Format

Send to

Choose Destination
Lancet Diabetes Endocrinol. 2015 Oct;3(10):816-25. doi: 10.1016/S2213-8587(15)00225-9. Epub 2015 Jun 10.

Thyroid function in critically ill patients.

Author information

1
Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, AZ, Amsterdam, Netherlands.
2
Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA.
3
Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University of Leuven, Leuven, Belgium.
4
Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, AZ, Amsterdam, Netherlands. Electronic address: a.boelen@amc.uva.nl.

Abstract

Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and macronutrient restriction, which might be beneficial. Pathogenesis of NTIS in long-term critical illness is more complex and includes suppression of hypothalamic thyrotropin-releasing hormone, accounting for persistently reduced secretion of thyroid-stimulating hormone despite low plasma thyroid hormone. In some cases distinguishing between NTIS and severe hypothyroidism, which is a rare primary cause for admission to the ICU, can be difficult. Infusion of hypothalamic-releasing factors can reactivate the thyroid axis in patients with NTIS, inducing an anabolic response. Whether this approach has a clinical benefit in terms of outcome is unknown. In this Series paper, we discuss diagnostic aspects, pathogenesis, and implications of NTIS as well as its distinction from severe, primary thyroid disorders in patients in the ICU.

PMID:
26071885
PMCID:
PMC4979220
DOI:
10.1016/S2213-8587(15)00225-9
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center