Euthyroid Sick Syndrome

BackgroundDespite bariatric surgery’s success for most patients, up to 30% do not experience optimal weight loss outcomes. Reasons remain incompletely understood. Thyroid hormones, due to their role in energy expenditure, have received study. Yet research to date is inconclusive regarding the impact of standard thyroid markers (e.g., thyroid stimulating hormone, or TSH) on weight regulation after bariatric surgery. This prospective observational study investigates whether the early development of euthyroid sick syndrome (ESS) predicts reduced longer-term post-bariatric weight loss. ESS develops during periods of stress (e.g., critical illness, severe infection, famine) and is thought to serve a protective function by suppressing metabolism and conserving weight. Levels of metabolically active free triiodothyronine (FT3) drop, levels of non-catabolic reverse 3,3’,5’-triiodothyronine (rT3) rise, and TSH levels remain euthyroid. Reductions in the ratio of FT3to rT3significantly predict...

Thyroid dysfunction is a widespread and complex issue in the field of endocrine disorders. It has a significant impact on multiple physiological systems, particularly on the heart. This review explores the complex interaction between thyroid dysfunction and cardiac dynamics, examining the detailed network of molecular, cellular, and systemic changes that underlie the close connection between these two physiological areas. Thyroid dysfunction, which includes both hyperthyroidism and hypothyroidism, is a common endocrine condition that affects millions of people worldwide. The thyroid hormones thyroxine and triiodothyronine regulate various metabolic activities essential for maintaining cellular balance. Disruptions in thyroid function result in widespread consequences, affecting the cardiovascular system. Thyroid hormones directly impact cardiac muscle cells, controlling their ability to contract, their electrical properties, and their reaction to hypertrophy. Thyroid dysfunction goes beyond the level of individual cells and involves complex interactions among vascular dynamics, neurohormonal control, and endothelial function. These factors all contribute to the development of cardiovascular illness. The impact of thyroid dysfunction on cardiac structure, function, and outcomes is not limited to a one-way pattern. Instead, it involves a dynamic two-way interaction. The manifestations of this condition can vary from minor changes in the electrical activity of the heart to more obvious structural abnormalities, such as an increase in the size of the heart muscle and a decrease in its ability to relax during the filling phase. Furthermore, the correlation between thyroid dysfunction and adverse cardiovascular outcomes, such as heart failure and arrhythmias, highlights the clinical importance of this connection. This review provides a complete overview of the relationship between thyroid dysfunction and cardiac dynamics by analyzing a wide range of research from clinical, molecular, and epidemiological perspectives. This study seeks to enhance our comprehension of the comprehensive effects of thyroid dysfunction on the anatomy and function of the heart by explaining the complex molecular mechanisms and systemic consequences. The goal is to establish a basis for informed clinical treatment and future research efforts.

Background: Patients with coronavirus disease 2019 (COVID-19) particularly critically ill ones may present with different types of thyroid abnormalities. However, data regarding thyroid function tests (TFTs) among noncritical patients with COVID-19 are scarce. This study aimed to assess thyroid functions and their associations with the severity of illness among non-critically ill hospitalized patients with COVID-19. Methods: This cross-sectional study assessed TFTs in 87 (aged 18-65 years) RT-PCR-confirmed COVID-19 patients admitted to a tertiary-care hospital in Bangladesh. Diagnosis of non–critical illness and severity (mild, moderate, and severe) were defined by WHO’s interim guidance. Patients having known thyroid dysfunctions or taking drugs that may affect thyroid functions were excluded from the study. Serum TSH, FT4, and FT3 were measured by chemiluminescent immunoassay. Results: Majority of the patients (72%) had normal thyroid function. Among the abnormalities, the highest...

Background: The cardiovascular system is one of the most important targets on which thyroid hormones act, thyroid hormone has a major role in the cardiovascu¬lar system function and cardiac hemodynamics. Objectives: The primary aim of our study was to evaluate the prevalence of thyroid dysfunction in patients with acute myocardial infarction and to study the impact of these dysfunctions on in-hospital morbidity and mortality among those subjects. Patients and Methods: This study was conducted on one hundred critically ill patients admitted to the critical care department with the diagnosis of acute myocardial infarction in the period from April 2017 to January 2019. Results: According to thyroid profile, 78 patients (78%) had euthyroid status and the remaining 22 patients (22%) had thyroid dysfunctions which include: 12 patients (54.54%) were euthyroid sick syndrome, 7 patients (13.81%) had subclinical hypothyroidism, 3 patients (13.63%) had subclinical hyperthyroidism. Conclusion: Thyroid dysfunction in association with acute myocardial infarction affect the myocardial performance and this was evident in our study by lower ejection fraction, higher initial killip class, higher wall motion score index, and increased myocardial performance index compared to those with normal thyroid status but it has no impact on the in-hospital mortality.

