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B. Bewig - One of the best experts on this subject based on the ideXlab platform.
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Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases – implications for the Euthyroid Sick Syndrome
Intensive Care Medicine, 1999Co-Authors: H. Mönig, T. Arendt, M. Meyer, S. Kloehn, B. BewigAbstract:Objective : To determine whether cytokine release or activation of the hypothalamo-pituitary-adrenal (HPA) axis is predominantly involved in the development of the Euthyroid Sick Syndrome (ESS). Design : Prospective observational study. Setting : Intensive care unit at a tertiary care medical center in Germany. Patients : Nine patients with sepsis of different causes and eight patients with acute myocardial infarction. Interventions : None. Measurements and results : Immediately on admission and on day 7 the following parameters were determined: total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), thyrotropin (TSH), interleukin-1 β (IL-1 β ), interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), serum cortisol and plasma adrenocorticotropin (ACTH). On admission, concentrations of all thyroid hormones and TSH were significantly lower in septic patients compared to non-septic patients, whereas all cytokines except IL-2 were significantly elevated in the sepsis group. By contrast, there was no difference in serum cortisol and plasma ACTH levels between the two groups. On day 7, T4 and T3 were still lower in the septic group, whereas IL-1 β , sIL-2R and IL-6 were still elevated. Again, no differences were found with regard to cortisol and ACTH levels. Conclusions : Euthyroid Sick Syndrome occurs very early during the course of septic diseases. Significantly decreased levels of total T4, FT4, T3 and TSH in septic patients suggest central suppression of TSH as well as inhibition of thyroid hormone release in ESS. The HPA axis is activated in septic patients and in non-septic patients and does not contribute to the development of ESS.
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Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases--implications for the Euthyroid Sick Syndrome.
Intensive care medicine, 1999Co-Authors: H. Mönig, T. Arendt, M. Meyer, S. Kloehn, B. BewigAbstract:Objective: To determine whether cytokine release or activation of the hypothalamo-pituitary-adrenal (HPA) axis is predominantly involved in the development of the Euthyroid Sick Syndrome (ESS). Design: Prospective observational study. Setting: Intensive care unit at a tertiary care medical center in Germany. Patients: Nine patients with sepsis of different causes and eight patients with acute myocardial infarction. Interventions: None. Measurements and results: Immediately on admission and on day 7 the following parameters were determined: total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), thyrotropin (TSH), interleukin-1β (IL-1β), interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), serum cortisol and plasma adrenocorticotropin (ACTH). On admission, concentrations of all thyroid hormones and TSH were significantly lower in septic patients compared to non-septic patients, whereas all cytokines except IL-2 were significantly elevated in the sepsis group. By contrast, there was no difference in serum cortisol and plasma ACTH levels between the two groups. On day 7, T4 and T3 were still lower in the septic group, whereas IL-1β, sIL-2R and IL-6 were still elevated. Again, no differences were found with regard to cortisol and ACTH levels. Conclusions: Euthyroid Sick Syndrome occurs very early during the course of septic diseases. Significantly decreased levels of total T4, FT4, T3 and TSH in septic patients suggest central suppression of TSH as well as inhibition of thyroid hormone release in ESS. The HPA axis is activated in septic patients and in non-septic patients and does not contribute to the development of ESS.
Eliane Gluckman - One of the best experts on this subject based on the ideXlab platform.
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the Euthyroid Sick Syndrome incidence risk factors and prognostic value soon after allogeneic bone marrow transplantation
British Journal of Haematology, 1993Co-Authors: Patrick Vexiau, Patricia Perezcastiglioni, Gerard Socie, A Devergie, Marie Elisabeth Toubert, S Aractingi, Eliane GluckmanAbstract:Summary We studied the incidence of thyroid function abnormalities observed soon after allogeneic bone marrow transplantations (BMT) and their predictive value on the overall prognosis. Free serum thyroxine, free serum triiodothyronine, total serum reverse triiodothyronine and serum thyrotropin levels were systematically measured in 78 patients before and 3 months after BMT. 41 (52%) had normal hormone levels and 37 (48%) had abnormal ones, among whom four (5%) had peripheral compensated hypothyroidism and 33 (43%) were described as having ‘Euthyroid Sick Syndrome’ (low thyroxine state, or low T3 Syndrome). Two factors strongly influenced the appearance of thyroid abnormalities: steroid dose at the time of thyroid function testing, and age (≤16 years/>16 years). Among the younger patients, 21 had no thyroid abnormalities, while five did. Among the older patients. 20 had no thyroid abnormalities, while 32 did (P<0.001). The occurrence of thyroid abnormalities seemed to influence survival strongly, since the 30-month projected survival time was 83% for patients without abnormalities whereas it was 49% for patients with an abnormal profile (P < 0.001). In conclusion, evidence obtained among our population reveals that Euthyroid Sick Syndrome indicates a poor prognosis and that it is very important to monitor thyroid hormone levels (particnlady free hormones) soon after allogeneic BMT and regularly thereafter.
