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Related Experiment Videos

Thyrotropin concentration predicts outcome in critical illness

P M Rothwell1, Z F Udwadia, P G Lawler

  • 1Intensive Care Unit, South Cleveland Hospital, Middlesbrough.

Anaesthesia
|May 1, 1993
PubMed
Summary

Abnormal thyrotropin levels in critically ill patients are common and indicate prognosis. Subnormal or elevated thyrotropin (thyroid-stimulating hormone) concentrations significantly impact patient outcomes, highlighting the need for reassessment of thyroid status in critical illness.

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Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Internal Medicine

Background:

  • Thyroid dysfunction is frequently observed in critically ill patients.
  • The assumption of euthyroidism in critical illness may not always hold true.
  • Thyrotropin levels can be altered during severe illness.

Purpose of the Study:

  • To investigate the prevalence and prognostic significance of abnormal thyrotropin concentrations in critically ill patients.
  • To assess the correlation between thyrotropin, thyroxine, and cortisol levels.
  • To evaluate the dynamic changes in thyrotropin during recovery.

Main Methods:

  • Measurement of thyrotropin, total thyroxine, total tri-iodothyronine, and cortisol in 200 intensive care unit patients not receiving dopamine.

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  • Analysis of mortality rates in subgroups with subnormal or elevated thyrotropin.
  • Correlation analysis between hormone levels.
  • Repeat measurements in a subset of patients upon recovery.

    • Main Results:

    • 12% of patients had subnormal thyrotropin (< 0.4 mU.l-1) and 13% had elevated thyrotropin (> 5.0 mU.l-1).
    • Mortality was significantly higher in the subnormal thyrotropin group (88%) compared to the elevated group (4%), despite similar APACHE II predictions.
    • Thyrotropin correlated positively with total thyroxine and negatively with cortisol.
    • In 13 of 15 patients with elevated thyrotropin on admission, levels normalized upon recovery.

    Conclusions:

    • Abnormal thyrotropin concentrations are frequent in critically ill patients.
    • Admission thyrotropin levels possess significant prognostic value.
    • These findings challenge the assumption of euthyroidism in critical illness and suggest routine thyroid function monitoring is warranted.