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[The quantitative analysis of thyroid hormones and thyrotropin in children critically ill with septicemia]
F Mendoza-Morfín1, M R Vaca-Arellano, A D Toledo-Villalpando
1Departamento de Endocrinología Pediátrica, Hospital General, Centro Médico La Raza, México, D.F.
Insights
In septicemic children, thyroid hormone levels (T3, T4) significantly decreased while reverse T3 (T3r) and TSH increased. These changes normalized in survivors, indicating a homeostatic response to conserve energy.
Area of Science:
- Endocrinology
- Pediatric Critical Care
Background:
- Sepsis can profoundly affect endocrine function, particularly the hypothalamic-pituitary-thyroid axis.
- Understanding these alterations is crucial for managing critically ill children.
Purpose of the Study:
- To investigate the functional changes in the hypothalamus, hypophysis, and thyroid glands during sepsis in children.
- To quantify key thyroid hormones and thyrotropin levels in septicemic versus healthy children.
Main Methods:
- Studied 23 critically-ill septicemic children and 15 healthy controls.
- Quantified serum levels of 3,3',5-triiodothyronine (T3), 3,3',5'-triiodothyronine (T3r), thyroxine (T4), and thyrotropin (TSH).
Main Results:
- Septicemic children exhibited significantly lower T3 and T4 levels (P < 0.001).
- A significant increase in T3r and TSH was observed in septicemic children compared to controls (P < 0.001).
- In 18 surviving children, these hormonal levels normalized upon recovery.
Conclusions:
- Sepsis in children induces significant alterations in thyroid hormone metabolism, characterized by decreased T3/T4 and increased T3r/TSH.
- These biochemical changes represent a homeostatic mechanism for energy conservation during critical illness.
- Thyroid function recovery is associated with recuperation from sepsis in pediatric patients.
Abstract:
The function of the hypothalamus, hypophysis, and thyroid glands was studied in 23 critically-ill septicemic children and 15 other healthy children used as controls. A comparison in the quantification of 3,3'5-triiodothyronine (T3), 3,3',5'triiodothyronine (T3r), thyroxine (T4) and thyrotropin (TSH) from those in the control group with the initial values from the patients showed a notable decrease of T3 and T4 and a rise in T3r and TSH in the septicemic children, with a statistical significant difference (P less than 0.001). These biochemical changes which translate into a homeostatic command to avoid catabolism through the conservation of energy, spontaneously returned to normal in 18 of the surviving septicemic children once they recuperated.