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The 'Euthyroid Sick Syndrome': incidence, risk factors and prognostic value soon after allogeneic bone marrow transplantation.
British journal of haematology, 1993Co-Authors: Patrick Vexiau, Gerard Socie, A Devergie, Marie Elisabeth Toubert, S Aractingi, Patricia Perez-castiglioni, Eliane GluckmanAbstract:Summary We studied the incidence of thyroid function abnormalities observed soon after allogeneic bone marrow transplantations (BMT) and their predictive value on the overall prognosis. Free serum thyroxine, free serum triiodothyronine, total serum reverse triiodothyronine and serum thyrotropin levels were systematically measured in 78 patients before and 3 months after BMT. 41 (52%) had normal hormone levels and 37 (48%) had abnormal ones, among whom four (5%) had peripheral compensated hypothyroidism and 33 (43%) were described as having ‘Euthyroid Sick Syndrome’ (low thyroxine state, or low T3 Syndrome). Two factors strongly influenced the appearance of thyroid abnormalities: steroid dose at the time of thyroid function testing, and age (≤16 years/>16 years). Among the younger patients, 21 had no thyroid abnormalities, while five did. Among the older patients. 20 had no thyroid abnormalities, while 32 did (P
Giulio Maccauro - One of the best experts on this subject based on the ideXlab platform.
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Euthyroid Sick Syndrome in hip fractures: Valuation of vitamin D and parathyroid hormone axis.
Injury, 2020Co-Authors: Raffaele Vitiello, Carlo Perisano, Marcello Covino, Andrea Perna, Antonio Bianchi, Maria Serena Oliva, Tommaso Greco, Mattia Sirgiovanni, Giulio MaccauroAbstract:Femur fracture is an acute event with a high incidence and mortality worldwide. Euthyroid Sick Syndrome (ESS) is a disease characterized by an alteration of fT3 in the absence of a primary thyroid pathology. The aim of the study is evaluating the association between femur fracture and ESS and post-operative fluctuations of the parathyroid hormone (PTH) and vitamin D and their physio-pathological implications. All patients older than 65 years, admitted in our emergency care unit with a diagnosis of proximal femur fracture were recruited. Exclusion criteria were acute cardio-pulmonary events, neoplastic diseases, any thyroid or endocrine pathology and use of drugs with thyroidal interactions. All patients underwent surgery within 48 h from the injury. The outcome of the study is the presence of ESS, moreover, post-operative fluctuations of the PTH and vitamin D are also evaluated. 45 patients (13 men and 32 females) were enrolled. 20 patients had a normal thyroidal function, while 23 had a diagnosis of ESS. Mean age was 81.9. BMI was lower in the ESS group than the controls (25,3 vs 22,7; p < 0.02). In the ESS group a significantly higher decrease in Vitamin D levels was observed, compared to controls (3.96 ng/ml, p<0.001). Values of PTH were significantly different between the two groups, with a level 44.29 pg/ml lower among the ESS group compared to controls (p = 0.002). In the ESS group a significant decrease of serum calcium on the first post-surgery day was observed, compared to controls (8,7 vs 8,3; p < 0,01). There were no differences in the CCI, serum electrolytes and other variables collected between the two groups. Part of the geriatric population suffering from fractures of the proximal femur are affected by ESS. This population displays anomalies of the Vitamin d-PTH axis and a lower BMI. Copyright © 2020 Elsevier Ltd. All rights reserved.
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Euthyroid Sick Syndrome in hip fractures: Valuation of vitamin D and parathyroid hormone axis.
