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Non-thyroidal Illness in Children with Congestive Heart Failure

Biswajit Sahoo1, Aashima Dabas1, Binita Goswami2

  • 1Maulana Azad Medical College and Lok Nayak Hospital, Clinic of Pediatrics, New Delhi, India

Journal of Clinical Research in Pediatric Endocrinology
|February 13, 2024
PubMed

Insights

Non-thyroidal illness (NTI) affects nearly half of children with congenital heart disease (CHD) and congestive heart failure (CHF). Low fT3 levels are linked to NTI severity and increased mortality risk in these pediatric patients.

Area of Science:

  • Pediatric Endocrinology
  • Pediatric Cardiology
  • Critical Care Medicine

Background:

  • Congenital heart disease (CHD) and congestive heart failure (CHF) are significant health concerns in pediatric populations.
  • Non-thyroidal illness (NTI) is a complex endocrine-dysfunction syndrome observed in critically ill patients.
  • Understanding NTI prevalence and its impact in pediatric CHD with CHF is crucial for risk stratification and management.

Purpose of the Study:

  • To determine the proportion of children with CHD and CHF who experience NTI.
  • To identify risk factors associated with NTI in this vulnerable pediatric cohort.
  • To investigate the relationship between NTI, disease severity, and mortality.

Main Methods:

  • Prospective enrollment of 80 children (6 weeks to 60 months) with CHD and CHF.
  • Assessment of clinical profiles, disease severity using Pediatric Early Warning Score (PEWS).
  • Measurement of thyroid hormones (fT3, fT4, TSH, reverse T3) and NT-pro-BNP at hospitalization.

Main Results:

  • NTI was diagnosed in 46% of enrolled children, with low fT3 levels in 27%.
  • NTI prevalence was significantly higher in children with severe CHD and CHF (p=0.018).
  • NTI was associated with a substantially increased mortality risk (OR: 7.593, p=0.006); PEWS predicted mortality independently.

Conclusions:

  • NTI is prevalent in children with CHD and CHF, correlating with disease severity.
  • Low fT3 levels are significantly associated with NT-pro-BNP, indicating CHF severity.
  • NTI is an independent predictor of mortality in pediatric patients with CHD and CHF.
Abstract

Keywords:
Non-thyroidal illnessfree T3reverse T3NT pro-BNPPediatric Early Warning Score

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