivariate logistic regression, NTIS was associated with an increased ICU-LOS, increased duration of mechanical ventilation, acute kidney injury and liver failure, but showed no independent association with increased ICU-mortality.ConclusionDuration of mechanical ventilation as well as incidence of acute kidney injury, sepsis and acute liver failure were detected as independent predictors of mortality in patients with NTIS. NTIS itself was no independent predictor of increased ICU-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.

Biochemical Assessments of Thyroid Profile and Renal Function Test in Chronic Kidney Disease

Introduction: CKD is a clinical syndrome which occurs due to irreversible loss of renal function leading to metabolic, endocrine, excretory and synthetic function resulting in accumulation of non – protein nitrogenous substances which leads to metabolic derangements and ends up with distinct clinical manifestations. Aim: To study thyroid function abnormalities in patients with chronic kidney disease. To correlate the thyroid function abnormalities with severity of renal failure. To differentiate primary hypothyroidism from thyroid dysfunction due to chronic kidney disease. Methodology: After selection of patients, fulfilling the above criteria, about 5 ml of blood sample is collected in non-heparinised serum bottle and sent for thyroid profile test. Components of thyroid profile included in our study and Quantitative determination of T3, T4 and TSH is done by Enzyme Linked Immunosorbent Assay. Result: In our study out of 50 patients, 33 patients had low serum T3 levels . 4 patients among low serum T3 value, they also had low T4 and high TSH suggesting primary hypothyroidism. So excluding 4 patients of hypothyroidism 29 patients had low T3 syndrome in our study. Low T4 levels in our study, out of which 4 patients had low T3 and high TSH suggesting primary hypothyroidism. Conclusion: In my study population, 50 CKD patients who were on conservative management were studied. Among them 66% of the patients had low T3 values. The change in the serum levels of T3 and T4 in patients with CKD can be considered as being protective, promoting conservation of protein. There is increase in incidence of hypothyroidism in patients with chronic kidney disease.

From the Thyroid to the Heart

The pathogenesis of human disease is commonly considered to be unique to each organ or system. This has led to specialization in medical practice leaving little space for global pathogenesis concepts. In this review we have departed from a biochemical concept of coenzyme Q10 (CoQ10) deficiency and its relation to the initiation of hypoxia response in a systemic way. Several conditions of secondary CoQ10 deficiency are known in the literature by which the organs involved could be affected by hypoxia and switch to glycolytic metabolism. The most salient biomarkers of this situation are the low T3 syndrome and the elevation of IL-6. These parameters together with CoQ10 deficiency delineate a condition of acquired mitochondrial dysfunction. Additional related biochemical deficiency conditions affect magnesium, selenium, and iron levels. Visualization of glycolysis can be clearly achieved by diagnostic imaging methods based on the use of 18F-fluoro-deoxyglucose (18F-FDG). We present several examples of diagnostic imaging with 18F-FDG to demonstrate our model of acquired mitochondrial dysfunction and disease.

Thyroid Abnormalities in Children with Sepsis

Introduction: Sepsis is the most common cause of mortality in infants and children. A hormonal disorder that often affected in sepsis is thyroid hormones which occur in the form of euthyroid sick syndrome (ESS) or nonthyroidal illness syndrome (NTIS). The aim of study was to evaluate thyroid hormones changes and the outcome in children with sepsis. Materials and Methods: Present study is hospital based observational cohort study.70 children with diagnosed sepsis were required in sample size. Serum free T3, free T4 and TSH was measured on day one and also on follow up (7th day). Result: on day one Serum FT3 level was low in 40 (57.2%) subjects and Serum FT4 level was low in 12 (17.2%) subjects. TSH was normal in most 66 (94.2%) of subjects. Mortality was more in children with low serum FT3 (22.5%) as compared to those with normal FT3 (3.4%). Mortality was also more in children with low serum FT4 level (41.6%) as compared to those with normal FT4 level (8.7%), (p=0.002). Mortality was more in children with low serum FT3 (29%) on follow up as compared to those with normal FT3 (2.5%) (p=0.001). Conclusion: Thyroid hormones dysfunctions are common in children with sepsis. Mortality is significantly associated with low levels of serum FT3 &amp; FT4. So Thyroid hormones dysfunctions could be an indicator of disease severity with possible need for hormone supplementation. Keywords: Thyroid hormones, Serum free T3, free T4, TSH, sepsis, children

The impact of low T3 syndrome on the prognosis of patients with newly diagnosed multiple myeloma

Objective: This study aimed to examine the relationship between low T3 syndrome (LT3S) and the prognosis of newly diagnosed multiple myeloma (NDMM) patients. Methods: A retrospective examination of 211 NDMM patients treated at the Department of Hematology, Jiangsu Provincial People's Hospital from July 2009 to December 2020 was performed, and all patients received thyroid function testing to determine if they had LT3S. We investigated the relationship between LT3S and clinical features, as well as its impact on MM prognosis. Results: Of the 211 patients, 119 were males, and 92 were females, with a median age of 60 (33-86) years. Patients with LT3S had significantly higher levels of β(2)-microglobulin, C-reactive protein, and blood creatinine compared to those with normal T3 levels. They also had lower levels of hemoglobin, platelets, and serum albumin, as well as more advanced ISS stages (P<0.001) . Patients with LT3S had shorter progression-free survival (PFS) (16 months vs 30 months, P=0.003) and overall survival (OS) (57 months vs 75 months, P=0.004) than patients without LT3S. LT3S was found to be a standalone unfavorable factor in multivariate analysis, LT3S was an independent unfavorable factor in predicting both PFS (HR=2.114, 95% CI 1.271-3.516, P=0.004) and OS (HR=2.231, 95% CI 1.088-4.577, P=0.029) . Conclusions: Low T3 syndrome was an independent unfavorable prognostic predictor for NDMM.

The Spectrum of Thyroid Function Tests and Autoantibodies During Hospitalization and After Six Months of Discharge in COVID-19 Patients: Does COVID-19 Trigger Autoimmunity?

ABSTRACT Objective The aim of the study was to investigate thyroid function test (TFT) results and anti-thyroid antibody titers in acutely infected COVID-19 patients, as well as the changes in TFT and autoantibody results during the 6-months recovery period among survivors. Patients and Design A total of 163 adult COVID-19 patients and 124 COVID-19 survivors were evaluated in terms of TFT (thyroid stimulating hormone [TSH], free triiodothyronine [fT3], and free thyroxine [fT4]) and anti-thyroid antibodies (anti-thyroglobulin [anti-Tg] and anti-thyroid peroxidase [anti-TPO]). Results Thyroid dysfunction was noted in 56.4% of patients on admission, including the non-thyroidal illness syndrome (NTIS) in most cases. Presence vs. absence of thyroid dysfunction on admission was associated with significantly higher rate of severe disease (p < 0.001), while severe vs. mild-to-moderate disease was associated with significantly lower serum fT3 levels (p = 0.001). Overall, 94.4% of survivors were euthyroid at the time of 6 months post-discharge, while in some patients, the post-COVID-19 recovery period was also associated with significantly increased anti-TPO titers and the presence of new-onset or persistent subclinical hypothyroidism. Conclusion This is one of the few studies to evaluate TFT and autoantibodies over a 6-month period after recovery from COVID-19. The presence of emergent or persistent subclinical hypothyroidism and the significantly increased anti-TPO titers in some patients during the convalescence period suggest the need for follow-up for development of thyroid dysfunction and autoimmunity among COVID-19 survivors.