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The Role of Thyroid Hormones in the Differential Diagnosis of Tuberculous and Parapneumonic Pleural Effusions. Am J Med Sci 2021; 363:495-501. [PMID: 34843677 DOI: 10.1016/j.amjms.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/07/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The differential diagnosis of tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE) is challenging due to similar clinical manifestations and body fluid biochemical profiles. Thyroid hormone levels change in response to lymphocyte proliferation in the peripheral blood of patients with mycobacterial infections such as tuberculosis; therefore, this study aimed to investigate the utility of assessing thyroid hormone levels to aid in the differential diagnosis of TPE and PPE. METHODS We measured free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels in the pleural effusions of 59 newly admitted patients (32 and 27 with TPE and PPE, respectively). Hormone levels were assessed using an electrochemiluminescence technique, and the diagnostic parameters for tuberculosis were evaluated. Differences in hormone levels between patients with TPE and PPE were assessed by t-tests, and their diagnostic value for a differential diagnosis was evaluated by receiver operating characteristic curve analyses. RESULTS FT3 and FT4 levels in patients with TPE were significantly higher than those in patients with PPE (p < 0.01 and p < 0.05, respectively), whereas TSH expression did not significantly differ between the two groups (p > 0.05). FT3 and FT4 levels showed no correlation with sex or history of smoking, although FT3 levels decreased with age. The highest sensitivity was observed for the quantification of FT3 levels (84.38%). CONCLUSIONS Increased FT3 and FT4 levels could potentially be used for the differential diagnosis of TPE and PPE.
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Lado-Abeal J, Diaz C, Berdine G, Iwuji K, Araujo-Vilar D, Lampon-Fernandez N, Wang M, Lojo S, Rodriguez-Perez A, Rivas AM. High prevalence of non-thyroidal illness syndrome in patients at long-term care facilities. Endocrine 2020; 70:348-355. [PMID: 32346815 DOI: 10.1007/s12020-020-02321-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients in acute care hospitals are often transferred to long-term care (LTC) when there is an expectation for a lengthy recovery. Prolonged non-thyroidal illness syndrome (NTIS) creates a state of hypothyroidism. We aimed to investigate the prevalence of NTIS in patients at LTC facilities. METHODS A cross-sectional study at University Hospitals and Rehabilitation and Skilled Nursing facility was performed. Four groups: control (n:33), intensive care unit (ICU) (n:34), long-term care hospital (LTCH) (n:50), and long-term care on chronic ventilatory support (LTCVS) (n:30). Serum levels of TSH, free T4 (FT4), free T3 (FT3), and interleukin 6 (IL6) measured at admission day in controls, within 48 h of admission in the intensive care group, between days 31 and 120 in the LTC hospital group and days 31 and 6 years in the LTC on chronic ventilatory support group. RESULTS Serum FT3 levels were lower in groups intensive care unit ICU, LTCH, and LTCVS than control. Low serum FT3 levels were observed in 80% ICU, 54% LTCH, 37% LTCVS, and 6% control patients. Low serum FT4 levels were observed in 32% ICU, 16% LTCH, and 20% LTCVS patients. Both low serum FT4 and FT3 levels were observed in 32% ICU, 16% LTCH, and 13% LTCVS patients. Serum IL6 and FT3 levels showed a negative correlation. CONCLUSIONS NTIS is highly prevalent in patients in LTC, creating a state of persistent hypothyroidism. The effects of thyroid hormone replacement in patients at LTC with non-thyroidal illness deserve further investigation.
