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Chen Z, Wan H, Min T, Su S, Yang DG. Thyroid dysfunction in nonvalvular atrial fibrillation and clinical outcomes. Endocrine 2024:10.1007/s12020-024-03838-9. [PMID: 38649647 DOI: 10.1007/s12020-024-03838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Thyroid dysfunction's effects on those who have been diagnosed with atrial fibrillation have not been well investigated. We looked at how thyroid function among patients with pre-existing atrial fibrillation related to thromboembolic risk and clinical outcomes. METHODS We gathered the medical information of patients diagnosed with nonvalvular atrial fibrillation (NVAF) between 2016 and 2020 at Dongguan People's Hospital. We then assessed the correlation between thyroid dysfunction and thrombotic risk (CHA2DS2-VASc) as well as the occurrence of clinical composite endpoint (all-cause death, heart failure, systemic embolism and hemorrhage events). RESULTS Of 1329 patients were admitted, 82.6% were euthyroid, 7.4% had subclinical hyperthyroidism, 4.2% had subclinical hypothyroidism, and 6.7% had low triiodothyronine (T3) syndrome. Lower levels of total triiodothyronine (TT3) were linked to an increased risk of thromboembolism (P < 0.005). During a median follow-up period of 1.84 years, there were 608 clinical composite endpoint occurrences. In the adjusted model, Low T3 syndrome was linked to a higher risk of the clinical composite endpoint (HR, 1.68; 95% CI, 1.20-2.37; P < 0.05) in comparison to euthyroidism. Specifically, low T3 syndrome was linked to a higher risk of heart failure (HR, 1.52; 95%CI, 1.01-2.30; P < 0.05) and all-cause death (HR, 3.34; 95% CI, 1.76-6.36; P < 0.001). CONCLUSION Low T3 syndrome are linked to an increased risk of heart failure and all-cause death in individuals with NVAF. And Patients with NVAF and low TT3 levels have a higher risk of thromboembolism.
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Affiliation(s)
- Zeni Chen
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huaibin Wan
- Department of Cardiology, Shenhe People's Hospital, the Fifth Affiliated Hospital of Jinan University, Heyuan, China
- Department of Cardiology, Dongguan People's Hospital, the First School of Clinical Medicine, Southern Medical University, Dongguan, China
| | - Tingting Min
- Department of Cardiology, Dongguan People's Hospital, the First School of Clinical Medicine, Southern Medical University, Dongguan, China
| | - Shaohui Su
- Department of Cardiology, Dongguan People's Hospital, the First School of Clinical Medicine, Southern Medical University, Dongguan, China
| | - De-Guang Yang
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China.
- Department of Cardiology, Shenhe People's Hospital, the Fifth Affiliated Hospital of Jinan University, Heyuan, China.
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Li W, Gao R, Wang W, Tang J, Yin H, Wu J, Liang J, Li Y, Wang L, Li J, Shen H, Xu W. Low T3 syndrome as a predictor of poor prognosis in peripheral T-cell lymphomas. Clin Transl Oncol 2024; 26:613-622. [PMID: 37460749 DOI: 10.1007/s12094-023-03280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE The purpose of the study was to evaluate the prognostic value of low T3 syndrome in peripheral T-cell lymphomas (PTCLs). METHODS One hundred and seventy-four patients of newly diagnosed PTCLs were enrolled in the study. We performed statistical analysis based on the clinical data collected. RESULTS Thirty-Six (20.69%) patients had low T3 syndrome at first admission. Results suggested that the patients with higher score of ECOG PS, International Prognostic Index (IPI) and Prognostic Index for T-cell lymphoma (PIT), bone marrow involvement and lower level of albumin tended to develop low T3 syndrome. The median progression-free survival (PFS) and overall survival (OS) were 10 months and 36 months, respectively, for all patients. Pre-existing low T3 syndrome was in correlation with worse PFS and OS. Patients with low T3 syndrome showed worse PFS (4 months vs 13 months, P = 0.0001) and OS (7 months vs 83 months, P < 0.0001) than patients without low T3 syndrome. IPI and PIT, respectively, combined with low T3 syndrome improved the ability to predict OS and PFS of PTCLs. CONCLUSIONS The study indicated that low T3 syndrome may be a good candidate for predicting prognosis of peripheral T-cell lymphomas.
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Affiliation(s)
- Wenyi Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Rui Gao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Weiting Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jing Tang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua Yin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jiazhu Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jinhua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yue Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Haorui Shen
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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Yang Y, Huang X. Correlation between a low serum free triiodothyronine level and mortality of severe pulmonary tuberculosis patients. BMC Infect Dis 2024; 24:202. [PMID: 38355432 PMCID: PMC10865520 DOI: 10.1186/s12879-024-09099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND This study aimed to assess the relationship between a low serum free triiodothyronine (FT3) level and the mortality of severe pulmonary tuberculosis (TB) patients. METHODS We performed a retrospective study and reviewed the medical records of patients with severe pulmonary TB between January 2016 and June 2022. The patient demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, survival or death at 28 and 90 days after hospital admission, and serum FT3 level were recorded. Bivariate regression analysis was performed to study the relationship between mortality and the FT3 level. The Kaplan-Meier method and the log-rank test were used to compare the survival rates between patients with different serum FT3 levels. RESULTS Our study included 495 severe pulmonary TB patients, with 383 (77.4%) patients having a low serum FT3 level. The low-serum FT3 group had high 28-day and 90-day mortalities. The patients who had died by 28 or 90 days after hospital admission had a low FT3 level. Survival analysis showed that the patients with a low serum FT3 level had a low probability of survival at 28 days and at 90 days after hospital admission. CONCLUSION The serum FT3 level was correlated with the 28-day and 90-day mortalities in patients with severe pulmonary TB. The serum FT3 level should be monitored in these patients to help manage their disease.
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Affiliation(s)
- Yan Yang
- Department of Respiratory and Critical Care Medicine, Hangzhou Red Cross Hospital, Hangzhou City, Zhejiang Province, China
| | - Xiaoqing Huang
- Department of Tuberculosis Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou City, Zhejiang Province, China.
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Xue LG, Shen HR, Gao R, Du KX, Xing TY, Wang WT, Wang L, Li JY, Liang JH, Xu W. Low T3 syndrome as a predictor of poor outcomes in patients with follicular lymphoma. Ann Hematol 2023; 102:851-862. [PMID: 36735075 PMCID: PMC9897155 DOI: 10.1007/s00277-023-05117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
The aim of this study was to investigate the prognostic value of low T3 syndrome in follicular lymphoma (FL). A total of 221 FL patients with detailed serum thyroid hormone levels and other complete clinical data were enrolled. Baseline features associated with low T3 syndrome were analyzed and balanced by propensity score matching. Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). A receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to assess the predictive accuracy of FL international prognostic index FLIPI-1/FLIPI-2 and low T3 syndrome. A total of 22 patients (10.0%) had low T3 syndrome at diagnosis, which was associated with poor PFS and OS in the rituximab era. It is an independent prognostic factor for PFS and OS. Low T3 syndrome and FLIPI-1/FLIPI-2 significantly increased the AUC of PFS and OS compared to FLIPI-1/FLIPI-2 alone. Low T3 is a risk factor for POD24. In conclusion, low T3 syndrome may be a good candidate for predicting the prognosis of CLL in future clinical practice. Our study demonstrates that low T3 syndrome is associated with poorer survival outcomes in FL patients.
