![]() There is also decreased expression of type I deiodinase, which normally converts T4 to T3. ![]() It is believed that the pathogenesis of NTIS involves the induction of type III deiodinase, which catabolizes T4 to rT3 instead of T3. Instead, serum TSH might even decrease due to inhibition of the hypothalamic–pituitary–thyroid (HPT) axis. 4 A salient feature of this syndrome is that the drop in the levels of T3 and T4 is not accompanied by a concomitant rise in serum thyroid-stimulating hormone (TSH) levels. This decrease may also be associated with an increase in the serum level of reverse T3 (rT3) and, in severe cases, a decrease in the level of thyroxine (T4). The most consistent finding in NTIS is a decrease in the serum level of triiodothyronine (T3) that occurs rapidly after the onset of stress, hence the term “low T3 syndrome”. 2 It also occurs in fasting states in otherwise healthy individuals. NTIS has been reported in the context of infection, trauma, burns, myocardial infarction, and malignancy. In the context of acute illness, several changes in thyroid hormones occur that are collectively known as non-thyroidal illness syndrome (NTIS) or euthyroid sick syndrome. ConclusiónĮl SEE es común en niños críticos y parece estar asociado a la mortalidad y la gravedad de la enfermedad. El valor de T3L fue significativamente menor en pacientes tratados con perfusión de dopamina, comparados con pacientes que no la recibieron (2,1 ± 0,66 versus 2,76 ± 0,91 pg/ml, p = 0,011). Se observó una correlación negativa entre la TSH y la duración de la estancia en la UCIP (r s = -0,35 p = 0,011). La combinación de niveles bajos de T3L, T4L, y TSH fue el mejor factor pronóstico independiente de mortalidad (OR = 16,9 IC 95% = 1,40–203,04 p = 0,026). El SEE predijo la mortalidad de manera independiente (OR = 3,91 IC 95% = 10,06–15,19 p = 0,0491). Los valores bajos de T4L se observaron con una frecuencia significativamente mayor en pacientes fallecidos en comparación con supervivientes (50% versus 19,2%, p = 0,028). Hubo un hallazgo inusual de TSH elevada en 3 pacientes que podría estar asociado a la gravedad de la enfermedad. La combinación de valores bajos de T3L, T4L, y TSH ocurrió en el 7,1% de los pacientes. El patrón más frecuente fue un nivel bajo de T3L con niveles normales de T4L y TSH (25,7% de los pacientes). Se observó SEE en el 62,9% de los pacientes, aunque adoptó formas diversas. La variable de resultado principal fue la mortalidad a los 30 días. Se determinaron los niveles de triyodotironina libre (T3L), tiroxina libre (T4L) y tirotropina (TSH) en las primeras 24 horas de ingreso. Materiales y métodosĮstudio prospectivo observacional en 70 niños críticos ingresados en la unidad de cuidados intensivos pediátricos (UCIP). El objetivo del estudio fue evaluar la prevalencia y el valor pronóstico del SEE en niños críticos. No obstante, los datos en población pediátrica son escasos. Se ha sugerido que las alteraciones en las hormonas tiroideas ocurridas en pacientes con enfermedad crítica, fenómeno conocido como síndrome del enfermo eutiroideo (SEE), pueden tener valor pronóstico. NTIS is common among critically ill children and appears to be associated with mortality and illness severity. FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1 ± 0.66 versus 2.76 ± 0.91 pg/mL, P =. TSH was negatively correlated with length of PICU stay ( r s = -0.35, P =. Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR = 16.9 95% CI = 1.40–203.04 P =. NTIS independently predicted mortality (OR = 3.91 95% CI = 1.006–15.19 P =. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P =. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. The commonest pattern was low FT3 with normal FT4 and TSH (25.7% of patients). NTIS occurred in 62.9% of patients but it took several forms. ![]() Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24 h of PICU admission. Materials and methodsĪ prospective observational study conducted on 70 critically ill children admitted into paediatric intensive care unit (PICU). The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children. ![]() Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value.
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