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Affiliation(s)
- Joaquin Lado-Abeal
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Truman Medical Centers and University of Missouri Kansas City, Kansas City, MO, USA.
| | - Carmen Diaz
- Division of Endocrinology and Nutrition, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Gilbert Berdine
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Iwuji
- Department of Internal Medicine, Division of General Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - David Araujo-Vilar
- Division of Endocrinology and Nutrition, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
- Thyroid and Metabolic Diseases Unit (UETeM), Department of Psychiatry, Radiology, Public Health, Nursing and Medicine (Medicine Area), Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS)-IDIS, University of Santiago de Compostela School of Medicine, Santiago de Compostela, Spain
| | - Natalia Lampon-Fernandez
- Division of Clinical Analysis, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Min Wang
- Department of Management Science and Statistics, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Santiago Lojo
- Division of Clinical Analysis, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Alfonso Rodriguez-Perez
- Division of Anaesthesia and Reanimation, Complexo Hospitalario Universitario de Santiago (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Ana Marcella Rivas
- Department of Internal Medicine, Division of Endocrinology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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de Oliveira Custódio JM, Enokida IM, Gonçalves DA, Leone de Oliveira SMDV, Venturini J, Carvalho LR, Mendes RP, Paniago AMM. Dynamics of plasma micronutrient concentrations and their correlation with serum proteins and thyroid hormones in patients with paracoccidioidomycosis. PLoS One 2019; 14:e0226609. [PMID: 31877169 PMCID: PMC6932777 DOI: 10.1371/journal.pone.0226609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/01/2019] [Indexed: 01/08/2023] Open
Abstract
Minerals, such as zinc, copper, and iron are reported to play roles in chronic infectious diseases; however, their role in paracoccidioidomycosis (PCM) remains unknown. This study aimed to examine the micronutrient dynamics and their correlation with serum proteins and thyroid hormones in patients with PCM. In 14 patients with PCM and 10 healthy subjects, we evaluated the body mass index (BMI) along with serum levels of hemoglobin, iron, ferritin, zinc, copper, magnesium, albumin, globulin, thyroid stimulating hormone (TSH), thyroxine (free T4), and triiodothyronine (T3). Evaluations were conducted at the first appointment, before treatment, and at the end of the first, second, fourth, and sixth month of PCM treatment. The control group was only evaluated once. We observed that before treatment, patients with PCM, had higher levels of copper and lower level of iron than those of the control group. After one month of treatment, the iron levels increased, whereas the levels of copper after six months of treatment. Reduction in inflammatory activity, indicated by the normalization of C-reactive protein, ferritin, albumin, and globulin levels, was observed during treatment. However, no correlation was observed between the serum levels of minerals and inflammatory activity or thyroid function in this study. In conclusion, our results showed higher serum copper levels in control group compared to those in pretreatment patients; the clinical importance of this observation should be investigated in further studies. After treatment, serum copper levels showed a tendency to decrease. In addition, serum iron levels were decreased at the stage of active disease, and were increased after treatment. Thus, serum iron levels can be used as a better biomarker for treatment control.
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Affiliation(s)
| | - Iasmim Mayumi Enokida
- Scientific initiation CNPq, Faculty of Medicine - FAMED, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Daniel Araujo Gonçalves
- Department of Chemistry, Minas Gerais State University - UEMG, Ituiutaba, Minas Gerais, Brazil
| | - Sandra Maria do Valle Leone de Oliveira
- Faculty of Medicine- FAMED, Center for Biological and Health Sciences- CCBS, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Campo Grande, Brazil
| | - James Venturini
- Faculty of Medicine- FAMED, Center for Biological and Health Sciences- CCBS, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Campo Grande, Brazil
| | - Lidia Raquel Carvalho
- Department of Biostatistics, Institute of Biosciences, State University Paulista "Júlio de Mesquita Filho" -UNESP, Botucatu, São Paulo Brazil
| | - Rinaldo Poncio Mendes
- Department of Tropical Diseases, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Faculty of Medicine- FAMED, Center for Biological and Health Sciences- CCBS, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Campo Grande, Brazil
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Abstract
OBJECTIVE The aim of this study was to determine the prevalence and type of thyroid hormone levels alterations in patients with acute pancreatitis (AP) and analyze if variations are useful AP progression predictors. METHODS Three groups of patients were analyzed: AP patients (n = 90), abdominal pain patients (n = 30), and healthy control subjects (n = 40). Usual blood parameters for AP diagnosis and prognosis, thyroid-stimulating hormone (or thyrotropin), FT4 (free thyroxine), FT3 (free triiodothyronine), and TT3 (total triiodothyronine) levels were analyzed. RESULTS Thyroid hormone level alterations were detected only within the AP group (41% of total cases), being the reduction in T3 levels the most frequently detected deviation (15.6% of FT3 and 8.3% of TT3 cases). Alterations were not influenced by age or sex. Free thyroxine average values were also significantly higher in the AP group, compared with the healthy control group (P = 0.0005), resulting as independent predictors of both severity and mortality. Mortality in this group was 50%, with deceased patients showing FT4 levels above the reference limit. CONCLUSIONS Our results show that FT4 level determination during the initial clinical evaluation of patients admitted to the emergency service with AP can be included as a severity indicator to help determine the differential care of these cases.
