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Prospective study on thyroid function anomalies in severely ill patients.

N Custro1, V Scafidi, G Costanzo

  • 1Cattedra di Patologia Medica, Istituto di Medicina Interna e Geriatria, Università degli Studi di Palermo.

Annali Italiani Di Medicina Interna : Organo Ufficiale Della Societa Italiana Di Medicina Interna
|January 1, 1992
PubMed
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Severe non-thyroidal illness (NTI) can cause thyroid function anomalies. Low triiodothyronine (T3) levels in NTI patients indicate a poor prognosis and higher mortality risk.

Area of Science:

  • Endocrinology
  • Internal Medicine
  • Critical Care Medicine

Background:

  • Patients with severe non-thyroidal illness (NTI) frequently exhibit altered thyroid function (TF).
  • Understanding these TF changes is crucial for assessing disease severity and prognosis.

Purpose of the Study:

  • To monitor thyroid function changes in patients with severe NTI.
  • To investigate the relationship between TF anomalies and patient outcomes, including mortality.

Main Methods:

  • A cohort of 45 patients with severe NTI (liver cirrhosis, renal failure, malignancy) was studied.
  • Thyroid function tests, including TSH, T3, and rT3, were assessed upon admission and during the study period.
  • Patient outcomes, including mortality, were tracked.

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Main Results:

  • 28 patients presented with decreased triiodothyronine (T3) and increased reverse triiodothyronine (rT3).
  • Of those with low T3, 53.5% experienced a decline in thyroxine (T4) levels, often preceding death.
  • The 'low T3 and low T4 syndrome' may be linked to decreased TSH due to feedback mechanism failure.
  • Mortality was 89% in patients with initial T3 levels below 0.40 nmol/L.

Conclusions:

  • Initial low T3 levels in NTI patients are a significant indicator of poor prognosis.
  • Thyroid function monitoring in severe NTI can provide valuable prognostic information.