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Affiliation(s)
- Lian-Guo Xue
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
- Department of Hematology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, 222002, China
| | - Hao-Rui Shen
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Rui Gao
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Kai-Xin Du
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Tong-Yao Xing
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Wei-Ting Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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Zhang J, Zhang LN, Xia Y, Jin YY, Shen XX, Chen LJ. [The impact of low T3 syndrome on the prognosis of patients with newly diagnosed multiple myeloma]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:216-221. [PMID: 37356983 DOI: 10.3760/cma.j.issn.0253-2727.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Objective: This study aimed to examine the relationship between low T3 syndrome (LT3S) and the prognosis of newly diagnosed multiple myeloma (NDMM) patients. Methods: A retrospective examination of 211 NDMM patients treated at the Department of Hematology, Jiangsu Provincial People's Hospital from July 2009 to December 2020 was performed, and all patients received thyroid function testing to determine if they had LT3S. We investigated the relationship between LT3S and clinical features, as well as its impact on MM prognosis. Results: Of the 211 patients, 119 were males, and 92 were females, with a median age of 60 (33-86) years. Patients with LT3S had significantly higher levels of β(2)-microglobulin, C-reactive protein, and blood creatinine compared to those with normal T3 levels. They also had lower levels of hemoglobin, platelets, and serum albumin, as well as more advanced ISS stages (P<0.001) . Patients with LT3S had shorter progression-free survival (PFS) (16 months vs 30 months, P=0.003) and overall survival (OS) (57 months vs 75 months, P=0.004) than patients without LT3S. LT3S was found to be a standalone unfavorable factor in multivariate analysis, LT3S was an independent unfavorable factor in predicting both PFS (HR=2.114, 95% CI 1.271-3.516, P=0.004) and OS (HR=2.231, 95% CI 1.088-4.577, P=0.029) . Conclusions: Low T3 syndrome was an independent unfavorable prognostic predictor for NDMM.
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Affiliation(s)
- J Zhang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L N Zhang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y Xia
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y Y Jin
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - X X Shen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L J Chen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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Müller NA, Kaegi-Braun N, Durmisi M, Gressies C, Tribolet P, Stanga Z, Mueller B, Schuetz P. Low T3 syndrome upon admission and response to nutritional support in malnourished medical inpatients. J Clin Endocrinol Metab 2022; 108:e240-e248. [PMID: 36546619 DOI: 10.1210/clinem/dgac743] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION During illness, deiodination of thyroxine (T4) to triiodothyronine (T3) is down regulated. This is called "low T3 syndrome", an adaptive metabolic mechanism to reduce energy expenditure and prevent catabolism. We investigated the prognostic role of low T3 syndrome in patients at nutritional risk regarding mortality, clinical outcomes and response to nutritional support. METHODS This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized-controlled Swiss multicenter trial comparing effects of individualized nutritional support with usual care in adult medical inpatients at nutritional risk. The primary endpoint was all-cause mortality over 30-,180-days and 5-years. RESULTS We had complete data including fT3 concentration of 801/2028 (39.5%) patients from the initial trial. Of these 492 (61.4%) had low T3 syndrome (fT3 < 3.2 pmol/l). Low T3 syndrome was associated with higher mortality over 30 days (adjusted hazard ratio 1.97 [95%CI 1.17 to 3.31], p 0.011) and other adverse clinical outcomes. Nutritional support only lowered mortality in the group of patients with but not in those without low T3 syndrome (adjusted odds ratio of nutritional support of 0.82 [95%CI 0.47 to 1.41] vs. 1.47 [95%CI 0.55 to 3.94]). This finding, however, was not significant in interaction analysis (p for interaction = 0.401). CONCLUSIONS Our secondary analysis of a randomized trial suggests that medical inpatients at nutritional risk with low T3 syndrome have a substantial increase in mortality and may show a more pronounced beneficial response to nutritional support interventions.
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Affiliation(s)
- Natasha Anouschka Müller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
- Medical Faculty of the University Basel, Switzerland
| | - Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
| | - Mirsada Durmisi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
- Medical Faculty of the University Basel, Switzerland
| | - Carla Gressies
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Life Sciences University of Vienna, Vienna, Austria
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital Bern, Bern University Hospital, University of Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
- Medical Faculty of the University Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Switzerland
- Medical Faculty of the University Basel, Switzerland
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Kobayashi Y, Okumura G, Morizumi T, Nagamatsu K, Shimizu Y, Sasaki T, Sato A, Sekijima Y, Hongo K. Thyroid hormone decreasing after mechanical thrombectomy for cerebral infarction. Clin Neurol Neurosurg 2022; 219:107335. [PMID: 35724614 DOI: 10.1016/j.clineuro.2022.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/05/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Mechanical thrombectomy (MT) is an established treatment for large vessel occlusion in patients with cerebral infarction. The use of iodine contrast agent decreases thyroid hormone levels via the Wolff-Chaikoff effect. Low triiodothyronine (T3) syndrome caused due to severe illness status can contribute to decreased levels of thyroid hormones. Reportedly, a low T3 level is associated with poor prognosis in patients with cerebral infarction. This study aimed to clarify the changes in thyroid hormone levels in the acute phase after MT and the effects of the iodine contrast agent on these hormones. METHODS This was a single-center, prospective, and single-arm trial. Thyroid stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4) levels were tested on admission and 24 h postoperatively in patients who were approved for MT. RESULTS A total of 37 patients were screened during the study period and 31 patients were enrolled in this study. Significant decreases were observed in TSH (P < 0.001) and FT3 (P < 0.001) levels 24 h after MT. Moreover, there was a correlation between the decrease in ratio of change in FT3 levels and the amount of iodine contrast agent used per body surface area (r = 0.43, P = 0.019), while no such correlations were detected for TSH and FT4. CONCLUSION We demonstrated that TSH and FT3 levels decreased in the acute phase after MT and that FT3 levels were associated with the amount of iodine contrast agent used.
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Affiliation(s)
- Yuya Kobayashi
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan.
| | - Gaku Okumura
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Teruya Morizumi
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Kiyoshiro Nagamatsu
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Yusaku Shimizu
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Tetsuo Sasaki
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Atsushi Sato
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
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Lin X, Chen X, Yang CY. An analysis of perinatal factors of low T3 syndrome in preterm neonates with a gestational age of 28-35 weeks. Ann Med 2021; 53:1722-1726. [PMID: 34596490 PMCID: PMC8491668 DOI: 10.1080/07853890.2021.1985731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Low triiodothyronine syndrome (LT3S) is a common endocrine disease in preterm neonates. Various serious acute or chronic diseases result in LT3S. Few studies have investigated the causal relationship between perinatal factors and LT3S in preterm neonates with a gestational age (GA) of 28-35 weeks. The present study comprehensively analyzed the perinatal factors of LT3S in preterm neonates. METHODS This was a retrospective study of neonates with and without LT3S from January 2018 to November 2019. Compared to 206 preterm neonates without LT3S, 158 neonates were diagnosed with LT3S, excluding neonates with congenital malformations, other endocrine diseases, genetic diseases and inherited metabolic diseases. RESULTS Five perinatal risk factors for LT3S were confirmed using univariate and multivariate analyses: smaller gestational age, lower birth weight, respiratory distress syndrome (RDS), neonatal sepsis, and dopamine use. CONCLUSIONS LT3S in preterm neonates was associated with multiple perinatal factors, including smaller gestational age, lower birth weight, RDS, sepsis, and dopamine use. Preterm neonates with a GA of 28-35 weeks who are exposed to a series of high-risk perinatal factors must be closely observed, diagnosed early and treated for primary diseases promptly to reduce the occurrence of LT3S and improve the outcomes.Key Message:Few studies have investigated the relationship between perinatal factors and Low triiodothyronine syndrome (LT3S) in preterm neonates with a gestational age (GA) of 28-35 weeks.LT3S was associated with multiple perinatal factors, including smaller gestational age, lower birth weight, respiratory distress syndrome (RDS), sepsis, and dopamine use.