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Kleynhans L, Ruzive S, Ehlers L, Thiart L, Chegou NN, Conradie M, Kriel M, Stanley K, van der Spuy GD, Kidd M, van Helden PD, Walzl G, Ronacher K. Changes in Host Immune-Endocrine Relationships during Tuberculosis Treatment in Patients with Cured and Failed Treatment Outcomes. Front Immunol 2017; 8:690. [PMID: 28674532 PMCID: PMC5475380 DOI: 10.3389/fimmu.2017.00690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/29/2017] [Indexed: 12/23/2022] Open
Abstract
A bidirectional communication between the immune and endocrine systems exists and facilitates optimum responses in the host during infections. This is in part achieved through changes in secretion patterns of hypothalamic hormones induced by inflammatory cytokines. The aim of this study was to elucidate the immune–endocrine alterations during tuberculosis (TB) treatment in patients with cured and failed TB treatment outcomes. Blood samples were collected from 27 cured and 10 failed patients and hormone as well as cytokine concentrations quantified at baseline, week 4, and month 6 of TB treatment. Hormone profiles of the two treatment outcome groups were different from each other prior to as well as during TB treatment. Treatment response effects were observed for cortisol, estradiol, T3, T4 ghrelin, leptin, amylin, adiponectin, and dehydroepiandrosterone (DHEA). Trends suggest that T4, amylin, and DHEA concentrations were different between treatment outcomes, although these did not reach statistical significance. Relationships between endocrine and inflammatory markers and the biological pathways involved differed between cured and failed treatment patients. These results highlight the complex interaction between the endocrine and immune system during active TB disease and throughout treatment and suggest that endocrine markers in conjunction with inflammatory markers may be useful in predicting unfavorable treatment outcomes.
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Affiliation(s)
- Léanie Kleynhans
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sheena Ruzive
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lizaan Ehlers
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lani Thiart
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Novel N Chegou
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Magda Conradie
- Division of Endocrinology and Metabolism, Faculty of Medicine and Health Sciences, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Magdalena Kriel
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kim Stanley
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gian D van der Spuy
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - Paul D van Helden
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Walzl
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Katharina Ronacher
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,Translational Research Institute, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
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Vinnard C, Blumberg EA. Endocrine and Metabolic Aspects of Tuberculosis. Microbiol Spectr 2017; 5:10.1128/microbiolspec.TNMI7-0035-2016. [PMID: 28233510 PMCID: PMC5785104 DOI: 10.1128/microbiolspec.tnmi7-0035-2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Indexed: 12/26/2022] Open
Abstract
Endocrine and metabolic derangements are infrequent in patients with tuberculosis, but they are important when they occur. The basis for these abnormalities is complex. While Mycobacterium tuberculosis has been described to infect virtually every endocrine gland, the incidence of gland involvement is low, especially in the era of effective antituberculosis therapy. Furthermore, endocrine and metabolic abnormalities do not always reflect direct infection of the gland but may result from physiological response or as a consequence of therapy. Metabolic disease may also predispose patients to the development of active tuberculosis, particularly in the case of diabetes mellitus. While hormonal therapy may be necessary in some instances, frequently these endocrine complications do not require specific interventions other than antituberculous therapy itself. With the exception of diabetes mellitus, which will be covered elsewhere, this chapter reviews the endocrinologic and metabolic issues related to tuberculosis.
