Fastiggi Michele, Meneghel Alessandra, Gutierrez de Rubalcava Doblas Joaquin, Vittadello Fabio, Tirelli Francesca, Zulian Francesco, Martini Giorgia
Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy.
Pediatric Diabetes and Pediatric Metabolism Unit, Department of Woman and Child Health, University of Padova, Padova, Italy.
Front Pediatr. 2023 Aug 10;11:1217151. doi: 10.3389/fped.2023.1217151. eCollection 2023.
Euthyroid sick syndrome (ESS) is characterized by low serum levels of free triiodothyronine (fT3) with normal or low levels of thyroid stimulating hormone (TSH) and free thyroxine (fT4) and is reported in different acute clinical situations, such as sepsis, diabetic ketoacidosis and after cardiac surgery. Our aim was to evaluate the predicting role of ESS for disease severity in patients with Multisystem Inflammatory Syndrome in children (MIS-C).
A single-centre observational study on consecutive patients with MIS-C. Before treatment clinical, and laboratory data were collected and, in a subset of patients, thyroid function tests were repeated 4 weeks later. Variables distribution was analyzed by Mann-Whitney -test and correlations between different parameters were calculated by Spearman's Rho coefficient.
Forty-two patients were included and 36 (85.7%) presented ESS. fT3 values were significantly lower in patients requiring intensive care, a strong direct correlation was shown between fT3 and Hb, platelet count and ejection fraction values. A significant inverse correlation was retrieved between fT3 levels and C-reactive protein, brain natriuretic peptide, IL-2 soluble receptor and S-100 protein. Subjects with severe myocardial depression (EF < 45%) had lower fT3 values than subjects with higher EF. The thyroid function tests spontaneously normalized in all subjects who repeated measurement 4 weeks after admission.
ESS is a frequent and transient condition in acute phase of MIS-C. A severe reduction of fT3 must be considered as important prognostic factor for severe disease course, with subsequent relevant clinical impact in the management of these patients.
甲状腺功能正常的病态综合征（ESS）的特征是血清游离三碘甲状腺原氨酸（fT3）水平降低，而促甲状腺激素（TSH）和游离甲状腺素（fT4）水平正常或降低，在不同的急性临床情况下均有报道，如脓毒症、糖尿病酮症酸中毒以及心脏手术后。我们的目的是评估ESS对儿童多系统炎症综合征（MIS-C）患者疾病严重程度的预测作用。
对连续的MIS-C患者进行单中心观察性研究。在治疗前收集临床和实验室数据，并且在一部分患者中，4周后重复进行甲状腺功能测试。通过曼-惠特尼检验分析变量分布，并通过斯皮尔曼等级相关系数计算不同参数之间的相关性。
纳入42例患者,其中36例（85.7%）出现ESS。需要重症监护的患者fT3值显著更低，fT3与血红蛋白、血小板计数和射血分数值之间呈现出强烈的直接相关性。fT3水平与C反应蛋白、脑钠肽、白细胞介素-2可溶性受体和S-100蛋白之间存在显著的负相关。严重心肌抑制（射血分数<45%）的患者fT3值低于射血分数较高的患者。所有入院4周后重复测量的患者甲状腺功能测试均自发恢复正常。
ESS是MIS-C急性期常见的短暂情况。fT大幅降低必须被视为疾病严重病程的重要预后因素，对这些患者的管理具有后续相关的临床影响。
