Leeuwen L, van Heijst A F J, van Rosmalen J, de Rijke Y B, Beurskens L W J E, Tibboel D, van den Akker E L T, IJsselstijn H
Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Neonatology, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands.
J Perinatol. 2017 Aug;37(8):906-910. doi: 10.1038/jp.2017.56. Epub 2017 Apr 27.
Thyroid hormone concentrations can be disturbed during critical illness. Our aim was to determine changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation (ECMO).
We included 21 ECMO-treated neonates. Age-specific s.d. scores (SDS) of free and total thyroxine (FT4; TT4), reverse and total triiodothyronine (rT3; TT3), thyroid-stimulating hormone (TSH) and thyroxine-binding globulin (TBG) were determined at six fixed time-points. Data were analyzed using general linear models.
At baseline, mean SDS FT4 (-0.78, 95% CI: -1.37 to -0.19), TT4 (-1.97, 95% CI: -2.76 to -1.18), TT3 (-0.88, 95% CI: -1.13 to -0.63), TSH (-2.14, 95% CI: -2.93 to -1.35) and TBG (-3.52, 95% CI: -4.55 to -2.50) were low with high mean SDS rT3 (0.53, 95% CI: 0.28 to 0.78). One hour after start ECMO, TT4, TSH and TBG had further declined; 12 h after start ECMO TT3 had declined (all P<0.05). After this decline, mean SDS TSH increased to the baseline level 12 h after start ECMO (-2.50, 95% CI: -3.22 to -1.79), and was higher than baseline 48 h after start ECMO (-0.56, 95% CI: -1.29 to 0.17). This TSH increase was followed by increases in TT4 and TT3. FT4 remained constant within the normal range during ECMO.
Thyroid hormone concentrations before ECMO were suggestive of non-thyroidal illness syndrome (NTIS). During ECMO, increases in TSH, TT4 and TT3 after an initial decline possibly reflect spontaneous restoration of the hypothalamic-pituitary-thyroid axis. FT4 remained constant within the normal range. This suggests that thyroxine therapy is not required during ECMO.
危重症期间甲状腺激素浓度可能会受到干扰。我们的目的是确定新生儿体外膜肺氧合（ECMO）期间甲状腺激素浓度的变化。
我们纳入了21例接受ECMO治疗的新生儿。在六个固定时间点测定游离和总甲状腺素（FT4；TT4）、反式和总三碘甲状腺原氨酸（rT3；TT3）、促甲状腺激素（TSH）和甲状腺素结合球蛋白（TBG）的年龄特异性标准差评分（SDS）。使用一般线性模型分析数据。
基线时，平均SDS FT4（-0.78，95%CI：-1.37至-0.19）、TT4（-1.97，95%CI：-2.76至-1.18）、TT3（-0.88，95%CI：-1.13至-0.63）、TSH（-2.14，95%CI：-2.93至-1.35）和TBG（-3.52，95%CI：-4.55至-2.50）较低，而平均SDS rT3较高（0.53，95%CI：0.28至0.78）。开始ECMO后1小时，TT4、TSH和TBG进一步下降；开始ECMO后12小时，TT3下降（所有P<0.05）。此次下降后，平均SDS TSH在开始ECMO后12小时升至基线水平（-2.50，95%CI：-3.22至-1.79），并在开始ECMO后48小时高于基线水平（-0.56，95%CI：-1.29至0.17）。TSH升高后，TT4和TT3随之升高。ECMO期间，FT4在正常范围内保持恒定。
ECMO前的甲状腺激素浓度提示非甲状腺疾病综合征（NTIS）。在ECMO期间，TSH、TT4和TT3在最初下降后升高，可能反映了下丘脑-垂体-甲状腺轴的自发恢复。FT4在正常范围内保持恒定。这表明ECMO期间不需要甲状腺素治疗。
