Development of a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients.

PURPOSE: Thyroid dysfunction in COVID-19 carries clinical and prognostic implications. In this study, we developed a prediction score (ThyroCOVID) for abnormal thyroid function (TFT) on admission amongst COVID-19 patients. METHODS: Consecutive COVID-19 patients admitted to Queen Mary Hospital were prospectively recruited during July 2020-May 2021. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were measured on admission. Multivariable logistic regression analysis was performed to identify independent determinants of abnormal TFTs. ThyroCOVID was developed based on a clinical model with the lowest Akaike information criteria. RESULTS: Five hundred and forty six COVID-19 patients were recruited (median age 50 years, 45.4% men, 72.9% mild disease on admission). 84 patients (15.4%) had abnormal TFTs on admission. Patients with abnormal TFTs were more likely to be older, have more comorbidities, symptomatic, have worse COVID-19 severity, higher SARS-CoV-2 viral loads and more adverse profile of acute-phase reactants, haematological and biochemical parameters. ThyroCOVID consisted of five parameters: symptoms (malaise), comorbidities (ischaemic heart disease/congestive heart failure) and laboratory parameters (lymphocyte count, C-reactive protein, and SARS-CoV-2 cycle threshold values). It was able to identify abnormal TFT on admission with an AUROC of 0.73 (95% CI 0.67-0.79). The optimal cut-off of 0.15 had a sensitivity of 75.0%, specificity of 65.2%, negative predictive value of 93.5% and positive predictive value of 28.1% in identifying abnormal TFTs on admission amongst COVID-19 patients. CONCLUSION: ThyroCOVID, a prediction score to identify COVID-19 patients at risk of having abnormal TFT on admission, was developed based on a cohort of predominantly non-severe COVID-19 patients.

Correlation and Prognostic Assessment of Low T3 Syndrome and Norepinephrine Dosage for Patients with Sepsis: A Retrospective Single-Center (Cohort) Study.

Purpose: To investigate the correlation and prognostic significance of low triiodothyronine (T3) syndrome and norepinephrine dosage in patients with sepsis and septic shock. Methods: This single-center, retrospective, cohort study enrolled 169 patients with sepsis and septic shock that were admitted to the intensive care unit of First Hospital of Nanchang, Nanchang, China from June 2017 to July 2019. All included patients were followed up for 28 days or died, whichever was earlier. Patients with free T3 (FT3) of <3.1 pmol/L were considered with low T3 syndrome. The correlation and prognostic significance of the FT3 and maximum dosage of norepinephrine (MDN) within 72 h, as well as other clinical indicators, were analyzed by using correlation analysis, principal component analysis, receiver operating characteristic curve, Youden index, and logistic regression. Results: A total of 138 patients were allocated to the low T3 group. FT3 inversely correlated with the Sequential Organ Failure Assessment (SOFA) score within 24 h, fluid resuscitation volume within 24 h, and lactic acid levels, and positively correlated with the mean arterial pressure. The critical values of age, SOFA, and MDN for predicting the 28-day mortality were 79.5 years, 8.5 points, and 0.61 µg/kg/min, respectively. The mortality of the low T3 and normal T3 groups was similar. Considering the MDN of 0.61 µg/kg/min as the cutoff value, the mortality between the two groups was significantly different. Conclusion: Among patients with sepsis and septic shock, FT3 was inversely correlated with the disease severity. An MDN ≥ 0.61 µg/kg/min within 72 h may be an important prognostic indicator.

Deiodinases and the Three Types of Thyroid Hormone Deiodination Reactions.

Thyroid hormone (TH) signaling is strictly regulated by iodothyronine deiodinase activity, which both preserves the circulating levels of the biologically active triiodothyronine (T3) and regulates TH homeostasis at the local level, in a cell- and time-dependent manner. Three deiodinases have been identified-namely iodothyronine deiodinase 1 (DIO1), DIO2, and DIO3-that differ in their catalytic properties and tissue distribution. The deiodinases represent a dynamic system that changes in the different stages of life according to their functions and roles in various cell types and tissues. Deiodinase activity at the tissue level permits cell-targeted fine regulation of TH homeostasis, mediating the activation (DIO1 and DIO2) and inactivation (DIO3) of THs. Deiodinase homeostasis is the driving force that leads T3-target cells towards customized TH signaling, which takes into account both the hormonal circulating levels and the tissue-specific response. This review analyzes the complex role of deiodinases in physiological and pathological contexts, exploring new challenges and opportunities deriving from a deeper knowledge of the dynamics underlying their roles and functions.

Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients.

