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[Study of thyroid function parameters and thyrotropin in general non-thyroid diseases].

J M Gómez, N Virgili, M A Navarro

    Medicina Clinica
    |January 14, 1989
    PubMed
    Summary

    General non-thyroidal illness (GNTD) significantly alters thyroid function tests, often causing low triiodothyronine (T3) and thyroxine (T4) levels. These thyroid hormone changes normalize upon recovery from the acute illness.

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    Area of Science:

    • Endocrinology
    • Internal Medicine
    • Clinical Biochemistry

    Background:

    • General non-thyroidal illness (GNTD) can profoundly affect thyroid hormone levels.
    • Understanding these alterations is crucial for accurate diagnosis and management of critically ill patients.
    • Previous studies have shown variable changes in thyroid function tests during acute illness.

    Purpose of the Study:

    • To evaluate changes in thyroid function parameters and thyrotropin (TSH) in patients with GNTD.
    • To compare thyroid function changes across different GNTD conditions: infection, myocardial infarction, and metabolic derangements.
    • To assess the reversibility of these thyroid function changes after recovery.

    Main Methods:

    • Radioimmunoassay (RIA) and immunoradiometric analysis (IRMA) were used to measure thyroxine (T4), triiodothyronine (T3), and reverse T3 (rT3).

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  • Free T4 and TBC index were also assessed using specific assays.
  • Thyroid function was evaluated at the onset of GNTD and after patient recovery.

    • Main Results:

    • Significant alterations in thyroid hormones were observed across all GNTD groups, normalizing post-recovery.
    • The most pronounced changes occurred in diabetic ketoacidosis, followed by hyperosmolar decompensation and protein-calorie undernutrition.
    • Low T3 levels were most common (57.3%), followed by decreased T4 and TBC index (26.8%). Elevated rT3 was noted in 39% of cases.
    • Thyroid-stimulating hormone (TSH) levels were mostly normal or borderline, with suppression in only one patient.

    Conclusions:

    • GNTD induces substantial and characteristic changes in thyroid functional parameters.
    • These changes include reductions in T3 and T4, and an increase in rT3, which are reversible upon recovery.
    • TSH levels are generally preserved, indicating a non-pituitary origin for these alterations in most GNTD cases.