Thyroid function in critically ill patients

Summary 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 s...

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Bibliographic Details
Published in:The lancet. Diabetes & endocrinology 2015-10, Vol.3 (10), p.816-825
Main Authors: Fliers, Eric, Prof, Bianco, Antonio C, Prof, Langouche, Lies, PhD, Boelen, Anita, Dr
Format: Article
Language:English
Subjects:
Critical Illness
Endocrinology & Metabolism
Euthyroid Sick Syndromes - metabolism
Humans
Hypothalamo-Hypophyseal System - metabolism
Other
Thyroid Gland - metabolism
Thyrotropin - metabolism
Thyrotropin-Releasing Hormone - metabolism
Thyroxine - metabolism
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Summary:Summary 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.
ISSN:2213-8587
2213-8595
DOI:10.1016/S2213-8587(15)00225-9