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Affiliation(s)
- Christopher Vinnard
- The Public Health Research Institute Center and Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
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Ige OM, Akinlade KS, Rahamon SK, Edem VF, Arinola OG. Thyroid function in multidrug-resistant tuberculosis patients with or without human immunodeficiency virus (HIV) infection before commencement of MDR-TB drug regimen. Afr Health Sci 2016; 16:596-602. [PMID: 27605977 DOI: 10.4314/ahs.v16i2.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mycobacterium tuberculosis and human immunodeficiency virus (HIV) are known to cause abnormal thyroid function. There is little information on whether HIV infection aggravates alteration of thyroid function in patients with MDR-TB. OBJECTIVES This study was carried out to determine if HIV co-infection alters serum levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) in patients with MDR-TB patients and to find out the frequency of subclinical thyroid dysfunction before the commencement of MDR-TB therapy. METHODS This observational and cross-sectional study involved all the newly admitted patients in MDR-TB Referral Centre, University College Hospital, Ibadan, Nigeria between July 2010 and December 2014. Serum levels of thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were determined using ELISA. RESULTS Enrolled were 115 patients with MDR-TB, out of which 22 (19.13%) had MDR-TB/HIV co-infection. Sick euthyroid syndrome (SES), subclinical hypothyroidism and subclinical hyperthyroidism were observed in 5 (4.35%), 9 (7.83%) and 2 (1.74%) patients respectively. The median level of TSH was insignificantly higher while the median levels of T3 and T4 were insignificantly lower in patients with MDR-TB/HIV co-infection compared with patients with MDRT-TB only. CONCLUSION It could be concluded from this study that patients with MDR-TB/HIV co-infection have a similar thyroid function as patients having MDR-TB without HIV infection before commencement of MDR-TB drug regimen. Also, there is a possibility of subclinical thyroid dysfunction in patients with MDR-TB/HIV co-infection even, before the commencement of MDR-TB therapy.
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Affiliation(s)
- Olusoji Mayowa Ige
- Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Kehinde Sola Akinlade
- Deaprtment of Chemical Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Sheu Kadiri Rahamon
- Deaprtment of Chemical Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Victory Fabian Edem
- Deaprtment of Chemical Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Jacobs TQ, Ross A. Adverse effects profile of multidrug-resistant tuberculosis treatment in a South African outpatient clinic. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- TQ Jacobs
- Department of Family Medicine, University of KwaZulu-Natal
| | - A Ross
- Department of Family Medicine, University of KwaZulu-Natal
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Can non-thyroid illness syndrome predict mortality in lung cancer patients? A prospective cohort study. Discov Oncol 2014; 5:240-6. [PMID: 24832769 DOI: 10.1007/s12672-014-0183-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022] Open
Abstract
This study aims to evaluate the incidence of non-thyroid illness syndrome (NTIS) among patients diagnosed as lung cancer and its association with the stage of the disease, Eastern Cooperative Oncology Group (ECOG) performance score, nutritional parameters, and survival. We enrolled 120 patients that 71 of them with newly diagnosed and staged non-small cell lung cancer and 49 of them small-cell lung cancer. The cases were examined for thyroid function tests, ECOG performance score, and nutritional evaluation before treatment. Also, cases were evaluated for their overall survival rates. NTIS was identified in 30 (42 %) of the 71 non-small cell lung cancer patients and 22 (44 %) of the 49 small-cell lung cancer patients. NTIS was more frequent among advanced stage of cases. Serum albumin level, cholesterol level, lymphocyte level, and body mass index were detected to be significantly low and ECOG performance score was significantly high in cases with NTIS when compared to cases without NTIS. NTIS was found to be negatively correlated with body mass index, ECOG performance score, and serum albumin level, and it was positively correlated with disease stage. NTIS was detected significantly as a poor prognostic factor for lung cancer. NTIS was frequently seen in cases with non-small cell lung cancer and small-cell lung cancer. NTIS can be used as a predictor of poor prognosis for lung cancer patients.
