Clinical implications of abnormal thyroid hormone levels in patients with critical non-thyroidal illness. Prevalence of low T3, low T4 and low TSH levels in cardiogenic shock, septic shock and chronic severe illnesses.:Prevalence of Low T3, Low T4 and Low
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To assess the pituitary-thyroid axis, we measured serum concentrations of thyroid hormones [triiodothyronine (T3) and thyroxine (T4)] and thyroid-stimulating hormone (TSH) in 311 patients with common cardiac diseases [excluding congestive heart failure (CHF), acute myocardial infarction (AMI) and shock], 60 patients with AMI (36 class 1-3 patients and 24 class 4 patients, according to the Killip classification), in 30 patients with septic shock, and in 62 patients with severe chronic desease. The incidence of low T3, low T4 and low TSH levels in AMI was 75%, 28.3% and 16.7%, respectively. Low T4 and low TSH were significantly more frequent in AMI than in other common cardic diseases (T4 13.5%, TSH 1.9%). The mean serum T3 levels in cardiogenic shock, septic shock and chronic severe illnesses were 45±25, 25±15 and 33±25ng/dl, respectively. The low T3 was exceedingly advanced in septic shock and chronic severe illnesses. The mean serum T4 levels in cardiogenic shock, septic shock and chronic severe illnesses were 6.3±2.0, 3.8±1.8 and 5.4±2.2μg/dl, respectively. The low T4 was very common in septic shock. The prevalence of low T3, low T4 and low TSH was 100%, 33.3% and 25%, respectively, in cardiogenic shock, 100%, 76.7% and 40%, respectively, in septic shock, and 91%, 56.5% and 9.7%, respectively, in chronic severe illnesses. Low T4 and low TSH occurred significantly more frequently in septic shock, and as a result dysfunction of the feedback mechanism of the pituitary-thyroid axis was suspected in septic shock. The mortality in low T3 was 40% in patients with AMI, and increased to 76.5% at lower T3 levels (<50ng/dl). The mortality rate in low T4 was 70.6% in patients with AMI, and all of the patients with lower T4 levels (<4.0μg/dl) died. These findings show that serum T3 and T4 are useful prognostic and severity indices in patients with AMI. The present findings suggest that thyroid hormones and TSH frequently decrease in cardiogenic and septic shock, and diminution of these hormone levels was related to the severity and outcome of AMI and shock.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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