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Pituitary-thyroid axis in critical illness.

J Faber, C Kirkegaard, B Rasmussen

    The Journal of Clinical Endocrinology and Metabolism
    |August 1, 1987
    PubMed
    Summary
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    Severe nonthyroidal illness does not cause secondary hypothyroidism. However, dopamine treatment in critically ill patients can induce reduced free thyroxine and TSH levels, suggesting hypothyroidism.

    Area of Science:

    • Endocrinology
    • Critical Care Medicine
    • Thyroidology

    Background:

    • The concept of secondary hypothyroidism induced by severe nonthyroidal illness is debated.
    • Accurate assessment of thyroid function in critically ill patients requires sensitive assays.

    Purpose of the Study:

    • To reevaluate the claim that severe nonthyroidal illness causes secondary hypothyroidism.
    • To investigate the effect of dopamine on pituitary-thyroid function in critically ill patients.

    Main Methods:

    • Measured serum free thyroxine (fT4) and free triiodothyronine (fT3) using ultrafiltration.
    • Measured serum thyroid-stimulating hormone (TSH) using an ultrasensitive technique (detection limit 0.05 mU/L).
    • Studied 45 critically ill patients with conditions including hepatic coma, cancer, stroke, and respiratory insufficiency, with and without dopamine treatment.

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    Main Results:

    • Patients without dopamine generally exhibited normal serum fT4, fT3, TSH levels, and TSH responses to thyrotropin-releasing hormone (TRH).
    • Dopamine-treated patients showed significantly reduced serum fT4 and TSH levels, and blunted TSH responses to TRH compared to controls.
    • A minority of patients (3/34 for fT4, 1/34 for fT3) had subnormal thyroid hormone levels; 2/34 had undetectable TSH.

    Conclusions:

    • Critically ill patients with nonthyroidal illness not receiving dopamine maintain normal pituitary-thyroid function.
    • Dopamine administration in critically ill patients is associated with a degree of secondary hypothyroidism.
    • This study clarifies the role of dopamine, rather than nonthyroidal illness itself, in thyroid dysfunction in critical illness.