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Affiliation(s)
- Xin Lin
- Department of Neonatal, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xian Chen
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chang-Yi Yang
- Department of Neonatal, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Li LZ, Hu JH, Xu ZY, Hong M, Sun Q, Qian SX, Liu WJ. [Clinical features and prognosis of low triiodothyronine syndrome in patients with acute myeloid leukemia]. Zhonghua Xue Ye Xue Za Zhi 2021; 42:923-9. [PMID: 35045654 DOI: 10.3760/cma.j.issn.0253-2727.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical features and prognosis of low triiodothyronine syndrome (LT3S) in patients with acute myeloid leukemia (AML) . Methods: A total of two 236 patients with AML who presented at the Jiangsu Provincial Hospital between January 2013 and December 2019 were included, and their data were retrospectively reviewed. The patients were divided into two groups, including the LT3S group and the non-LT3S group, according to their serum thyroxine level. The clinical characteristics and prognosis of the two groups were compared. Results: Among the 236 patients, 62 (26.3%) patients had LT3S. Serum-free T3 level was positively correlated with albumin (r=0.443, P<0.001) and hemoglobin (r=0.187, P=0.005) levels and negatively correlated with C-reactive protein (r=-0.406, P<0.001) and lactate dehydrogenase (r=-0.274, P<0.001) levels. The overall survival (OS) (7.5 months vs 29.9 months, P<0.001) and progression-free survival (PFS) (2.0 months vs 24.0 months, P<0.001) were significantly shortened in the LT3S group compared with the non-LT3S group. After propensity score matching, the OS (9.6 months vs 30.4 months, P=0.010) and PFS (3.0 months vs 30.0 months, P=0.014) were still significantly reduced in the LT3S group compared with the non-LT3S group. Therefore, LT3S was an independent risk factor for OS (HR=2.553, 95% CI 1.666-3.912, P<0.001) and PFS (HR=1.701, 95% CI 1.114-2.597, P=0.014) in patients with AML. Subgroup analysis suggested that patients with LT3S had a worse prognosis in patients with AML who were obese, fragile, or treated with standard chemotherapy. Conclusions: The occurrence of LT3S reflects the poor clinical status and prognosis of patients with AML.
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Liu YJ, Xu WP, Wang Y, Wang WZ. [The predictive value of low T3 syndrome for delayed encephalopathy caused by severe acute carbon monoxide poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:744-7. [PMID: 34727654 DOI: 10.3760/cma.j.cn121094-20201201-00662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the predictive value of low T3 syndrome (LT3S) for patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) . Methods: In May 2020, 137 severe acute carben monoxide poisoning (SACMP) patients were selected from Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to January 2020 as subjects. Blood samples were taken after admission to test thyroid function. Followed up for 60 d, the patients were divided into DEACMP group (45 cases) and non DEACMP group (92 cases) according to their prognosis. Clinical data of patients in two groups were collected and compared. The Cox regression with multiple independent variables was used to analyze the independent risk factors of DEACMP. Pearson correlation analysis was used to evaluate the correlation between totall triiodochyronine (TT3) level and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score. The receiver operating characteristic (ROC) curve of TT3 and APACHE Ⅱ scores for predicting DEACMP were drawn. Results: Compared with non DEACMP group, the age, APACHE II score, LT3S rate and diabetes prevalence in DEACMP group were higher, and the Glasgow coma scale (GCS) score was lower (P<0.05) . Cox regression analysis showed that age, APACHEⅡ score and LT3S were independent risk factors of DEACMP in patients with SACMP (OR=1.040, 95%CI:1.005-1.077; OR=1.070, 95%CI: 1.002-1.143; OR=4.210, 95%CI: 1.707-10.379; P<0.05) . Pearson correlation analysis showed that TT3 level was negatively correlated with APACHE Ⅱ score (r=-0.397, P=0.000) . ROC curve showed that the cut-off value of TT3 level for DEACMP prediction was 1.078 nmol/L, the area under curve (AUC) was 0.755, the sensitivity was 82.6%, and the specificity was 73.3%. The cut-off value of the APACHE Ⅱ score for predicting DEACMP was 16, and the AUC was 0.725, sensitivity was 93.3%, and specificity was 60.9%. Conclusion: This study showed that LT3S minght be an independent predictor of DEACMP in patients with SACMP. Thyroid function is closely related to the severity of SACMP patients.
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Abstract
The non-thyroidal illness syndrome (NTIS) was first reported in the 1970s as a remarkable ensemble of changes in serum TH (TH) concentrations occurring in probably any severe illness. Ever since, NTIS has remained an intriguing phenomenon not only because of the robustness of the decrease in serum triiodothyronine (T3), but also by its clear correlation with morbidity and mortality. In recent years, it has become clear that (parenteral) feeding in patients with critical illness should be taken into account as a major determinant not only of NTIS but also of clinical outcome. Moreover, both experimental animal and clinical studies have shown that tissue TH concentrations during NTIS do not necessarily reflect serum low TH concentrations and may decrease, remain unaltered, or even increase according to the organ and type of illness studied. These differential changes now have a solid basis in molecular studies on organ-specific TH transporters, receptors and deiodinases. Finally, the role of inflammatory pathways in these non-systemic changes has begun to be clarified. A fascinating role for TH metabolism in innate immune cells, including neutrophils and monocytes/macrophages, was reported in recent years, but there is no evidence at this early stage that this may be a determinant of susceptibility to infections. Although endocrinologists have been tempted to correct NTIS by TH supplementation, there is at present insufficient evidence that this is beneficial. Thus, there is a clear need for adequately powered randomized clinical trials (RCT) with clinically relevant endpoints to fill this knowledge gap.
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Affiliation(s)
- E Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - A Boelen
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
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Zhao X, Zhang R, Jiang H, Liu K, Ma C, Bai M, An T, Yao Y, Wang X, Wang M, Li Y, Zhang Y, Zhang J. Combined use of low T3 syndrome and NT-proBNP as predictors for death in patients with acute decompensated heart failure. BMC Endocr Disord 2021; 21:140. [PMID: 34215247 PMCID: PMC8252209 DOI: 10.1186/s12902-021-00801-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with established HF, low triiodothyronine syndrome (LT3S) is commonly present, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful marker for predicting death. This study was aimed to evaluate the prognostic value of LT3S in combination with NT-proBNP for risk of death in patients with heart failure (HF). METHODS A total of 594 euthyroid patients hospitalized with acute decompensated HF were enrolled by design. Of these patients, 27 patients died during hospitalization and 100 deaths were identified in patients discharged alive during one year follow-up. Patients were divided into 2 groups on the base of the reference ranges of free T3 (FT3) levels: LT3S group (FT3 < 2.3pg/mL, n = 168) and non-LT3S group (FT3 ≥ 2.3pg/mL, n = 426). RESULTS In multivariable Cox regression, LT3S was significantly associated with 1 year all-cause mortality (adjusted hazard ratio, 1.85; 95 % confidence interval [CI], 1.21 to 2.82; P = 0.005), but not significant for in-hospital mortality (adjusted hazard ratio, 1.58; 95 % CI, 1.58 to 2.82; P = 0.290) after adjustment for clinical variables and NT-proBNP. Addition of LT3S and NT-proBNP to the prediction model with clinical variables significantly improved the C statistic for predicting 1 year all-cause mortality. CONCLUSIONS In patients with acute decompensated HF, the combination of LT3S and NT-proBNP improved prediction for 1 year all-cause mortality beyond established risk factors, but was not strong enough for in-hospital mortality.
