Time course of changes in free thyroid indices, rT3, TSH, cortisol and ACTH following exposure to sulfur mustard

In order to evaluate the time course of changes in serum concentration of thyroid hormones, cortisol and ACTH in patients exposed to chemical weapons containing sulfur mustard, we measured serum concentrations of hormones on the first, third and fifth week following injury in 13 soldiers and compared them to the results obtained from 34 control men. Free T4 and T3 indices were decreased and rT3, cortisol and ACTH were increased in the first week following exposure. There was a subnormal TSH response to TRH in 2 of 3 men tested. Except for an increase in FT4I and a decrease in TSH by the third week, and a steady decline in serum cortisol, serum hormone concentrations were unchanged until the fifth week after injury. The decline in serum cortisol occurred despite a constant increase in serum ACTH. By the fifth week only 1 of 13 men had serum cortisol levels > 10 micrograms/dl. We conclude that exposure to chemical weapons containing sulfur mustard results in alterations in serum concentrations of thyroid and adrenal hormones and ACTH, resembling changes seen in burn trauma. Some evidence of direct effects of mustard on endocrine glands exist.