BACKGROUND: Data on the association between coronavirus disease 2019 (COVID-19) and thyroid have been reported, including overt thyrotoxicosis and suppression of thyroid function. We aimed to evaluate the thyroid hormone profile and its association with the prognosis of COVID-19 in Korean patients. METHODS: The clinical data of 119 patients with COVID-19, admitted in the Myongji Hospital, Goyang, South Korea, were retrospectively evaluated. The thyroid hormone profiles were analyzed and compared based on disease severity (non-severe disease vs. severe to critical disease). Clinical outcomes were analyzed according to the tertiles of thyroid hormones. RESULTS: Of the 119 patients, 76 (63.9%) were euthyroid, and none presented with overt thyroid dysfunction. Non-thyroidal illness syndrome was the most common manifestation (18.5%), followed by subclinical thyrotoxicosis (14.3%) among patients with thyroid dysfunction. Thyroid stimulating hormone (TSH) and triiodothyronine (T3) levels were significantly lower in patients with severe to critical disease than in those with non-severe disease (P<0.05). Patients in the lowest T3 tertile (<0.77 ng/mL) had higher rates of mechanical ventilation, intensive care unit admission, and death than those in the middle and highest (>1.00 ng/mL) T3 tertiles (P<0.05). COVID-19 patients in the lowest T3 tertile were independently associated with mortality (hazard ratio, 5.27; 95% confidence interval, 1.09 to 25.32; P=0.038) compared with those in the highest T3 tertile. CONCLUSION: Thyroid dysfunction is common in COVID-19 patients. Changes in serum TSH and T3 levels may be important markers of disease severity in COVID-19. Decreased T3 levels may have a prognostic significance in COVID-19 related outcome.

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors.

BACKGROUND: The occurrence of Graves' disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. METHODS: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. RESULTS: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. CONCLUSION: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Role of non-thyroidal illness syndrome in predicting adverse outcomes in COVID-19 patients predominantly of mild-to-moderate severity.

OBJECTIVE: Existing studies reported the potential prognostic role of non-thyroidal illness syndrome (NTIS), characterized by low triiodothyronine (T3) with normal/low thyroid-stimulating hormone (TSH), mainly in severe COVID-19. None considered the significant impact of SARS-CoV-2 viral load on adverse outcomes. We aimed to clarify the prognostic role of NTIS among predominantly mild-to-moderate COVID-19 patients. DESIGN: A prospective study of COVID-19 patients. PATIENTS AND MEASUREMENTS: Consecutive adults admitted to Queen Mary Hospital for confirmed COVID-19 from July to December 2020 were prospectively recruited. SARS-CoV-2 viral load was represented by cycle threshold (Ct) values from real-time reverse transcription-polymerase chain reaction of the respiratory specimen on admission. Serum TSH, free thyroxine and free T3 were measured on admission. The outcome was deterioration in clinical severity, defined as worsening in ≥1 category of clinical severity according to the Chinese National Health Commission guideline. RESULTS: We recruited 367 patients. At baseline, 75.2% had mild disease, and 27 patients (7.4%) had NTIS. Fifty-three patients (14.4%) had clinical deterioration. Patients with NTIS were older, had more comorbidities, worse symptomatology, higher SARS-CoV-2 viral loads and worse profiles of inflammatory and tissue injury markers. They were more likely to have clinical deterioration (p < .001). In multivariable stepwise logistic regression analysis, NTIS independently predicted clinical deterioration (adjusted odds ratio 3.19, p = .017), in addition to Ct value <25 (p < .001), elevated C-reactive protein (p = .004), age >50 years (p = .011) and elevated creatine kinase (p = .017). CONCLUSIONS: Non-thyroidal illness syndrome was not uncommon even in mild-to-moderate COVID-19 patients. NTIS on admission could predict clinical deterioration in COVID-19, independent of SARS-CoV-2 viral load, age and markers of inflammation and tissue injury.

The Independent Association of TSH and Free Triiodothyronine Levels With Lymphocyte Counts Among COVID-19 Patients.

Background: Both lymphopenia and thyroid dysfunction are commonly observed among COVID-19 patients. Whether thyroid function independently correlates with lymphocyte counts (LYM) remains to be elucidated. Methods: We included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to April 2021 who had thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3) and LYM measured on admission. Results: A total of 541 patients were included. Median LYM was 1.22 x 109/L, with 36.0% of the cohort lymphopenic. 83 patients (15.4%) had abnormal thyroid function tests (TFTs), mostly non-thyroidal illness syndrome (NTIS). Patients with lymphopenia had lower TSH, fT4 and fT3 levels than those without. Multivariable stepwise linear regression analysis revealed that both TSH (standardized beta 0.160, p<0.001) and fT3 (standardized beta 0.094, p=0.023), but not fT4, remained independently correlated with LYM, in addition to age, SARS-CoV-2 viral load, C-reactive protein levels, coagulation profile, sodium levels and more severe clinical presentations. Among the 40 patients who had reassessment of TFTs and LYM after discharge, at a median of 9 days from admission, there were significant increases in TSH (p=0.031), fT3 (p<0.001) and LYM (p<0.001). Furthermore, patients who had both lymphopenia and NTIS were more likely to deteriorate compared to those who only had either one alone, and those without lymphopenia or NTIS (p for trend <0.001). Conclusion: TSH and fT3 levels showed independent positive correlations with LYM among COVID-19 patients, supporting the interaction between the hypothalamic-pituitary-thyroid axis and immune system in COVID-19.