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Abstract
GOALS This study was designed to investigate the clinical features of nonthyroidal illness syndrome (NTIS) compared with euthyroid patients in Crohn's disease (CD), to explore the etiology of NTIS in CD, to evaluate the clinical outcomes of NTIS patients, and to inspect the correlation of clinical variables and NTIS, and their ability of differentiating NTIS from euthyroid patients. BACKGROUND NTIS has been described for more than 30 years. However, only few studies focused on the relationship between NTIS and CD. The incidence, underlying pathogenesis, clinical outcomes, and correlation with other inflammatory disease severity and nutritional variables of NTIS in CD have not been completely established. METHODS Prospectively, 44 CD patients were enrolled. Medical records and various laboratory values (including thyroidal, nutritional, and inflammatory variables) were collected in all participants. RESULTS The incidence of NTIS in CD was 36.4%. Albumin, Acute Physiology and Chronic Health Evaluation II score, and Crohn's Disease Activity Index score in NTIS group were statistically different from those in euthyroid group. A decreased sum activity of deiodinases and a reduced ratio of TT4/FT4 were observed in NTIS group. Duration of hospitalization was significantly longer for NTIS patients than euthyroid patients. Albumin was confirmed as a protective factor of NTIS in CD. Receiver operating characteristic curve analysis demonstrated the differentiating capacity of albumin, suggesting 37.6 g/L as optimal cut-off value with sensitivity and specificity of 81.3% and 79.2%, respectively. CONCLUSIONS NTIS was a common complication in CD. NTIS patients showed worse nutrition status and clinical outcome, and more critical disease activity and severity compared with euthyroid patients. A hypodeiodination condition and a potential thyroid-hormone-binding dysfunction may play a role in the etiology of NTIS in CD. Albumin was a meaningful protective and distinguishing marker of NTIS in CD.
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Barca-Mayo O, Liao XH, DiCosmo C, Dumitrescu A, Moreno-Vinasco L, Wade MS, Sammani S, Mirzapoiazova T, Garcia JGN, Refetoff S, Weiss RE. Role of type 2 deiodinase in response to acute lung injury (ALI) in mice. Proc Natl Acad Sci U S A 2011; 108:E1321-9. [PMID: 22065740 PMCID: PMC3241808 DOI: 10.1073/pnas.1109926108] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Thyroid hormone (TH) metabolism, mediated by deiodinase types 1, 2, and 3 (D1, D2, and D3) is profoundly affected by acute illness. We examined the role of TH metabolism during ventilator-induced lung injury (VILI) in mice. Mice exposed to VILI recapitulated the serum TH findings of acute illness, namely a decrease in 3,5,3'-triiodothyronine (T(3)) and thyroid-stimulating hormone and an increase in reverse T(3). Both D2 immunoreactivity and D2 enzymatic activity were increased significantly. D1 and D3 activity did not change. Using D2 knockout (D2KO) mice, we determined whether the increase in D2 was an adaptive response. Although similar changes in serum TH levels were observed in D2KO and WT mice, D2KO mice exhibited greater susceptibility to VILI than WT mice, as evidenced by poorer alveoli integrity and quantified by lung chemokine and cytokine mRNA induction. These data suggest that an increase in lung D2 is protective against VILI. Similar findings of increased inflammatory markers were found in hypothyroid WT mice exposed to VILI compared with euthyroid mice, indicating that the lungs were functionally hypothyroid. Treatment of D2KO mice with T(3) reversed many of the lung chemokine and cytokine profiles seen in response to VILI, demonstrating a role for T(3) in the treatment of lung injury. We conclude that TH metabolism in the lung is linked to the response to inflammatory injury and speculate that D2 exerts its protective effect by making more TH available to the injured lung tissue.