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Affiliation(s)
- Xinke Zhao
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Rongcheng Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Hugang Jiang
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Kai Liu
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Chengxu Ma
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Ming Bai
- Department of Cardiology, The First Hospital of Lanzhou University, 730000, Lanzhou, China
| | - Tao An
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Younan Yao
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Xinqiang Wang
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Ming Wang
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Yingdong Li
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China.
| | - Yuhui Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China.
| | - Jian Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China.
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Jabbar A, Ingoe L, Thomas H, Carey P, Junejo S, Addison C, Vernazza J, Austin D, Greenwood JP, Zaman A, Razvi S. Prevalence, predictors and outcomes of thyroid dysfunction in patients with acute myocardial infarction: the ThyrAMI-1 study. J Endocrinol Invest 2021; 44:1209-1218. [PMID: 32897534 PMCID: PMC8124048 DOI: 10.1007/s40618-020-01408-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Thyroid dysfunction in patients with cardiac disease is associated with worse outcomes. This study aimed to evaluate the prevalence and analyse predictors and outcomes of thyroid dysfunction in patients presenting with an acute myocardial infarction (AMI). METHODS A prospective multicentre observational study of patients recruited from six acute hospitals within the North of England. Consecutive patients without previous thyroid disease presenting with both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) were recruited to the Thyroxine in Acute Myocardial Infarction 1 (ThyrAMI-1) cohort study between December 2014 and 2016. Thyroid profile, standard biochemistry measurements and demographic information were obtained within 12 h of admission to hospital. Multivariable logistic regression analyses were performed to assess the predictors of thyroid dysfunction and Cox proportional hazards analyses were utilised to compare all-cause mortality by categories of thyroid dysfunction up to June 2019. RESULTS Of the 1802 participants analysed, 1440 (79.9%) were euthyroid, 312 (17.3%) had subclinical hypothyroidism (SCH), 22 (1.2%) had subclinical hyperthyroidism (SHyper) and 25 (1.3%) had low T3 syndrome (LT3S). Predictors for SCH were increasing age, female sex, higher thyroid peroxidase antibody (TPOAb) levels, higher serum creatinine levels and early morning sampling time (between 00:01-06:00 h). The predictors of SHyper were lower body mass index and afternoon sampling time (between 12:01 and 18:00 h). Predictors of LT3S were increasing age, higher creatinine levels and presence of previous ischaemic heart disease. Compared to the euthyroid group, patients with LT3S had higher all-cause mortality; adjusted hazard ratio (95% CI) of 2.02 (1.03-3.95), p = 0.04, whereas those with SCH and SHyper did not exhibit significantly increased mortality; adjusted hazard ratios (95% CI) of 1.05 (0.74-1.49), p = 0.79 and 0.27 (0.04-1.95), p = 0.19, respectively. CONCLUSIONS Thyroid dysfunction is common in AMI patients on admission to hospital and our data provide an understanding regarding which factors might influence thyroid dysfunction in these patients. Furthermore, the negative association between LT3S and increased mortality post-AMI has once again been highlighted by this study. More research is required to assess if treatment of thyroid dysfunction improves clinical outcomes.
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Affiliation(s)
- A Jabbar
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
- Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L Ingoe
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - H Thomas
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - P Carey
- Department of Endocrinology and Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - S Junejo
- Department of Endocrinology and Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - C Addison
- Department of Biochemistry, South of Tyne Pathology Centre, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - J Vernazza
- Department of Biochemistry, South of Tyne Pathology Centre, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - D Austin
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Zaman
- Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Razvi
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK.
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK.
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Sciacchitano S, De Vitis C, D'Ascanio M, Giovagnoli S, De Dominicis C, Laghi A, Anibaldi P, Petrucca A, Salerno G, Santino I, Amodeo R, Simmaco M, Napoli C, Tafuri A, Di Napoli A, Sacconi A, Salvati V, Ciliberto G, Fanciulli M, Piaggio G, de Latouliere L, Ricci A, Mancini R. Gene signature and immune cell profiling by high-dimensional, single-cell analysis in COVID-19 patients, presenting Low T3 syndrome and coexistent hematological malignancies. J Transl Med 2021; 19:139. [PMID: 33794925 PMCID: PMC8016508 DOI: 10.1186/s12967-021-02805-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background Low T3 syndrome is frequent in patients admitted to intensive care units for critical illness and pneumonia. It has been reported also in patients with COVID-19, Hodgkin disease and chronic lymphocytic leukemia. We analyzed the clinical relevance of Low T3 syndrome in COVID-19 patients and, in particular, in those with associated hematological malignancies. Methods Sixty-two consecutive patients, hospitalized during the first wave of SARS-CoV-2 outbreak in Sant’Andrea University Hospital in Rome, were subdivided in 38 patients (Group A), showing low levels of FT3, and in 24 patients (Group B), with normal FT3 serum values. During the acute phase of the disease, we measured serum, radiologic and clinical disease severity markers and scores, in search of possible correlations with FT3 serum values. In addition, in 6 COVID-19 patients, 4 with Low T3 syndrome, including 2 with a hematological malignancy, and 2 with normal FT3 values, we performed, high-dimensional single-cell analysis by mass cytometry, multiplex cytokine assay and gene expression profiling in peripheral blood mononuclear cells (PBMC). Results Low FT3 serum values were correlated with increased Absolute Neutrophil Count, NLR and dNLR ratios and with reduced total count of CD3+, CD4+ and CD8+ T cells. Low FT3 values correlated also with increased levels of inflammation, tissue damage and coagulation serum markers as well as with SOFA, LIPI and TSS scores. The CyTOF analysis demonstrated reduction of the effector memory and terminal effector subtypes of the CD4+ T lymphocytes. Multiplex cytokine assay indicates that mainly IL-6, IP-10 and MCAF changes are associated with FT3 serum levels, particularly in patients with coexistent hematological malignancies. Gene expression analysis using Nanostring identified four genes differently expressed involved in host immune response, namely CD38, CD79B, IFIT3 and NLRP3. Conclusions Our study demonstrates that low FT3 serum levels are associated with severe COVID-19. Our multi-omics approach suggests that T3 is involved in the immune response in COVID-19 and coexistent hematological malignancy and new possible T3 target genes in these patients have been identified. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02805-6.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy. .,Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi, 3, 00166, Rome, Italy.