Thyroid Dysfunction in Relation to Immune Profile, Disease Status, and Outcome in 191 Patients with COVID-19.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related thyroiditis is increasingly recognized. The role of thyroid autoimmunity and SARS-CoV-2 viral load in SARS-CoV-2-related thyroid dysfunction is unclear. We evaluated the thyroid function of a cohort of coronavirus disease 2019 (COVID-19) patients, in relation to their clinical features, and biochemical, immunological, and inflammatory markers. METHODS: Consecutive adult patients, without known thyroid disorders, admitted to Queen Mary Hospital for COVID-19 from July 21 to August 21, 2020, were included. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine (fT3), and antithyroid antibodies were measured on admission. RESULTS: Among 191 patients with COVID-19 (mean age 53.5 ±â€…17.2 years; 51.8% male), 84.3% were mild, 12.6% were moderate, and 3.1% were severe. Abnormal thyroid function was seen in 13.1%. Ten patients had isolated low TSH, suggestive of subclinical thyrotoxicosis due to thyroiditis, although the contribution of autoimmunity was likely in 2 of them. Autoimmune thyroiditis probably also contributed to subclinical hypothyroidism in another patient. Ten patients had isolated low fT3, likely representing nonthyroidal illness syndrome. Lower SARS-Cov-2 polymerase chain reaction cycle threshold values and elevated C-reactive protein were independently associated with occurrence of low TSH (P = .030) and low fT3 (P = .007), respectively. A decreasing trend of fT3 with increasing COVID-19 severity (P = .032) was found. Patients with low fT3 had more adverse COVID-19-related outcomes. CONCLUSION: Around 15% of patients with mild to moderate COVID-19 had thyroid dysfunction. There may be a direct effect of SARS-CoV-2 on thyroid function, potentially leading to exacerbation of pre-existing autoimmune thyroid disease. Low fT3, associated with systemic inflammation, may have a prognostic significance.

La T3 baja marcaría peor evolución en pacientes internados por insuficiencia cardíaca descompensada / Low T3 Would Indicate Adverse Outcomes for Inpatients with Decompensated Heart Failure

RESUMEN Introducción: El síndrome de T3 baja se asocia con niveles elevados de interleucinas y citoquinas circulantes, lo que refuerza la hipótesis de una estrecha relación entre el sistema neuroendocrino y ciertos mecanismos inflamatorios e inmunológicos, involucrados en la insuficiencia cardíaca. Objetivo: Evaluar la evolución de pacientes ingresados por insuficiencia cardíaca descompensada según niveles de T3 al ingreso, y eventos durante la hospitalización y en el seguimiento. Material y métodos: Estudio prospectivo, observacional, analítico de 524 pacientes internados por primera vez con diagnóstico de insuficiencia cardíaca descompensada. Se evaluó la mortalidad intrahospitalaria, y al seguimiento y readmisiones de acuerdo con niveles de T3 normal o disminuida al ingreso. Se excluyeron 91 pacientes con distiroidismo conocido, hipotiroidismo o hipertiroidismo, cirugía tiroidea previa, sepsis o síndrome coronario agudo. Se realizó un análisis de subgrupo de pacientes según recibieran crónicamente amiodarona y se evaluaron variables pronosticas. Resultados: De 433 pacientes analizados, el 40,0% presentaban bajos niveles de T3 (BT3). La edad, albúmina, TFG y edad mayor de 75 años, fueron predictores independientes de BT3. Si bien se observó un aumento en ambos grupos en la adecuación de tratamientos recomendados por las guías, el grupo de BT3 mostró significativamente tasas menores de estos con respecto a aquellos con T3 normal (BT3 vs. NT3: betabloqueantes 81,5% vs. 89,4%, p = 0,02; IECA/ARAII 78,5% vs. 87,9% p <0,001; antialdosterónicos 29,2% vs. 40,5% p = 0,019). La mortalidad hospitalaria fue mayor en BT3 (5,8% vs. 1,5%) sin diferencias en readmisiones o mortalidad en el seguimiento. Del subgrupo de pacientes sin amiodarona al ingreso (353), 37,8% tenían BT3. Se halló que los pacientes de este subgrupo presentaron diferencias significativas en cuanto a mortalidad intrahospitalaria y mortalidad en seguimiento (5,3% en BT3 vs. 0,9% NT3; p = 0,03 y 40,2% vs. 26,6%; p = 0,023), respectivamente. Conclusiones: Los pacientes ingresados por insuficiencia cardíaca descompensada con T3 baja al ingreso representarían un subgrupo de pacientes con enfermedad más grave y peor pronóstico durante la internación.

