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Reduced tissue thyroid hormone levels in fatal illness

R Arem1, G J Wiener, S G Kaplan

  • 1Division of Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030.

Metabolism: Clinical and Experimental
|September 1, 1993
PubMed
Summary

Severe nonthyroidal illnesses (NTIs) significantly reduce thyroid hormones like triiodothyronine (T3) and thyroxine (T4) in many body tissues, not just serum. This widespread tissue deficiency suggests a systemic impact of critical illness on thyroid hormone availability.

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pathophysiology

Background:

  • Severe nonthyroidal illnesses (NTIs) are often associated with altered thyroid hormone levels.
  • Reduced serum triiodothyronine (T3) and thyroxine (T4) are common in NTIs, but tissue-specific changes are less understood.
  • Distinguishing NTI-related hormone changes from primary hypothyroidism is clinically important.

Purpose of the Study:

  • To investigate whether tissue concentrations of T3 and T4 are reduced in patients with severe NTIs.
  • To compare thyroid hormone levels in various organs between NTI patients and healthy controls.
  • To determine the organ-specific distribution of thyroid hormone deficiency in critical illness.

Main Methods:

  • Autopsy tissue samples were analyzed from 12 patients who died from severe NTIs.

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  • Control group consisted of 10 individuals who died suddenly from trauma.
  • Serum and tissue concentrations of T3, T4, free T4 index, and thyrotropin (TSH) were measured.

    • Main Results:

    • NTI patients showed significantly lower serum T3 (79%), T4 (71%), and free T4 index (49%) compared to controls.
    • Tissue T3 levels were reduced in cerebral cortex, hypothalamus, pituitary, liver, kidney, and lung (43-76%) in NTI patients.
    • Tissue T4 levels were significantly lower in the liver (66%) but not significantly different in the cerebral cortex; heart and skeletal muscle T3/T4 did not differ significantly.

    Conclusions:

    • Severe NTIs lead to widespread deficiency of thyroid hormones in multiple tissues.
    • The degree of thyroid hormone reduction varies significantly across different organs.
    • These findings highlight the systemic impact of critical illness on thyroid hormone homeostasis.