Injury, 2020Co-Authors: Raffaele Vitiello, Carlo Perisano, Marcello Covino, Andrea Perna, Antonio Bianchi, Maria Serena Oliva, Tommaso Greco, Mattia Sirgiovanni, Giulio MaccauroAbstract:Abstract Introduction Femur fracture is an acute event with a high incidence and mortality worldwide. Euthyroid Sick Syndrome (ESS) is a disease characterized by an alteration of fT3 in the absence of a primary thyroid pathology. The aim of the study is evaluating the association between femur fracture and ESS and post-operative fluctuations of the parathyroid hormone (PTH) and vitamin D and their physio-pathological implications. Materials and Methods All patients older than 65 years, admitted in our emergency care unit with a diagnosis of proximal femur fracture were recruited. Exclusion criteria were acute cardio-pulmonary events, neoplastic diseases, any thyroid or endocrine pathology and use of drugs with thyroidal interactions. All patients underwent surgery within 48 h from the injury. The outcome of the study is the presence of ESS, moreover, post-operative fluctuations of the PTH and vitamin D are also evaluated. Result 45 patients (13 men and 32 females) were enrolled. 20 patients had a normal thyroidal function, while 23 had a diagnosis of ESS. Mean age was 81.9. BMI was lower in the ESS group than the controls (25,3 vs 22,7; p Conclusion Part of the geriatric population suffering from fractures of the proximal femur are affected by ESS. This population displays anomalies of the Vitamin d -PTH axis and a lower BMI.
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Euthyroid Sick Syndrome in hip fractures: Evaluation of postoperative anemia.
Injury, 2020Co-Authors: Cauteruccio M, Raffaele Vitiello, Carlo Perisano, Marcello Covino, Sircana G, Piccirillo N, Elisa Pesare, A Ziranu, Giulio MaccauroAbstract:Abstract Introduction Incidence of hip fractures is increasing with upward estimates representing one of the most current health problems. According to some authors this condition is associated with an early mortality rate ranging between 20% and 35% and low outcomes. One of the predictive factors of poor outcome after hip fracture is anaemia. In fragile patients, hormonal changes due to fracture and surgical trauma, may occur in the hypophyseal hypothalamus axis which may lead to the Euthyroid Sick Syndrome (ESS). This pathological condition is characterized by a reduction in the concentration of triiodothyronine (T3) with normal or slightly reduced thyrotropin (TSH) values and with or without a reduction (cancellata) of thyroxine (T4). ESS has been associated to an increased mortality in elderly patients. Materials and methods Inclusion criteria were: age > 65y, X-ray diagnosis of proximal femoral fracture classified as AO 31A or 31B requiring surgical treatment, admittance to the emergency room within 72 hours from trauma. Exclusion criteria were: any thyroid-related pathology, concomitant acute coronary Syndrome, active pneumonia, concomitant neoplastic disease, assumption of medications able to affect thyroid function, refusal to undergo surgical treatment. All patients underwent routine blood testing and a complete thyroid-hormone profile dosage before surgical operation. The same blood tests performed before surgical operation were repeated on the first and third post-operative days. Results Thirtytwo patients met the inclusion criteria and were enrolled after they accepted to participate to the study. Sixteen patients presented with ESS on admission and 16 patients did not. The mean age was 82,5 yo. There was no statistically significant difference in bleeding risk factors among the two groups. In the ESS group there was a number of blood transfusions of 1.06 units higher than the control group (p=0.01). Conclusions We have demonstrated that patients with ESS have a higher need of red blood cells transfusion compared to patients without ESS and, thus they have a higher risk to develop anemia in the peri-operative period. We believe it would be useful to diagnose ESS in fragile patients at their arrival to the emergency room and apply a peri-operative therapeutic protocol to prevent anemia.
Clive S. Cockram - One of the best experts on this subject based on the ideXlab platform.
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Euthyroid Sick Syndrome in pulmonary tuberculosis before and after treatment
Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, 1995Co-Authors: Chun-chung Chow, Tony W.-l. Mak, C H S Chan, Clive S. CockramAbstract:SUMMARY. Alterations of circulating thyroid hormones are frequently present in chronic nonthyroidal illnesses and may predict prognosis. Pulmonary tuberculosis, a common treatable debilitating disease, may provide a useful model for detailed evaluation of changes of thyroid hormones in relation to subsequent recovery or mortality. Over a period of 12 months, we performed a prospective study of 40 consecutive Chinese patients aged over 50 years and admitted with newly diagnosed pulmonary tuberculosis. Blood samples were drawn for serial thyroid function tests [free thyroxine (T 4 ) , free triiodothyronine (T 3 ) and thyroid-stimulating hormone] before treatment and at I, 2 and 4 months afterwards. Mortality was determined up to 12 months of follow-up. The Euthyroid Sick Syndrome occurred in 63% of patients at presentation. Twelve of 25 Euthyroid Sick patients died as compared to one of 15 patients with normal baseline thyroid function tests (P
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Euthyroid Sick Syndrome in pulmonary tuberculosis before and after treatment.