| | - Claudia De Vitis
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Michela D'Ascanio
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Simonetta Giovagnoli
- Division of Pneumology, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Chiara De Dominicis
- Department of Medical and Surgical Sciences and of Translational Medicine, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Andrea Laghi
- Department of Medical and Surgical Sciences and of Translational Medicine, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Paolo Anibaldi
- Health Managment Director, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Andrea Petrucca
- Department of Neuroscience, Mental Health and Sense Organs, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Gerardo Salerno
- Department of Neuroscience, Mental Health and Sense Organs, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Iolanda Santino
- Department of Neuroscience, Mental Health and Sense Organs, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Rachele Amodeo
- Flow Cytometry Unit, Clinical Laboratory, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health and Sense Organs, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Christian Napoli
- Department of Medical and Surgical Sciences and of Translational Medicine, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Andrea Sacconi
- UOSD Oncogenomica ed Epigenetica, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Valentina Salvati
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maurizio Fanciulli
- UOSD SAFU, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giulia Piaggio
- UOSD SAFU, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Luisa de Latouliere
- UOSD SAFU, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
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Wang K, Wang W, Zhang K, Gao J, Liu Y, Zheng J, Li P, Tang Y. Prognostic value of free triiodothyronine and N-terminal pro-B-type natriuretic peptide for patients with acute myocardial infarction undergoing percutaneous coronary intervention: a prospective cohort study. Ann Transl Med 2021; 9:294. [PMID: 33708921 PMCID: PMC7944292 DOI: 10.21037/atm-20-5541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Altered thyroid function and increased N-terminal pro-B-type natriuretic peptide (NT-proBNP) are prognostic factors in acute myocardial infarction (AMI). The study aims to investigate whether free triiodothyronine (fT3) and NT-proBNP are prognostic factors for long-term outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI). Methods This was an observational, prospective, single-center study of consecutive patients enrolled at Fuwai Hospital between January, 2013 and December, 2013. The patients were divided into two groups according to fT3 levels: low fT3 (<2.5 pg/mL) and normal fT3 (2.50–4.09 pg/mL). The primary outcome of this study was the incidence of major adverse cardiovascular events (MACEs). Results There were 252 patients with low fT3 and 561 patients with normal fT3. After >2 years of follow-up, patients with low fT3 levels had higher rates of MACEs than those with normal fT3 (27.0% vs. 7.8%, P<0.001). Univariable Cox proportional hazards regression analyses showed that NT-proBNP >802.7 pg/mL [hazard ratio (HR) =5.063, 95% confidence interval (CI): 3.176–8.071, P<0.001] and fT3 <2.5 pg/mL (HR =3.867, 95% CI: 2.646–5.651, P<0.001) were the strongest predictors of MACEs. After adjustment for traditional risk predictors, fT3 <2.5 pg/mL (HR =2.570, 95% CI: 1.653–3.993, P<0.001) was one of the most important independent predictors of MACEs. Patients with NT-proBNP ≤802.7 pg/mL and fT3 ≥2.5 pg/mL had the best prognosis, while patients with NT-proBNP >802.7 pg/mL and fT3 <2.5 pg/mL had the worst outcomes (P<0.001). Conclusions Low fT3 is a strong predictor of poor prognosis after AMI. The fT3+NT-proBNP combination might be a valuable predictor of the long-term outcomes of PCI after AMI.
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Affiliation(s)
- Kaihao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yupeng Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jilin Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yida Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wang Y, Tian X, Zheng H, Guo Y, Zuo Y, Cong M, Zhang H. Association between acute disseminated encephalomyelitis and thyroid autoimmunity in children. Mult Scler Relat Disord 2020; 46:102573. [PMID: 33059214 DOI: 10.1016/j.msard.2020.102573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormal thyroid peroxidase antibody (TPOAb) levels are observed in various autoimmune diseases. However, the relationship between TPOAb and pediatric acute disseminated encephalomyelitis (PADEM) remains unclear. This study aimed to investigate the positive rate of TPOAb and thyroid dysfunction in children with acute disseminated encephalomyelitis (ADEM) and assess the relationship between TPOAb and clinical features of PADEM. METHODS This retrospective single-center case-control study was conducted from April 2017 to April 2019. We enrolled 23 children with ADEM and 23 age- and sex-matched healthy controls. Based on whether they were positive for TPOAb, the children with ADEM were allocated either to the TPOAb+ or TPOAb- group. The median follow-up time was 12 months (6-30 months). Observers were blinded to the patient groupings. We compared the clinical and imaging characteristics of the two groups. RESULTS Among the 23 patients with PADEM, 47.8% presented with abnormal TPOAb levels, while there were no TPOAb+ cases in the control group. Among the children with ADEM, there were significantly increased TPOAb positive rates and significantly decreased fT3 levels. TPOAb+ and TPOAb- subgroup analysis revealed significant differences in gait, fever, and total IgG. In the TPOAb+ group, there was a significant decrease in TPOAb levels at 2 weeks after ADEM onset. The follow-up of patients who were TPOAb+ at 3 months after onset showed a gradual decrease in their TPOAb levels back to normal. One patient who presented new nervous system symptoms after over 1 month also showed a simultaneous increase in TPOAb levels. There was a significant negative correlation between Glasgow Coma Scale (GCS) scores and TPOAb levels (p = 0.042, r = -0.892). CONCLUSION There was a negative correlation of TPOAb levels with GCS scores. Therefore, TPOAb levels could be used for the prognosis of patients with PADEM. We recommend determining thyroid function when assessing patients with PADEM during follow-up.
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Affiliation(s)
- Yuanyuan Wang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China; Second Department of Neurology, The Children's Hospital of Hebei Province, Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xiaoyu Tian
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Huacheng Zheng
- Second Department of Neurology, The Children's Hospital of Hebei Province, Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Yinghui Guo
- Department of Laboratory Medicine, The Children's Hospital of Hebei Province, Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Yuexian Zuo
- Second Department of Neurology, The Children's Hospital of Hebei Province, Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Mengdi Cong
- Department of Computed Tomography and Magnetic Resonance, The Children's Hospital of Hebei Province, Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Huifeng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China.
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Sabatino L, Kusmic C, Iervasi G. Modification of cardiac thyroid hormone deiodinases expression in an ischemia/reperfusion rat model after T3 infusion. Mol Cell Biochem 2020; 475:205-214. [PMID: 32780210 DOI: 10.1007/s11010-020-03873-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/01/2020] [Indexed: 12/13/2022]
Abstract
The deiodinases regulate the activation and inactivation of Thyroid hormones (TH), in both physiological and pathological conditions. The three deiodinases, DIO1, DIO2 and DIO3, have different catalytic role and cellular and tissue distribution. Aim of this study is to evaluate a rat model of regional ischemia/reperfusion (I/R), the modification of cardiac main function after the administration of 6 µg/kg/day of triiodothyronine (T3), and the associated to DIO1, DIO2 and DIO3 gene expression. We also aim to study DIO1 and DIO2 protein levels in different left ventricular regions after an ischemic event. Four groups of rats were studied: sham-operated, sham-operated + T3, I/R rats and I/R rats + T3. DIO1, DIO2 and DIO3 expression were evaluated in I/R region (AAR: area-at-risk) and in a more distant region from ischemic wound (RZ: remote zone). In I/R group, circulating free-T3 (FT3) levels were significantly decreased with respect to basal values, whereas in I/R + T3 rats, FT3 levels were comparable to basal values. In AAR of I/R + T3 rats, DIO1 and DIO2 gene expression significantly increased with respect to sham. In RZ, DIO1 and DIO3 gene expression was significantly lower in sham and I/R rats when compared to I/R + T3. In sham + T3 group, DIO1 and DIO2 gene expression was not detectable, whereas DIO3 was significantly higher than in the other three groups. The present study gives interesting new insights on DIO1, DIO2 and DIO3 in the ischemic heart and their role in relation to T3-mediated amelioration of cardiac function and structure.
