Zargar A H, Ganie M A, Masoodi S R, Laway B A, Bashir M I, Wani A I, Salahuddin M
Department of Endocrinology and +Immunology, Sher-i-kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir.
J Assoc Physicians India. 2004 Jan;52:27-31.
Non-thyroidal illness is a common cause of alterations in thyroid hormone economy in absence of underlying intrinsic thyroid disorder.
To study the prevalence and pattern of alterations in thyroid hormone economy in various non-thyroidal illnesses in our region and also to correlate these alterations with the severity and outcome of the non-thyroidal illness.
We analyzed circulating T3, T4, TSH in 382 patients with non-thyroidal illness (285 acute and 97 acute on chronic) and correlated the alterations with severity and outcome of the non-thyroidal disorder. The patients had one or more organ failure at the time of enrollment to the study. The hormones were estimated at the onset of sickness, and at 3rd and 24th week. T3, T4 and TSH in 75 age and sex matched euthyroid subjects were taken as controls.
T3 (mean +/- SEM) was significantly reduced at the onset of illness, in both acute and chronic patient groups (1.61 +/- 0.05 nmol/l) compared to that in the controls (3.17 +/- 0.06 nmol/l). In spite of clinical improvement in most instances, T3 continued to remain low in the 3rd week (1.49 +/- 0.11 nmol/ l) but increased (2.14 +/- 0.09 nmol/l) in 24th week. Low T3 was found in 93 (32.6%) cases with acute illness in 20 (20.6%) cases with chronic illness. A combination of low T3 and T4 was found in 35 (12.3%) of cases with acute and 15 (15.5%) with chronic illness. Although serum TSH showed noticeable fall and rise in some individuals, no significant difference in mean TSH was observed during any period of illness compared to that in the controls. Severity of illness correlated with decrease in T3 (r=0.58) and T4 (r=0.38). A low T3 and T4 with low or undetectable TSH were associated with increased mortality. At the onset of acute illness low T3 was seen in 113 (29.6%, low T3 -low T4 in 50 (13.1%), high T4 in 28 (7.3%) lowT3-lowT4- low TSH in 10 (2.6%) and low T4 alone in 4 (1%) patients. Fifty one 1 (13.4%) of our patients demonstrated alterations in TSH in presence of normal T3 and T4-26 patients had decreased TSH while as 25 had increased TSH. Of 118 patients who followed at 24 weeks, 11 (9.3%) had low T3, 7(5.9%) had low T3- low T4 and 13 (11%) had elevated TSH.
Pattern and prevalence of sick euthyroid syndrome in this part of the world, a recognized iodine deficient region, appears to be similar to that reported elsewhere. Important finding in our study was higher percentage of TSH elevation, which we believe to reflect the underlying iodine deficiency state of our community. Besides a significant number of subjects persisted with alterations in thyroid functions even after 6 months of therapy. Though the severity of thyroid hormone derangement correlated with severity of sickness, the derangement was similar in acute vs. acute on chronic nonthyroidal illnesses.
非甲状腺疾病是在无潜在原发性甲状腺疾病情况下甲状腺激素代谢改变的常见原因。
研究本地区各种非甲状腺疾病中甲状腺激素代谢改变的患病率和模式，并将这些改变与非甲状腺疾病的严重程度和预后相关联。
我们分析了382例非甲状腺疾病患者（285例急性患者和97例慢性基础上的急性发作患者）的循环T3、T4、TSH，并将这些改变与非甲状腺疾病的严重程度和预后相关联。研究纳入时患者存在一种或多种器官功能衰竭。在疾病发作时、第3周和第24周对激素进行评估。75例年龄和性别匹配的甲状腺功能正常的受试者的T3、T4和TSH作为对照。
与对照组（3.17±0.06nmol/l）相比，急性和慢性患者组在疾病发作时T3（均值±标准误）显著降低（1.61±0.05nmol/l）。尽管在大多数情况下临床症状有所改善，但第3周时T3仍持续偏低（1.49±0.11nmol/l），而在第24周时升高（2.14±0.09nmol/l）。93例（32.6%）急性疾病患者和20例（20.6%）慢性疾病患者出现低T3。35例（12.3%）急性疾病患者和15例（15.5%）慢性疾病患者出现T3和T4均低的情况。尽管血清TSH在一些个体中出现明显下降和上升，但与对照组相比，在疾病的任何阶段平均TSH均未观察到显著差异。疾病严重程度与T3降低（r = 0.58）和T4降低（r = 0.38）相关。T3和T4低且TSH低或检测不到与死亡率增加相关。急性疾病发作时，113例（29.6%）患者出现低T3，50例（13.1%）患者出现低T3 -低T4，28例（7.3%）患者出现高T4，10例（2.6%）患者出现低T3 -低T4 -低TSH，4例（1%）患者仅出现低T4。51例（13.4%）患者在T3和T4正常时TSH出现改变，26例患者TSH降低，25例患者TSH升高。在随访24周的118例患者中，11例（9.3%）出现低T3，7例（5.9%）出现低T3 -低T4，13例（11%）出现TSH升高。
在这个世界上公认的碘缺乏地区，病态甲状腺功能正常综合征的模式和患病率似乎与其他地方报道的相似。我们研究中的重要发现是TSH升高的百分比更高，我们认为这反映了我们社区潜在的碘缺乏状态。此外，相当数量的受试者即使在治疗6个月后甲状腺功能仍持续存在改变。尽管甲状腺激素紊乱的严重程度与疾病严重程度相关，但急性非甲状腺疾病与慢性基础上的急性非甲状腺疾病中的紊乱情况相似。