ABSTRACT Background: Low T3 syndrome is associated with elevated circulating levels of cytokines and interleukins, reinforcing the hypothesis of a close relation between the neuroendocrine system and certain inflammatory and immunological mechanisms involved in heart failure. Objective: To assess the progress of patients admitted for decompensated heart failure according to T3 levels on admission, and events during hospitalization and follow-up. Materials and methods: It was a prospective, observational, analytical study of 524 patients hospitalized for the first time with a diagnosis of decompensated heart failure. In-hospital and follow-up mortality and readmissions were evaluated according to normal or low T3 levels on admission. Ninety-one patients with known dysthyroidism, hypo or hyperthyroidism, previous thyroid surgery, sepsis or acute coronary syndrome were excluded. A subgroup analysis of patients receiving chronic amiodarone therapy was conducted, and prognostic variables were evaluated. Results: Of the 433 patients analyzed, 40.0% had low T3 (LT3) levels. Age, albumin level, age >75 years, and glomerular filtration rate (GFR) were independent predictors of LT3. While adaptation of guideline-recommended treatments increased in both groups, treatment rates in the LT3 group were significantly lower than those in the normal T3 (NT3) group (LT3 vs. NT3: Betablockers 81.5% vs. 89.4%, p=0.02; ACEI/ARA II 78.5% vs. 87.9%, p=0.001; anti-aldosterone agents 29.2% vs. 40.5%; p=0.019). Hospital mortality was higher in the LT3 group (5.8 vs. 1.5%), with no difference in rehospitalizations or mortality rates at follow-up. Of the subgroup of patients without amiodarone on admission (353), 37.8% had LT3. Patients in this subgroup were found to have significant differences in follow-up and in-hospital mortality (5.3% in LT3 vs. 0.9% in NT3, p=0.03, and 40.2% vs. 26.6%, p=0.023) respectively. Conclusions: Decompensated heart failure patients with LT3 on admission would represent a subgroup with more severe disease and worse prognosis during hospitalization.

[Impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis].

Objective: To determine the impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis. Methods: The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis (onset of symptoms<1 month,patients were divided into low serum free triiodothyronine (FT3, n=20) group and normal FT3 (n=114) group. General information, clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed. Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine (TT3), normal or decreased free thyroxine (FT4) and total thyroxine (TT4) as well as normal thyroid stimulating hormone (TSH). Composite adverse cardiovascular events included death, persistent ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiac arrest. Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis. Results: Systolic blood pressure was significantly lower (P<0.01),while heart rate (P=0.004) and the prevalence of VT/VF were significantly higher (P=0.017) in low T3 group than in the normal T3 group. Level of white blood cell,C response protein,fasting glucose (all P<0.01) as well as creatinine (P=0.035) were significantly higher, while level of FT3 and left ventricular ejection fraction (LVEF) were significantly lower (both P<0.01) in low T3 group than in normal T3 group. Multivariate logistic regression analysis revealed that LVEF at admission less than 40% (OR=6.615,95%CI 1.186-36.907, P=0.031) and FT3 level less than 1.79 ng/L (OR=9.131, 95%CI 1.577-52.857, P=0.014) were independent risk factors of increased composite adverse cardiovascular events in patients with acute viral myocarditis. Conclusion: Low FT3 increases the risk of adverse cardiovascular events in adult patients with acute viral myocarditis.

Impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis / 中华心血管病杂志

Objective@#To determine the impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis.@*Methods@#The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis (onset of symptoms<1 month,patients were divided into low serum free triiodothyronine (FT3, n=20) group and normal FT3 (n=114) group. General information, clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed. Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine (TT3), normal or decreased free thyroxine (FT4) and total thyroxine (TT4) as well as normal thyroid stimulating hormone (TSH). Composite adverse cardiovascular events included death, persistent ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiac arrest. Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis.@*Results@#Systolic blood pressure was significantly lower (P<0.01),while heart rate (P=0.004) and the prevalence of VT/VF were significantly higher (P=0.017) in low T3 group than in the normal T3 group. Level of white blood cell,C response protein,fasting glucose (all P<0.01) as well as creatinine (P=0.035) were significantly higher, while level of FT3 and left ventricular ejection fraction (LVEF) were significantly lower (both P<0.01) in low T3 group than in normal T3 group. Multivariate logistic regression analysis revealed that LVEF at admission less than 40% (OR=6.615,95%CI 1.186-36.907, P=0.031) and FT3 level less than 1.79 ng/L (OR=9.131, 95%CI 1.577-52.857, P=0.014) were independent risk factors of increased composite adverse cardiovascular events in patients with acute viral myocarditis.@*Conclusion@#Low FT3 increases the risk of adverse cardiovascular events in adult patients with acute viral myocarditis.

Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes.

BACKGROUND: The effects of thyroid dysfunction in patients with preexisting heart failure have not been adequately studied. We examined the prevalence of thyroid dysfunction and associations with cardiovascular outcomes in a large, prospective cohort of outpatients with preexisting heart failure. METHODS AND RESULTS: We examined associations between thyroid dysfunction and New York Heart Association class, atrial fibrillation, and a composite end point of ventricular assist device placement, heart transplantation, or death in 1365 participants with heart failure enrolled in the Penn Heart Failure Study. Mean age was 57 years, 35% were women, and the majority had New York Heart Association class II (45%) or III (32%) symptoms. More severe heart failure was associated with higher thyroid-stimulating hormone (TSH), higher free thyroxine (FT4), and lower total triiodothyronine (TT3) concentrations ( P<0.001 all models). Atrial fibrillation was positively associated with higher levels of FT4 alone ( P≤0.01 all models). There were 462 composite end points over a median 4.2 years of follow-up. In adjusted models, compared with euthyroidism, subclinical hypothyroidism (TSH 4.51-19.99 mIU/L with normal FT4) was associated with an increased risk of the composite end point overall (hazard ratio, 1.82; 95% CI, 1.27-2.61; P=0.001) and in the subgroup with TSH ≥7.00 mIU/L (hazard ratio, 3.25; 95% CI, 1.96-5.39; P<0.001), but not in the subgroup with TSH 4.51-6.99 mIU/L (hazard ratio, 1.26; 95% CI, 0.78-2.06; P=0.34). Isolated low T3 was also associated with the composite end point (hazard ratio, 2.12; 95% CI, 1.65-2.72; P<0.001). CONCLUSIONS: In patients with preexisting heart failure, subclinical hypothyroidism with TSH ≥7 mIU/L and isolated low T3 levels are associated with poor prognosis. Clinical trials are needed to explore therapeutic effects of T4 and T3 administration in heart failure.

Is There Any Relationship between TSH Levels and Prognosis in Acute Coronary Syndrome? / Existe Alguma Relação entre Níveis de TSH e Prognóstico em Síndrome Coronariana Aguda?

Abstract Background: Some small studies have related higher levels of thyrotropin (TSH) to potentially worse prognosis in acute coronary syndromes. However, this relationship remains uncertain. Objective: To analyze the outcomes of patients with acute coronary syndromes in relation to the value of TSH at admission. Methods: Observational and retrospective study with 505 patients (446 in group I [TSH ≤ 4 mIU/L] and 59 in group II [TSH > 4 mIU/L]) with acute coronary syndromes between May 2010 and May 2014. We obtained data about comorbidities and the medications used at the hospital. The primary endpoint was in-hospital all-cause death. The secondary endpoint included combined events (death, non-fatal unstable angina or myocardial infarction, cardiogenic shock, bleeding and stroke). Comparisons between groups were made by one-way ANOVA and chi-square test. Multivariate analysis was determined by logistic regression. Analyses were considered significant when p < 0.05. Results: Significant differences between groups I and II were observed regarding the use of enoxaparin (75.2% vs. 57.63%, p = 0.02) and statins (84.08% vs. 71.19%, p < 0.0001), previous stroke (5.83% vs. 15.25%, p = 0.007), combined events (14.80% vs. 27.12%, OR = 3.05, p = 0.004), cardiogenic shock (4.77% vs. 6.05%, OR = 4.77, p = 0.02) and bleeding (12.09% vs. 15.25%, OR = 3.36, p = 0.012). Conclusions: In patients with acute coronary syndromes and TSH > 4 mIU/L at admission, worse prognosis was observed, with higher incidences of in-hospital combined events, cardiogenic shock and bleeding.

Resumo Fundamento: Estudos pequenos têm relacionado níveis mais elevados de hormônio tireoestimulante (TSH) a pior prognóstico em pacientes com síndrome coronariana aguda (SCA). Tal relação, no entanto, permanece incerta. Objetivo: Analisar os desfechos de pacientes com SCA, relacionando-os aos níveis de TSH medidos no setor de emergência. Métodos: Estudo retrospectivo observacional incluindo 505 pacientes com SCA (446 no grupo I: TSH ± 4 mUI/L; 59 no grupo II: TSH > 4 mUI/L) entre maio de 2010 e maio de 2014. Dados sobre comorbidades e medicamentos usados foram obtidos. O desfecho primário foi mortalidade intra-hospitalar por todas as causas. O desfecho secundário incluiu eventos combinados (morte, angina instável não fatal ou infarto do miocárdio, choque cardiogênico, sangramento e acidente vascular encefálico). A comparação entre grupos foi realizada através de ANOVA de uma via e teste do qui-quadrado. A análise multivariada foi realizada por regressão logística, adotando-se o nível de significância de p < 0,05. Resultados: Diferenças significativas foram observadas entre os grupos I e II relacionadas ao uso de enoxaparina (75,2% vs. 57,63%; p = 0,02) e estatinas (84,08% vs. 71,19%; p < 0,0001), acidente vascular encefálico prévio (5,83% vs. 15,25%; p = 0,007), eventos combinados (14,80% vs. 27,12%, OR = 3,05; p = 0,004), choque cardiogênico (4,77% vs. 6,05%, OR = 4,77; p = 0,02) e sangramento (12,09% vs. 15,25%, OR = 3,36; p = 0,012). Conclusão: Em pacientes com SCA e TSH > 4 mUI/L à admissão hospitalar, observou-se pior prognóstico associado à maior incidência de eventos combinados intra-hospitalares, choque cardiogênico e sangramentos.