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Affiliation(s)
- Laura Sabatino
- Institute of Clinical Physiology, National Research Council (C.N.R.), Pisa, Italy.
| | - Claudia Kusmic
- Institute of Clinical Physiology, National Research Council (C.N.R.), Pisa, Italy
| | - Giorgio Iervasi
- Institute of Clinical Physiology, National Research Council (C.N.R.), Pisa, Italy
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Yin GL, Huang JY, Tian T, Duan LM, Xu J, Qiu HX. Low T3 syndrome is a prognostic marker of poor outcomes in secondary hemophagocytic lymphohistiocytosis. Leuk Lymphoma 2020; 61:2947-2954. [PMID: 32643969 DOI: 10.1080/10428194.2020.1789623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study aimed to examine the association between low T3 syndrome and overall survival (OS) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH). The study consisted of 111 consecutive patients hospitalized due to newly diagnosed sHLH with detailed thyroid hormone profiles on admission. Low T3 syndrome was found in 75.7% of the studied sHLH population. After a median follow-up of 83 (interquartile range 25-365) days, there were 60 (71.4%) cumulative deaths in the low T3 syndrome group and 13 (48.1%) in the euthyroid group. Survival analysis showed a lower survival probability for patients with low FT3 than for those with normal FT3 (median OS, 60 vs. 365 days, p = .011). In the multivariate analysis, low T3 syndrome was an independent prognostic factor for OS (HR = 2.474; 95% CI 1.351-4.532, p = .003). Low T3 syndrome is frequently found and associated with worse outcomes in patients with sHLH.
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Affiliation(s)
- Guang-Li Yin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jia-Yu Huang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Tian Tian
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Li-Min Duan
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ji Xu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Hong-Xia Qiu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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Xiong H, Yan P, Huang Q, Shuai T, Liu J, Zhu L, Lu J, Shi X, Yang K, Liu J. A prognostic role for non-thyroidal illness syndrome in chronic renal failure:a systematic review and meta-analysis. Int J Surg 2019; 70:44-52. [PMID: 31437639 DOI: 10.1016/j.ijsu.2019.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/24/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic renal failure (CRF) is a serious disease that has become a burden on global and local economics and public health. In addition, non-thyroidal illness syndrome (NTIS) has become increasingly more prevalent in CRF patients. MATERIALS AND METHODS A data search was conducted on the PubMed/Medline, Cochrane Library, Web of Science, Embase, and CBM databases to identify studies up to November 1st, 2018, that compared low T3 and normal T3 levels in patients with CRF. Data analysis was done by calculating the relative risks (RR) and 95% confidence intervals (95% CI) and continuous variables were described by weighted mean difference (WMD) and 95% CI. The efficacy outcomes included renal function and mortality. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess the quality of the cohort and cross-sectional studies, respectively. A funnel plot was used to identify publication bias. RESULTS Seventeen studies with a total of 4593 patients were finally included in the analysis. Among the 17 studies, 11 reported the mortality of CRF patients with low T3 and normal T3 levels. Subgroups were assigned according to different follow-up times and different methods of treatment. The mortality rate in the low T3 group was much higher than in the normal T3 group. 11 studies reported creatinine (Cr) results in patients with low T3 and normal T3 levels and our analysis found no significant differences between the two groups (95%CI: 0.46-0.25; P-heterogeneity = 0.000; P = 0.559). Five studies reported uric acid results and we found no significant differences between the two groups (95%CI: 0.08-0.22; P-heterogeneity = 0.438; P = 0.377). Five studies reported the urea levels in the two groups and our analysis found no significant differences (95%CI: 1.60-1.23; I2 = 0.0%; P-heterogeneity = 0.498;P = 0.798). CONCLUSION Low T3 had a greater impact on the short-term prognosis of patients with CRF than on the long-term prognosis. NTIS did not cause substantial kidney damage.
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Affiliation(s)
- Huaiyu Xiong
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Peijing Yan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Qiangru Huang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Tiankui Shuai
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Jingjing Liu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Lei Zhu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Jiaju Lu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Xiue Shi
- Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China; Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, 730000, China; Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Jian Liu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.
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Fraczek-Jucha M, Zbierska-Rubinkiewicz K, Kabat M, Plens K, Rychlak R, Nessler J, Gackowski A. Low triiodothyronine syndrome and selenium deficiency - undervalued players in advanced heart failure? A single center pilot study. BMC Cardiovasc Disord 2019; 19:105. [PMID: 31064347 PMCID: PMC6505272 DOI: 10.1186/s12872-019-1076-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/11/2019] [Indexed: 12/28/2022] Open
Abstract
Background The function of deiodinases – selenoproteins converting thyroid hormones may be disturbed by oxidative stress accompanying heart failure. Selenium (Se) may be used by glutathione peroxidase, leading to a lack of deiodinase and triiodothyronine (T3). The aim of the study was the evaluation of the prevalence and clinical significance of low T3 syndrome in heart failure and the assessment of the association of low fT3 and Se deficiency. Methods The study group consisted of 59 consecutive patients hospitalized due to decompensated HFrEF NYHA III or IV. Exclusion criteria were: thyroid dysfunction, severe systemic disease, treatment with amiodarone, steroids or propranolol. Group A included 9 patients with low free T3 (fT3) concentration below 3.1 pmol/L. Group B consisted of the remaining 50 patients with normal fT3 levels. Results The prevalence of low T3 syndrome was 15.3%. The prevalence of Se deficiency was 74.6%. We demonstrated correlations between fT3 and main clinical variables (i.e. NT-proBNP, LVEF, hsCRP), but we did not find correlation between fT3 and the Se level. Kaplan-Meier survival analysis showed lower survival probability in patients with low fT3 (p < 0.001). Conclusions Low T3 syndrome is frequently found in patients with HFrEF and is associated with a poor outcome. We did not identify any significant correlation between Se and fT3 level.
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Affiliation(s)
- Magdalena Fraczek-Jucha
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland.,Department of Emergency Medical Care, Jagiellonian University Medical College, Krakow, Poland.,Department of Coronary Disease and Heart Failure, John Paul II Hospital, Krakow, Poland
| | | | - Małgorzata Kabat
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland.,Department of Coronary Disease and Heart Failure, John Paul II Hospital, Krakow, Poland
| | | | - Radoslaw Rychlak
- Department of Coronary Disease and Heart Failure, John Paul II Hospital, Krakow, Poland
| | - Jadwiga Nessler
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland.,Department of Coronary Disease and Heart Failure, John Paul II Hospital, Krakow, Poland
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland. .,Department of Coronary Disease and Heart Failure, John Paul II Hospital, Krakow, Poland.
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Abstract
The cardiovascular system is one of the main targets of thyroid hormone action, and triiodothyronine deficiency has crucial consequences on cardiac structure and function. Patients with overt or subclinical hypothyroidism should be treated with levothyroxine to improve their cardiovascular function and the potential risk of heart failure. Even patients with thyroid hormone deficiency and heart failure should receive replacement doses of levothyroxine to improve their prognosis and worsening of the cardiovascular function. An innovative therapeutic multifactorial approach could improve the progression of heart failure. There is a potential beneficial effect of thyroid hormones and their analogs in patients with heart failure.