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Affiliation(s)
| | | | | | | | | | - Michael S. Wade
- Department of Medicine, University of Illinois, Chicago, IL 60612
| | - Saad Sammani
- Department of Medicine, University of Illinois, Chicago, IL 60612
| | | | - Joe G. N. Garcia
- Department of Medicine, University of Illinois, Chicago, IL 60612
| | - Samuel Refetoff
- Departments of Medicine and
- Pediatrics, University of Chicago, Chicago, IL 60637; and
| | - Roy E. Weiss
- Departments of Medicine and
- Pediatrics, University of Chicago, Chicago, IL 60637; and
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The spectrum of thyroid disorders in systemic lupus erythematosus. Rheumatol Int 2010; 32:73-8. [PMID: 20658291 DOI: 10.1007/s00296-010-1556-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/11/2010] [Indexed: 10/19/2022]
Abstract
To study the spectrum of thyroid disorders in systemic lupus erythematosus (SLE). Hundred SLE patients as per American Rheumatology Association(ARA) classification criteria underwent clinical examination, including assessment of disease activity (SLEDAI) and laboratory evaluation for serum triiodothyronine (T3),free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroperoxidase (TPO) antibody and antithyroglobulin (TG) antibody. Hundred age- and sex-matched apparently healthy individuals served as control. Thirty-six (36%) lupus patients had thyroid dysfunction when compared to 8 (8%) of controls and all of them were women. Primary hypothyroidism was the commonest dysfunction in 14 (14%), while subclinical hypothyroidism and subclinical hyperthyroidism was seen in 12 (12%) and 2 (2%), respectively. Eight (8%) had isolated low T3 consistent with sick euthyroid syndrome. Eighteen (50%) of thyroid dysfunction were autoimmune in nature (autoantibody positive) and rest 18 (50%) were non-autoimmune. Euthyroid state with the elevation of antibodies alone was seen in 12 (12%) of the lupus patients. In contrast, only 5 (5%) of controls had primary hypothyroidism and 3 (3%) had subclinical hypothyroidism, while none had hyperthyroidism. SLEDAI score and disease duration were compared between lupus patients with thyroid dysfunction to those with normal thyroid function. A statistically significant association was found between SLEDAI and thyroid dysfunction of sick euthyroid type.SLE disease duration had no statistically significant association with thyroid dysfunction. Prevalence of thyroid autoantibodies in lupus patients was 30% when compared to 10% of controls. Ninety-six (96%) of the SLE patients were ANA positive, while 4 (4%) of them were ANA negative but were anti-Sm antibody positive. There were no suggestions of any other autoimmune endocrine diseases like diabetes or Addison's disease (clinically and on baseline investigations) in our lupus cohort and hence no further work up was done for these diseases. Thyroid disorders are frequent in SLE and are multifactorial with a definite higher prevalence of hypothyroidism as well as thyroid autoantibodies.
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Cengiz SE, Cetinkaya E, Altin S, Gunluoglu Z, Demir A, Gunluoglu G, Epozturk K. Nutritional and prognostic significance of sick euthyroid syndrome in non-small cell lung cancer patients. Intern Med 2008; 47:211-6. [PMID: 18277019 DOI: 10.2169/internalmedicine.47.0423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Our study aimed to determine the frequency of sick euthyroid syndrome (SES) among patients diagnosed as non-small cell lung cancer (NSCLC) and its association with the stage of the disease, Karnofsky index (KI), and nutritional parameters. METHODS We enrolled 80 consecutive patients with newly diagnosed NSCLC. Cases with NSCLC were staged by using the TNM system. The cases were examined for thyroid function tests, KI and nutritional evaluation before treatment. Moreover, cases were investigated for their overall survival ratio. RESULTS Out of 80 patients, SES was identified in 28 (35%). SES was more frequent among stage III (26%) and stage IV (62%) cases. The body mass index (BMI), KI and serum albumin level were found to be significantly low in cases with SES when compared to cases without SES. SES was found to be negatively correlated with BMI, KI and serum albumin level, and it was positively correlated with disease stage and weight loss. Additionally, the presence of SES was found as a prognostic factor at survival analysis (p=0.0002). CONCLUSION SES was frequently seen in cases with NSCLC. SES can be used as a predictor of poor prognosis in NSCLC patients.
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Affiliation(s)
- Seyhan Ekrem Cengiz
- Department of Chest Diseases, Yedikule Chest Diseases and Chest Surgery Education and Research Hospital, Istanbul, Turkey.
