Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 9;13(3):96132.
doi: 10.5492/wjccm.v13.i3.96132.

Low T3 vs low T3T4 euthyroid sick syndrome in septic shock patients: A prospective observational cohort study

Mirza Kovacevic  1 , Visnja Nesek-Adam  2 , Semir Klokic  3 , Ekrema Mujaric  4
Affiliations

Low T3 vs low T3T4 euthyroid sick syndrome in septic shock patients: A prospective observational cohort study

Mirza Kovacevic et al. World J Crit Care Med. .

Abstract

Background: Both phases of euthyroid sick syndrome (ESS) are associated with worse prognosis in septic shock patients. Although there are still no indications for supplementation therapy, there is no evidence that both phases (initial and prolonged) are adaptive or that only prolonged is maladaptive and requires supplementation.

Aim: To analyze clinical, hemodynamic and laboratory differences in two groups of septic shock patients with ESS.

Methods: A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups. The analysis included demographic data, mortality scores, intensive care unit stay, mechanical ventilation length and 28-day survival and laboratory with hemodynamics.

Results: The Simplified Acute Physiology Score II score (P = 0.029), dobutamine (P = 0.003) and epinephrine requirement (P = 0.000) and the incidence of renal failure and multiple organ failure (MOF) (P = 0.000) were significantly higher for the low T3T4. Hypoalbuminemia (P = 0.047), neutrophilia (P = 0.038), lymphopenia (P = 0.013) and lactatemia (P = 0.013) were more pronounced on T2 for the low T3T4 group compared to the low T3 group. Diastolic blood pressure at T0 (P = 0.017) and T1 (P = 0.007), as well as mean arterial pressure at T0 (P = 0.037) and T2 (P = 0.033) was higher for the low T3 group.

Conclusion: The low T3T4 population is associated with higher frequency of renal insufficiency and MOF, with worse laboratory and hemodynamic parameters. These findings suggest potentially maladaptive changes in the chronic phase of septic shock.

Keywords: Euthyroid sick syndrome; Intensive care unit; Low T3; Low T3T4; Septic shock.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow diagram of the study design. ICU: Intensive care unit; MV: Mechanical ventilation; SI: Shock index; VDI: Vasoactive drug-dependent index.
Figure 2
Figure 2
Systolic blood pressure, diastolic blood pressure and mean arterial blood pressure values according to groups. DBP: Diastolic blood pressure; MAP: Mean arterial blood pressure; SBP: Systolic blood pressure; T0: On the day of admission; T1: On the first day; T2: On the second day.
Figure 3
Figure 3
Heart rate values according to the groups. T0: On the day of admission; T1: On the first day; T2: On the second day.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Fliers E, Boelen A. An update on non-thyroidal illness syndrome. J Endocrinol Invest. 2021;44:1597–1607. - PMC - PubMed
    1. Padhi R, Kabi S, Panda BN, Jagati S. Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis. Int J Crit Illn Inj Sci. 2018;8:165–172. - PMC - PubMed
    1. Wasyluk W, Wasyluk M, Zwolak A. Sepsis as a Pan-Endocrine Illness-Endocrine Disorders in Septic Patients. J Clin Med. 2021;10 - PMC - PubMed
    1. Widmer A, Schuetz P. Endocrine dysfunction during sepsis—are changes in hormone levels a physiological adaptation or a therapeutic target? J Lab Precis Med. 2018;3:61–61.
    1. Wajner SM, Goemann IM, Bueno AL, Larsen PR, Maia AL. IL-6 promotes nonthyroidal illness syndrome by blocking thyroxine activation while promoting thyroid hormone inactivation in human cells. J Clin Invest. 2011;121:1834–1845. - PMC - PubMed

LinkOut - more resources