Analysis of influential factors of non-thyroidal illness syndrome in elderly inpatients / 中华老年医学杂志

Objective To investigate the effects of risk factors on non thyroidal Illness syndrome (NTIS) in elderly inpatients.Methods A total of 819 elderly inpatients who met inclusion criteria were consecutively recruited in thiscross-sectional study.Physicalmeasurements and mini nutritional assessment using the mini nutritional assessment-short form (MNA-SF) score were conducted.A serum levels of thyroid stimulating hormone (TSH),free triiodothyronine (FT3),free thyroxine (FT4),brain natriuretic peptide (BNP) and C-reactive protein (CRP) were examined.Data were analyzed with multivariatelogistic regression.Results The significant differences were found between NTIS group (n=145) versus control group (n=674)inage (78.5±8.1) years vs.(75.1±8.6) years(t=5.422,P＜0.01),in body mass index (23.0 ±3.8) kg/m2 vs.(24.1±3.6) kg/m2,in MNA-SF score 11.2±2.3 vs.12.3± 1.8(t=-3.315,6.754,P＜0.01),in level of serum albumin (36.0±4.5) g/L vs.(38.4±3.6) g/L (t=-6.977,P＜0.01),in triglyceride level (1.3± 0.9) mmol/L vs.(1.5±1.0) mmol/L(t=-3.039,P＜0.01),inCRP (Z=-8.857,P＜0.01)),and in BNP (t=6.331,P＜0.01).Logistic regression analysis revealed that age＞ =80 years (OR=2.433,95％CI:1.357 4.361),malnutrition (OR=1.946,95％CI:1.261-3.001),renal insufficiency (eG FR＜60 ml/min,OR =2.131,95％ CI:1.367-3.322),and high level of CRP (10 mg/L and 50 mg/L:OR=3.446,95％CI:2.117-5.611;over 50 mg/L:OR =10.029,95％CI:4.693-21.432,all P＜0.01)) were risk factors for NTIS.Conclusions Non-thyroidal illness syndrome in elderly inpatients is correlated with advanced age,renal insufficiency,malnutrition and stress,which are the independent risk factors.

Thyroid disorders among dialysis patients / Alteraciones tiroideas en pacientes en diálisis

The thyroid gland and the kidney are closely related. Thyroid hormones (TH) contribute to the homeostasis of the human being through complex interactions of fluids and electrolytes, protein synthesis, etc. The effects on the kidney of TH may be pre renal or direct actions. Decreasing glomerular filtration (GF) this balance especially in advanced stages of chronic kidney disease (CKD) is altered. CKD is linked to alterations in TH levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low free triiodothyronine (FT3) syndrome. These alterations are linked in micro inflammation, endothelial damage, cardiac abnormalities, and high mortality. In this study, we describe the most common thyroid abnormalities reported in CKD with dialytic stage approach.

La glándula tiroides y el riñón están estrechamente relacionados. Las hormonas tiroideas (HT) contribuyen en la homeostasis del ser humano a través de complejas interacciones de líquidos y electrolitos, síntesis de proteínas, etc. Los efectos de las HT sobre el riñón pueden ser pre-renales o directos. Está demostrado que al disminuir la filtración glomerular (FG) se altera este equilibrio, sobre todo en estadios avanzados de la enfermedad renal crónica (ERC). La ERC está vinculada con alteraciones en los niveles de HT y/o su metabolismo, lo que resulta en una alta prevalencia de hipotiroidismo subclínico y el síndrome de T3 libre baja. Estas alteraciones están relacionadas con micro inflamation, daño endotelial, alteraciones cardiacas y alta mortalidad. El presente estudio, describe las alteraciones tiroideas más frecuentes reportadas en ERC con enfoque en la etapa dialítica.