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Plikat K, Langgartner J, Buettner R, Bollheimer LC, Woenckhaus U, Schölmerich J, Wrede CE. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit. Metabolism 2007; 56:239-44. [PMID: 17224339 DOI: 10.1016/j.metabol.2006.09.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Accepted: 09/18/2006] [Indexed: 11/28/2022]
Abstract
Acute and chronic critical conditions are associated with reduced serum levels of free triiodothyronine (FT(3)), free thyroxine FT(4), and thyrotropin, known as nonthyroidal illness syndrome (NTIS). It is still controversial whether these changes reflect a protective mechanism or a maladaptive process during prolonged illness. However, larger studies to determine the prevalence of the NTIS and its association with outcome in medical intensive care units (ICUs) are missing. Complete thyroid hormone levels from 247 of 743 patients admitted to our ICU between October 2002 and February 2004 were retrospectively evaluated. From these patients, Acute Physiology and Chronic Health II scores, ICU mortality, length of stay, mechanical ventilation, and concomitant medication were recorded. Ninety-seven patients (44.1%) had low FT(3) levels indicating an NTIS, either with normal (23.6%) or reduced (20.5%) serum thyrotropin levels. Of 97 patients with NTIS, 24 (23.3%) also showed reduced serum FT(4) levels. The NTIS was significantly associated with Acute Physiology and Chronic Health II scores, mortality, length of stay, and mechanical ventilation. In a multivariate Cox regression analysis, the combination of low FT(3) and low FT(4) was an independent risk factor for survival. Nonthyroidal illness syndrome is frequent at a medical ICU. A reduction of FT(4) together with FT(3) is associated with an increase in mortality and might reflect a maladaptive process, thereby worsening the disease.
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Affiliation(s)
- Katharina Plikat
- Department of Internal Medicine I, University Hospital of Regensburg, University of Regensburg, 93042 Regensburg, Germany
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Gibson SC, Hartman DA, Schenck JM. The Endocrine Response to Critical Illness: Update and Implications for Emergency Medicine. Emerg Med Clin North Am 2005; 23:909-29, xi. [PMID: 15982552 DOI: 10.1016/j.emc.2005.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review will provide an updated overview of the neuroendocrine response to critical illness. Specifically, the current evidence for "stress steroid" administration will be examined, as well as interventional glucose control during critical illness. The emergency physician will also find relevance in the alterations of thyroid hormones that occur in the face of severe illness or trauma.
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Affiliation(s)
- Scott C Gibson
- MSU-KCMS EM, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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16
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Lee WY, Kang MI, Oh KW, Oh ES, Baek KH, Lee KW, Kim SW, Kim DW, Min WS, Kim CC. Relationship between circulating cytokine levels and thyroid function following bone marrow transplantation. Bone Marrow Transplant 2004; 33:93-8. [PMID: 14704661 DOI: 10.1038/sj.bmt.1704304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The relation between thyroid hormone changes and cytokines in bone marrow transplantation (BMT) patients has not been studied. This prospective study was designed to determine the relation between thyroid hormones and cytokine levels after BMT and their effects on the mortality. We studied 80 patients undergoing allogeneic BMT. Serum thyroid hormone parameters and cytokine levels were measured before and serially during 6 months after BMT. Serum T(3) decreased to a nadir 3 weeks post-BMT and serum T(4) was lowest at 3 months post-BMT. Serum thyroid stimulating hormone (TSH) sharply decreased to a nadir at 1 week and recovered. Serum interleukin-6 increased for 2 weeks after BMT and declined thereafter. Serum tumor necrosis factor-alpha increased for 3 weeks after BMT and declined thereafter. After 3 weeks post-BMT, both cytokine levels were negatively correlated with serum T(3) and T(4) levels. A total of 29 patients died before 1 year post-BMT and 51 patients survived longer than 1 year. Those patients who died before 1 year post-BMT had significantly lower levels of T(4) at 3 weeks, 3 and 6 months than surviving patients. In conclusion, increased levels of serum IL-6 and TNF-alpha were negatively correlated with thyroid hormone concentrations in BMT recipients suggesting the role of these cytokines in euthyroid sick syndrome.