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Abstract
Thyroid hormone is integral for normal function, yet during illness, circulating levels of the most active form (triiodothyronine [T3]) decline. Whether this is an adaptive response in critical illness or contributes to progressive disease has remained controversial. This review outlines the basis of thyroid hormone changes during critical illness and considers the evidence regarding T3 replacement.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia; Intensive Care Unit, Barwon Health, Ryrie St, Geelong, Victoria 3220, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
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El-Ella SSA, El-Mekkawy MS, El-Dihemey MA. [Prevalence and prognostic value of non-thyroidal illness syndrome among critically ill children]. An Pediatr (Barc) 2018; 90:237-243. [PMID: 29628400 DOI: 10.1016/j.anpedi.2018.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children. MATERIALS AND METHODS A prospective observational study conducted on 70 critically ill children admitted into pediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24hours of PICU admission. Primary outcome was 30-day mortality. RESULTS NTIS occurred in 62.9% of patients but it took several forms. The most common pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P=.028). NTIS independently predicted mortality (OR=3.91; 95% CI=1.006-15.19; P=.0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR=16.9; 95% CI=1.40-203.04; P=.026). TSH was negatively correlated with length of PICU stay (rs=-0.35, P=.011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1±0.66 versus 2.76±0.91pg/mL, P=.011). CONCLUSION NTIS is common among critically ill children and appears to be associated with mortality and illness severity.
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Affiliation(s)
- Sohair Sayed Abu El-Ella
- Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin El-Kom, Menufia, Egipto
| | - Muhammad Said El-Mekkawy
- Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin El-Kom, Menufia, Egipto.
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Su W, Zhao XQ, Wang M, Chen H, Li HW. Low T3 syndrome improves risk prediction of in-hospital cardiovascular death in patients with acute myocardial infarction. J Cardiol 2018; 72:215-219. [PMID: 29580665 DOI: 10.1016/j.jjcc.2018.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low triiodothyronine (T3) syndrome (LT3S) is frequently seen in patients with acute myocardial infarction (AMI). We examined the association between LT3S and severity of myocardial injury and determined whether LT3S adds predictive value over thrombolysis in myocardial infarction (TIMI) risk score for in-hospital cardiovascular (CV) death. METHODS Of 2459 AMI patients, 529 pairs of euthyroid and LT3S individuals with similar baseline characteristics were identified using 1:1 propensity score matching. LT3S was defined as free T3 (fT3) <2.36pg/mL, normal values of thyroid-stimulating hormone and free thyroxin. Primary outcome was in-hospital CV death. Receiver operating characteristic curves were generated to assess the predictive effects of fT3, TIMI risk score, and TIMI-LT3S risk score on in-hospital CV death. RESULTS LT3S was found in 23.3% of patients with AMI. The peak values of cardiac troponin I in ng/mL and N-terminal pro-brain natriuretic peptide in ng/mL were significantly higher in LT3S: 6.6 (1.3-19.6) vs. 3.5 (0.8-12.1), p<0.001 and 3625 (1046-12,776) vs. 2158 (774-6759), p<0.001. Patients with LT3S had significantly higher rate of in-hospital CV death than those without (4.7% vs. 1.7%, p=0.005). Lower levels of fT3 yielded an area under the curve (AUC) of 0.741 for predicting CV death. LT3S, when added to the TIMI risk score, significantly increased AUC for in-hospital CV death than TIMI risk score alone (0.775 vs. 0.738, p=0.005). CONCLUSIONS LT3S was associated with more severe myocardial injury and increased in-hospital CV mortality in patients with AMI. Furthermore, it improved risk prediction of in-hospital CV death post-AMI when it was added to the TIMI risk score.
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Affiliation(s)
- Wen Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Man Wang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.
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Ma X, Yin Q, Zeng Z, Wang C, Yang Y, Guo S. Thyroid Function and Autoimmune Indications in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Neuroimmunomodulation 2018; 25:110-117. [PMID: 30157483 DOI: 10.1159/000492179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Previous studies have shown that functional abnormalities of the thyroid are associated with the pathogenesis of several neurological diseases. However, their relationship in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis remains to be defined. METHODS Forty-three patients with anti-NMDAR encephalitis were examined for thyroid function and autoimmune indications, in comparison with 225 healthy controls (CTL). Patients were further classified into 2 subgroups based on their free tri-iodothyronine (fT3) levels. Moreover, fT3 levels were also investigated after at least three months of follow-up. The clinical characteristics of the patients and CTL were described in detail. RESULTS Serum levels of fT3 and thyroid-stimulating hormone (TSH) were found to be relatively lower in patients with anti-NMDAR encephalitis than in CTL (both p < 0.001). Low T3 syndrome also occurred more frequently in anti- NMDAR encephalitis (25.6 vs. 0.4%, p < 0.001). However, no statistical differences were detected between patients and CTL in terms of the positive rate of thyroid antibodies and other types of thyroid dysfunction. Patients with low T3 levels tended to have a longer hospital stay (p = 0.006), a higher rate of abnormal brain magnetic resonance imaging (MRI) findings (p = 0.033), a higher frequency of consciousness declination (p = 0.029), and a higher modified Rankin scale (mRS) score during hospitalization. Low fT3 levels were also associated with abnormal MRI findings, a decline in consciousness, and the mRS score on admission. In addition, fT3 seemed to gradually return to normal levels upon improvement of the mRS score (r = -0.649, p = 0.002). CONCLUSIONS Low T3 syndrome often copresents in anti-NMDAR encephalitis and indicates a longer hospitalization, abnormal MRI findings, consciousness declination, and a higher clinical severity. However, fT3 levels do not seem to influence the prognosis of anti-NMDAR encephalitis.
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Fragidis S, Sombolos K, Thodis E, Panagoutsos S, Mourvati E, Pikilidou M, Papagianni A, Pasadakis P, Vargemezis V. Low T3 syndrome and long-term mortality in chronic hemodialysis patients. World J Nephrol 2015; 4:415-422. [PMID: 26167466 PMCID: PMC4491933 DOI: 10.5527/wjn.v4.i3.415] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/03/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the predictive value of low freeT3 for long-term mortality in chronic hemodialysis (HD) patients and explore a possible causative role of chronic inflammation.
METHODS: One hundred fourteen HD patients (84 males) consecutively entered the study and were assessed for thyroid function and two established markers of inflammation, high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Monthly blood samples were obtained from all patients for three consecutive months during the observation period for evaluation of thyroid function and measurement of inflammatory markers. The patients were then divided in two groups based on the cut-off value of 1.8 pg/mL for mean plasma freeT3, and were prospectively studied for a mean of 50.3 ± 30.8 mo regarding cumulative survival. The prognostic power of low serum fT3 levels for mortality was assessed using the Kaplan-Meier method and univariate and multivariate regression analysis.
RESULTS: Kaplan-Meier survival curve showed a negative predictive power for low freeT3. In Cox regression analysis low freeT3 remained a significant predictor of mortality after adjustment for age, diabetes mellitus, hypertension, hsCRP, serum creatinine and albumin. Regarding the possible association with inflammation, freeT3 was correlated with hsCRP, but not IL-6, and only at the first month of the study.