Annals of clinical biochemistry, 1995Co-Authors: Chun-chung Chow, Tony W.-l. Mak, C H S Chan, Clive S. CockramAbstract:Alterations of circulating thyroid hormones are frequently present in chronic nonthyroidal illnesses and may predict prognosis. Pulmonary tuberculosis, a common treatable debilitating disease, may provide a useful model for detailed evaluation of changes of thyroid hormones in relation to subsequent recovery or mortality. Over a period of 12 months, we performed a prospective study of 40 consecutive Chinese patients aged over 50 years and admitted with newly diagnosed pulmonary tuberculosis. Blood samples were drawn for serial thyroid function tests [free thyroxine (T4), free triiodothyronine (T3) and thyroid-stimulating hormone] before treatment and at 1, 2 and 4 months afterwards. Mortality was determined up to 12 months of follow-up. The Euthyroid Sick Syndrome occurred in 63% of patients at presentation. Twelve of 25 Euthyroid Sick patients died as compared to one of 15 patients with normal baseline thyroid function tests (P < 0.02). Among Euthyroid Sick patients, those who died had significantly lower free T3 concentration at presentation than those who survived (P < 0.05). An undetectable free T3 concentration at presentation was associated with a subsequent mortality of 75% (9 of 12). Of the survivors, all patients demonstrated a significant rise in serum free T4 concentrations following treatment, which was apparent by 1 month. These data suggest that an undetectable free T3 concentration at presentation reflects severity of illness and predicts a subsequent high mortality.
H. Mönig - One of the best experts on this subject based on the ideXlab platform.
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Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases – implications for the Euthyroid Sick Syndrome
Intensive Care Medicine, 1999Co-Authors: H. Mönig, T. Arendt, M. Meyer, S. Kloehn, B. BewigAbstract:Objective : To determine whether cytokine release or activation of the hypothalamo-pituitary-adrenal (HPA) axis is predominantly involved in the development of the Euthyroid Sick Syndrome (ESS). Design : Prospective observational study. Setting : Intensive care unit at a tertiary care medical center in Germany. Patients : Nine patients with sepsis of different causes and eight patients with acute myocardial infarction. Interventions : None. Measurements and results : Immediately on admission and on day 7 the following parameters were determined: total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), thyrotropin (TSH), interleukin-1 β (IL-1 β ), interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), serum cortisol and plasma adrenocorticotropin (ACTH). On admission, concentrations of all thyroid hormones and TSH were significantly lower in septic patients compared to non-septic patients, whereas all cytokines except IL-2 were significantly elevated in the sepsis group. By contrast, there was no difference in serum cortisol and plasma ACTH levels between the two groups. On day 7, T4 and T3 were still lower in the septic group, whereas IL-1 β , sIL-2R and IL-6 were still elevated. Again, no differences were found with regard to cortisol and ACTH levels. Conclusions : Euthyroid Sick Syndrome occurs very early during the course of septic diseases. Significantly decreased levels of total T4, FT4, T3 and TSH in septic patients suggest central suppression of TSH as well as inhibition of thyroid hormone release in ESS. The HPA axis is activated in septic patients and in non-septic patients and does not contribute to the development of ESS.
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Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases--implications for the Euthyroid Sick Syndrome.
Intensive care medicine, 1999Co-Authors: H. Mönig, T. Arendt, M. Meyer, S. Kloehn, B. BewigAbstract:Objective: To determine whether cytokine release or activation of the hypothalamo-pituitary-adrenal (HPA) axis is predominantly involved in the development of the Euthyroid Sick Syndrome (ESS). Design: Prospective observational study. Setting: Intensive care unit at a tertiary care medical center in Germany. Patients: Nine patients with sepsis of different causes and eight patients with acute myocardial infarction. Interventions: None. Measurements and results: Immediately on admission and on day 7 the following parameters were determined: total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), thyrotropin (TSH), interleukin-1β (IL-1β), interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), serum cortisol and plasma adrenocorticotropin (ACTH). On admission, concentrations of all thyroid hormones and TSH were significantly lower in septic patients compared to non-septic patients, whereas all cytokines except IL-2 were significantly elevated in the sepsis group. By contrast, there was no difference in serum cortisol and plasma ACTH levels between the two groups. On day 7, T4 and T3 were still lower in the septic group, whereas IL-1β, sIL-2R and IL-6 were still elevated. Again, no differences were found with regard to cortisol and ACTH levels. Conclusions: Euthyroid Sick Syndrome occurs very early during the course of septic diseases. Significantly decreased levels of total T4, FT4, T3 and TSH in septic patients suggest central suppression of TSH as well as inhibition of thyroid hormone release in ESS. The HPA axis is activated in septic patients and in non-septic patients and does not contribute to the development of ESS.