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Affiliation(s)
- W Y Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Endocrine and Metabolic Manifestations of Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Abstract
AIM: To investigate the role of tri-iodothyronine supplement in protecting gut barrier in septic rats.
METHODS: Twenty-two rats were randomized into three groups: sham group (n = 6), sepsis group (n = 8), and sepsis plus tri-iodothyronine (T3) group (n = 8). Septic rat model was established through cecal ligation and puncture (CLP). After 5 h, sham and sepsis groups received saline, and the remaining group received T3 intraperitoneally. Twenty-one hours after CLP, intestinal permeability and serum free T3 and T4 were measured with fluorescence spectrophotometer and by radioimmunoassay, respectively. Intestinal ultrastructure and histologic morphology were observed under transmission electron microscopy (TEM) and light microscopy, respectively.
RESULTS: After 21 h, septic symptoms and signs in sepsis plus T3 group were milder than those in sepsis group. Serum FT3 or FT4 concentration in sepsis group was lower than that in sham group (1.59 ± 0.20, 3.41 ± 2.14 pmol/L vs 3.44 ± 1.40,9.53 ± 3.39 pmol/L, P < 0.05), and FT3 concentration in sepsis plus T3 group (3.40 ± 1.65 pmol/L, P < 0.05) was corrected. Portal concentration of fluorescein isothiocyanate-dextran (FITC-D) in sepsis group (2.51 ± 0.56 mg/L) was higher than that in sham group (1.22 ± 0.21 mg/L) (P < 0.01), and in sepsis plus T3 group (1.68 ± 0.38 mg/L) it was decreased significantly (P < 0.01). TEM and light microscopy showed that T3 supplement preserved well ultrastructure and morphology of intetinal mucosa in septic rats.
CONCLUSION: Tri-iodothyronine supplement protects gut barrier in septic rats.
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Affiliation(s)
- Zhi-Li Yang
- Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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Camacho PM, Dwarkanathan AA. Sick euthyroid syndrome. What to do when thyroid function tests are abnormal in critically ill patients. Postgrad Med 1999; 105:215-9. [PMID: 10223098 DOI: 10.3810/pgm.1999.04.694] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abnormal thyroid hormone concentrations are common in patients with serious nonthyroidal illnesses. Early evidence suggests that thyroid hormone levels may predict the prognosis for some patients. Abnormal thyroid function is usually reversible, but thyroid function tests should be repeated when the nonthyroidal illness is resolved. Whether active intervention using thyroid hormone supplements is beneficial or not remains controversial and requires future large-scale investigation.
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Affiliation(s)
- P M Camacho
- Loyola University Medical Center, Division of Endocrinology and Metabolism, Maywood, IL 60153, USA.
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Affiliation(s)
- L J De Groot
- Thyroid Study Unit, University of Chicago, Illinois 60637, USA
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21
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Abstract
Abnormalities of thyroid hormone concentrations are seen commonly in a wide variety of nonthyroidal illnesses, resulting in low triiodothyronine, total thyroxine, and thyroid stimulating hormone concentrations. These thyroid hormone changes may be mediated in part by cytokines or other inflammatory mediators, acting at the level of the hypothalamus and pituitary, the thyroid gland, and the hepatic deiodinase system, as well as on binding of thyroxine to thyroid binding globulin. The degree of thyroid function disturbance correlates with disease severity and low levels of thyroid hormones predict a poor prognosis in several illnesses. It remains unresolved whether the hormone responses in the euthyroid sick syndrome represent part of an adaptive response, which lowers tissue energy requirements in the face of systemic illness, or a maladaptive response, which induces damaging tissue hypothyroidism. Consequently, the use of thyroid hormone therapy in the euthyroid sick syndrome is controversial. The small number of controlled trials performed to date have shown conflicting results on the cardiovascular effects of triiodothyronine, and none has had the statistical power to address the question of altered mortality. Future trials of therapy should concentrate on patients with severe nonthyroidal illness and a high mortality rate. Meanwhile, better understanding is needed of the impact of the altered thyroid hormone status on tissue function.
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Affiliation(s)
- B McIver
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota 55905, USA
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