CONCLUSION: In chronic hemodialysis patients, low plasma freeT3 is a significant predictor of all-cause mortality. Further studies are required to identify the underlying mechanisms of this association.
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Balsamo C, Zucchini S, Maltoni G, Rollo A, Martini AL, Mazzanti L, Pession A, Cassio A. Relationships between thyroid function and autoimmunity with metabolic derangement at the onset of type 1 diabetes: a cross-sectional and longitudinal study. J Endocrinol Invest 2015; 38:701-7. [PMID: 25722223 DOI: 10.1007/s40618-015-0248-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/25/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Type 1 diabetes (T1DM) is an autoimmune disease often associated with thyroid abnormalities. PURPOSE We investigated the correlation between thyroid function and metabolic derangement at onset and the influence of autoimmunity on thyroid function at onset and subsequently. METHODS We evaluated 152 patients diagnosed with T1DM between 2000 and 2012 at onset and during a mean follow-up of 5.45 ± 2.8 years. Thyroid function at onset was correlated with metabolic derangement (degree of acidosis, metabolic control and adrenal function) and compared with that of 78 healthy children. Follow-up consisted of regular evaluation of thyroid function and autoimmunity. RESULTS Thyroid hormonal pattern was not influenced at onset by thyroid autoimmunity, but only by metabolic derangement: pH and base excess in fact were significantly lower in patients with impaired thyroid function (p < 0.0001). Patients presenting normal thyroid function at onset showed a reduced conversion from FT4 to FT3 compared to nondiabetic children (FT3/FT4 0.3 ± 0.4 in the control group, 0.24 ± 0.4 in diabetic patients, p < 0.0001). Multiple regression analysis showed the highest correlation (negative) between FT3 levels at onset and base excess (p < 0.005). Thyroid abnormalities related to metabolic derangement disappeared during follow-up. Patients with thyroid antibodies at T1DM onset were at higher risk to require levothyroxine treatment during follow-up (p < 0.05). CONCLUSIONS Thyroid function at T1DM onset is mainly influenced by metabolic derangement, irrespective of thyroid autoimmunity. Antithyroid antibodies evaluation at T1DM onset may be helpful to define which patients are at higher risk of developing hypothyroidism.
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Affiliation(s)
- C Balsamo
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - S Zucchini
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy.
| | - G Maltoni
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A Rollo
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A L Martini
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - L Mazzanti
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A Pession
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A Cassio
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
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Zygner W, Gójska-Zygner O, Bąska P, Długosz E. Low T3 syndrome in canine babesiosis associated with increased serum IL-6 concentration and azotaemia. Vet Parasitol 2015; 211:23-7. [PMID: 25976636 DOI: 10.1016/j.vetpar.2015.04.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 04/13/2015] [Accepted: 04/26/2015] [Indexed: 01/31/2023]
Abstract
Low triiodothyronine (T3) syndrome, also named euthyroid sick syndrome or non-thyroidal illness syndrome, has been recognized in canine babesiosis caused by Babesia rossi, where it manifested by lowering of the serum thyrotropin (TSH), total thyroxin (TT4) and free thyroxin (FT4) concentrations. This syndrome has also been observed in critical diseases in humans and animals, and the severity of the disease is considered an important factor in lowering of thyroid hormone concentrations. Interleukin-6 (IL-6) plays a role in the development of low T3 syndrome by causing a decrease in deiodinases 1 and 2 activity and increased activity of deiodinase 3, enzymes involved in the conversion of thyroxin (T4) to T3. The purpose of this study was to compare the concentrations of serum thyroid hormones and TSH between healthy dogs and dogs with babesiosis, and to determine correlations between serum IL-6 concentration and serum total T3 (TT3), TT4, FT4, and TSH concentrations, and the level of azotaemia in dogs with babesiosis. The concentrations of IL-6, TT3, TT4, FT4, TSH, urea and creatinine were determined in 13 dogs with canine babesiosis caused by Babesia canis and in 10 healthy dogs. The results of this study showed decreases in TT3, TT4, FT4, and TSH and increases in IL-6, urea and creatinine concentrations in affected dogs in comparison to healthy dogs. The concentration of IL-6 was negatively correlated with TT3 and TSH concentrations and the TT3 concentration was negatively correlated with serum urea and creatinine concentrations. This study showed low T3 syndrome in canine babesiosis, which was confirmed by the determination of the T3 concentration, and demonstrates that in canine babesiosis the T3 concentration is associated with IL-6 concentration.
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Affiliation(s)
- Wojciech Zygner
- Division of Parasitology, Department of Preclinical Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Ciszewskiego 8, 02-786 Warsaw, Poland.
| | | | - Piotr Bąska
- Division of Pharmacology and Toxicology, Department of Preclinical Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Ciszewskiego 8, 02-786 Warsaw, Poland
| | - Ewa Długosz
- Division of Parasitology, Department of Preclinical Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Ciszewskiego 8, 02-786 Warsaw, Poland
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Bai MF, Gao CY, Yang CK, Wang XP, Liu J, Qi DT, Zhang Y, Hao PY, Li MW. Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis. J Cardiol 2014; 64:496-500. [PMID: 24951271 DOI: 10.1016/j.jjcc.2014.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/10/2014] [Accepted: 03/15/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abnormal thyroid hormone metabolism influences the occurrence and progress of coronary heart disease (CHD). The aim of the present study was to analyze the severity of coronary artery lesions and the prognosis of thyroid dysfunction patients admitted for coronary angiography (CAG). METHODS From July 2011 to July 2012, 605 consecutive patients with suspected coronary heart disease admitted for CAG were selected. The patients were divided into three groups, based on their thyroid function prior to CAG: euthyroid group (n=455 patients), low T3 syndrome group (n=96 patients), and hypothyroidism group (n=54 patients). All patients underwent CAG. Then the severity of coronary artery lesions was assessed by Gensini scores. All patients were followed up for major adverse cardiac events. RESULTS The prevalence of CHD in low T3 syndrome group and hypothyroidism group was significantly higher than that in the euthyroid group (p<0.001 and p=0.004, respectively). Moreover, the severity of coronary artery lesions in low T3 syndrome group and hypothyroidism group was significantly greater than that in the euthyroid group (all p<0.001). Multinomial logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of coronary artery moderate [odds ratio (OR)=4.268, 95% CI: 3.294-7.450, p=0.016] and severe (OR=4.294, 95% CI: 2.259-9.703, p<0.001) lesions. The mean duration of follow-up was 15.3±3.8 months; patients with thyroid dysfunction had a significantly worse prognosis as compared to those in the euthyroid group for the composite end-point (p<0.01). Moreover, the incidence of the composite end-point (all-cause death, non-fatal myocardial infarction, and coronary revascularization) was significantly higher in low T3 syndrome group and hypothyroidism group compared with that of in the euthyroid group (all p<0.001). CONCLUSIONS The patients with hypothyroidism and low T3 syndrome had a high prevalence of CHD, increased severity of coronary artery lesions and poor prognosis.
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Affiliation(s)
- Min-fu Bai
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Chuan-yu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China.
| | - Chao-kuan Yang
- Department of Cardiology, Henan Medical College for Staff and Workers, Xinzheng, China.
| | - Xian-pei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jun Liu
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Da-tun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - You Zhang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
| | - Pei-yuan Hao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Mu-wei Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
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