[The thyroid function in children with purulent meningitis]

Purulent meningitis (BM) is a complex process and its outcome is largely influenced by host's response, both inflammatory or endocrine, to the infection. In this study thyroid function in children with BM was investigated by measuring serum or plasma levels of thyroid-stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (FT3), thyroxine (T4) and free thyroxine (FT4) 3 times in course of the disease: at admission, after 24-48 hrs. of treatment and at recovery (day 10-14 from the onset of the disease). The levels of hormones were measured by radioimmunoassay (RIA) or by enzyme linked fluorescent assay (ELFA). A decrease in serum or plasma concentrations of all measured hormones was found at the beginning of BM as compared to the controls. This indicates the low T4 variant of sick euthyroid syndrome in children with BM, which usually occurs in seriously ill patients. The levels of measured hormones rose at recovery in comparison to their initial values, but T3 concentrations and TSH (TSH - measured by RIA) were still lower in comparison to the controls. Serum T3 concentrations were significantly lower in children with sequelae of BM than in children who recovered without sequelae. This indicates a possible adverse effect of disturbed thyroid function resulting in low-T3 syndrome on the outcome from BM. An adjunctive anti-inflammatory treatment with dexamethasone started 10-15 minutes before the first antibiotic dose and, given every 12 hrs in a dose of 0.4 mg/kg for 2 days, it resulted in greater decrease in T3, FT3, T4 and FT4 plasma levels in comparison to non-steroid treated children.