The influence o end-stage liver disease and liver transplantation on thyroid hormoess / Avaliação do impacto da cirrose e do transplante hepático na função tireoidiana

Background Thyroid dysfunction has been reported in most chronic illnesses including severe liver disease. These defects in thyroid hormone metabolism result in the sick euthyroid syndrome, also known as low T3 syndrome. Objectives Our objective was to evaluate the thyroid function in patients with end stage liver disease prior and after deceased donor liver transplantation and to correlate thyroid hormonal changes with the MELD score (Model for End stage Liver Disease). Methods In a prospective study, serum levels of thyrotropin (thyroid stimulating hormone TSH), total thyroxine (tT4), free thyroxine (fT4) and triiodothyronine (T3) from 30 male adult patients with end stage liver disease were measured two to four hours before and 6 months after liver transplantation (LT). MELD was determined on the day of transplant. For this analysis, extra points were not added for patients with hepatocellular carcinoma. Results The patients had normal TSH and fT4 levels before LT and there was no change after the procedure. Total thyroxine and triiodothyronine were within the normal range before LT, except for four patients (13.3%) whose values were lower. Both hormones increased to normal values in all four patients after LT (P=0.02 and P<0.001, respectively). When the patients were divided into two groups (MELD <18 and MELD >18), it was observed that there was no change in the TSH, freeT4, and total T4 levels in both groups after LT. Although there was no significant variation in the level of T3 in MELD <18 group (P=0.055), there was an increase in the MELD >18 group after LT (P=0.003). Conclusion Patients with end stage liver disease subjected to liver transplantation had normal TSH and fT4 levels before and after LT. In a few patients with lower tT4 and T3 levels before LT, the level of these hormones increased to normal after LT. .

Contexto A disfunção tireoidiana tem sido relatada em associação com a maioria das doenças crônicas, incluindo a doença hepática terminal. Estes defeitos no metabolismo dos hormônios tireoidianos resultam na síndrome do doente eutireoideo ou, também conhecida como síndrome do T3 baixo. Objetivos Avaliar a função tireoidiana em pacientes com doença hepática avançada, antes e depois de serem submetidos ao transplante hepático cadavérico (THC) e, correlacionar as alterações hormonais da tireóide com o MELD. Métodos Em um estudo prospectivo, os níveis séricos de tireotropina (hormônio estimulante da tireóide TSH), tiroxina total (T4 total), tiroxina livre (T4 livre) e triiodotironina (T3) de 30 pacientes adultos do sexo masculino com doença hepática terminal foram dosados 2 e 4 horas antes e 6 meses após o THC. O valor do MELD foi determinado no dia do procedimento. Para esta análise, os pontos extras não foram adicionados para os pacientes com carcinoma hepatocelular. Resultados Os pacientes apresentaram níveis de TSH e T4 livre normais antes do THC e não houve nenhuma alteração após o procedimento. As dosagens de T4 total e T3 no início do estudo estavam dentro da faixa normal, exceto por quatro pacientes (13,3%), os quais apresentavam valores abaixo da referência. Ambos os hormônios apresentaram um aumento 6 meses após o THC (P=0,02 e P<0,001, respectivamente). Quando os pacientes foram divididos em dois grupos (MELD <18 e MELD >18) não observamos diferença nos níveis de TSH, T4 total e T4 livre entre os grupos após THC. Apesar de não haver variação nos níveis de T3 no grupo com MELD <18 (P=0,055), houve um aumento no grupo MELD >18 após THC (P=0,003). Conclusão Os pacientes com cirrose hepática submetidos a transplante hepático tinham valores normais de TSH e T4 livre antes e após o THC. Nos poucos pacientes que apresentavam valores baixos de T4 total e T3 antes do THC, houve normalização destes hormônios após o THC. .

Relationship between serum level of thyroid hormones and plasma level of N-terminal Pro-brain natriuretic peptide in elderly patients with type 2 diabetes / 中华老年医学杂志

Objective To investigate the relationship between thyroid function indexes and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) among patients who had high risks for cardiovascular diseases without thyroid diseases and heart failure.Methods Totally 166 elderly type 2 diabetic patients aged 80 years and over with normal range of thyroid stimulating hormone (TSH) were divided into group of euthyroid sick syndrome (ESS,n=62) and group of normal thyroid hormones (NESS,n=104).The patients in normal thyroid hormones group were divided into three subgroups according to the levels of total triiodothyronine (TT3),(low-level group,n=26; middle-level group,n=50; high-level group,n=28).Levels of thyroid hormones,NT-proBNP,cholesterol,low-density lipoprotein cholesterol,fibrinogen,HbA1C,glomerular filtration rate (eGRF),left ventricular ejection fraction (LVEF) and the incidences of concomitant diseases were measured and detected.lgNT-proBNP was used to calculated after NT-proBNP was changed by Log transformation.Results Compared with NESS group,ESS group showed that age was increased,systolic pressure and LVEF were decreased [(86.3 ± 5.8) years vs.(85.6 ± 5.2) years,(126.6±15.5) mmHg vs.(135.6±17.8) mmHg,(63.9±7.6)％ vs.(67.4±7.5)％,all P＜0.01].Compared with NESS group,ESS group showed that the levels of serum total T3 and free T3 were decreased [(0.89±0.17) nmol/L vs.(1.45±0.31) nmol/L,(3.31±0.55) pmol/L vs.(3.96± 0.59) pmol/L,both P＜0.01].The lgNT-proBNP level was higher and serum total thyroxine (TT4) level was lower in ESS group than in NESS group [(2.40±0.40) ng/L vs.(2.26±0.44) ng/L,(101.80±36.11) nmol/L vs.(111.07±23.29) nmol/L,both P＜0.05].Pearson analysis revealed that serum levels of TT3,TT4 and FT3 were negatively correlated with lgNT-proBNP (r=-0.217,-0.180,-0.174,respectively,all P＜0.05) after adjustment for age,systolic pressure and LVEF.Stepwise regressive analysis showed TT3 was the risk factors for lgNT-proBNP (β=-0.267,P＜ 0.01).Compared with the low-level group,the lgNT-proBNP were significantly reduced in the middle-,and high-level groups [(2.19±0.42) ng/L,(2.19±0.46) ng/L vs.(2.44±0.39) ng/L,both P＜0.05].Conclusions TT3 has a close correlation with NT-proBNP in elderly type 2 diabetic patients with normal TSH.It has a significant meaning to test TT3 level for monitoring heart function in clinical medicine.

Relationship among thyroid function,FT3 level and coronary artery disease in patients with coronary heart disease / 心血管康复医学杂志

Objective:To explore the relationship among thyroid function ,free thyroxine (FT3) level and coronary artery disease in patients with coronary heart disease (CHD) .Methods :A total of 238 CHD patients ,who hospital-ized in our hospital from 2012 to 2014 and were proved by coronary angiography (CAG) ,were selected .Their thy-roid function was analyzed .After patients with hyperthyroidism ,hypothyroidism ,subclinical hyperthyroidism and subclinical hypothyroidism were excluded ,the remaining 217 patients were divided into normal FT3 group (n=192) and low FT3 group (n=25) according to FT3 level . General clinical condition and CAG results were compared be-tween two groups . Results:(1 ) Among the 238 CHD patients , there were two cases with hyperthyroidism (0.84% ) ,11 cases with hypothyroidism (4.62% ) ,three cases with subclinical hyperthyroidism (1.26% ) ,five ca-ses with subclinical hypothyroidism (2.10% ) and 25 cases with low T3 syndrome (10.50% );(2) Compared with normal FT3 group ,there were significant rise in levels of total cholesterol [TC ,(4.14 ± 1.59) mmol/L vs .(7.33 ± 1.72) mmol/L] ,apoprotein E [ApoE ,(3.91 ± 0.98) mmol/L vs .(4.55 ± 1.52) mmol/L] ,creatinine [Cr ,(97.99 ± 30.85)μmol/L vs .(116.64 ± 43.20) μmol/L] and N terminal pro brain natriuretic peptide [NT-proBNP ,140 (62~462) pg/ml vs .739 (304~4922) pg/ml] in low T3 group , P<0.01 all;(3) In CHD patients ,percentage of triple-vessel coronary disease in low FT3 group was significantly higher than that of normal FT3 group (76.0% vs . 40.1% , P<0.01) .Conclusion:Low free thyroxine syndrome is a most frequent thyroid dysfunction in patients with coronary heart disease ,and patients with low free thyroxine are more likely to involve multi-vessel disease .

Changes of iodothyronine deiodinase type 1 and type 3 mRNA level and activity in liver of mice with endotoxemia / 中华实用儿科临床杂志

Objective To explore the effect of endotoxemia on triiodothyronine (T3) and thyroxine (T4),and the level and activity of iodothyronine deiodinase type 1 and type 3 mRNA.Methods Sixteen mice were randomly divided into control group and lipopolysaccharide (LPS) group,with 8 mice in each group.The mouse model of endotoxemia was replicated in the LPS group.In the both groups,blood samples from femoral week were collected to assay T3 and T4 levels,and the livers were sampled to inspect D1 and D3 mRNA levels and activities.Serum T3 and T4 levels were assayed with radioimmunoassay,D1 and D3 mRNA levels in liver were detected with real-time polymerase chain reaction,the activity of D1 and D3 in liver were measured by using ion-exchange chromatography combined with immunoassay.The data were statistically analyzed by SPSS 13.0 software.Results Statistical differences of T3,D1 and D3 mRNA levels and activities between the 2 groups were found (all P ＜0.01),while,there was no statistic difference in the statuses of T4 (P ＞ 0.05).Conclusions It is possible that euthyroid sick syndromes happens in endotoxemia episodes,and the changes of D1 and D3 mRNA levels and activities are the possible influencing factors.