BACKGROUND Patients with critical illness can have changes in thyroid hormone metabolism along with changes within the hypothalamus-pituitary-thyroid axis, even though there is no previous history of thyroid disease. Such changes have been named as “Sick Euthyroid Syndrome” or “Non-Thyroidal Illness Syndrome (NTIS)”. Such alterations in thyroid function can be seen in patients with sepsis and they are known to affect the prognosis of the disease. The most common abnormality in sick euthyroid syndrome is low serum T3. This study aims to find the proportion and pattern of sick euthyroid syndrome in patients with sepsis. METHODS This was a hospital based cross sectional study done in the Department of Internal Medicine in a tertiary care centre in south Kerala. 100 patients with diagnosis of sepsis were selected based on American College of Chest Physician / Society of Critical Care Medicine 2001 Consensus Conference definitions, and included in the study. Serum levels of total T3, tot...

A Síndrome Nefrótica (SN) é uma conseqüência da doença glomerular renal e se caracteriza por proteinúria, hipoalbuminemia, hipercolesterolemia, hiperlipemia e edema; podendo estar ou não associada a distúrbios infecciosos. Este relato descreve o caso de um cão, Fila Brasileiro, com histórico de fraqueza, edema facial e dos membros, apatia e desidratação. Os exames complementares revelaram infecção por Babesia canis, insuficiência renal crônica, hipertensão arterial e os sinais já citados da SN.

IntRoductIon During the course of any critical illness, a common phenomenon experienced is the alteration in the levels of thyroid hormones, sex hormones, and corticosteroids. [1] These changes correlate with the outcome and mortality of critically ill patients treated in Intensive Care Units (ICUs). [2,3] In the 20 th century, various studies observed that thyroid dysfunction is associated with increased morbidity and mortality in ICU-admitted patients. [4] Such alterations in thyroid hormone levels during critical illness is described as "euthyroid sick syndrome" or "nonthyroidal illness syndrome." [5,6] It is characterized by low levels of free and total triiodothyronine (T3) and high levels of reverse T3 (rT3) with variable values of thyroxine (T4) and thyroid-stimulating hormone (TSH) in the low to normal range. Various studies were conducted to demonstrate an association of thyroid dysfunction in critically ill patients with mortality and morbidity of such patients. Initial studies showed inconsistent results with some showing decreased free T3 (fT3) levels in nonsurvivors, [7,8] while others failed to show any such association. [9] Whether thyroid hormones can independently predict mortality in ICU patients remains a matter of debate. A large prospective trial involving 480 critically ill patients admitted to ICU showed fT3 levels to be an independent and powerful predictor of mortality. [10] A few Indian studies have also tried to demonstrate the association of low T3 levels with poor clinical outcome in critically ill patients. [11,12] Owing to lack of data in India regarding endocrine dysfunction in critically ill patients, we conducted this prospective, observational study to evaluate the thyroid hormone levels Background: Patients suffering from critical illness admitted to the Intensive Care Unit (ICU) exhibit alterations in their thyroid hormone levels, collectively termed as euthyroid sick syndrome or nonthyroidal illness syndrome. Our study was conducted to determine the correlation between these changes in thyroid hormone levels and the prognosis of ICU-admitted patients. Methods: A total of 270 ICU-admitted patients without previous history of thyroid disorder were included in the study. We recorded their baseline characteristics, acute physiology and chronic health evaluation (APACHE-II) score, thyroid hormone levels, lactate, and other parameters on admission. ICU mortality was the primary outcome. We analyzed the ability of each parameter to predict mortality in the participants. Further, we also evaluated whether the combination of thyroid hormone levels with APACHE-II score could improve the mortality prediction. Results: The mean age of the study population was 38.99 ± 18.32 years. A total of 81 patients (30%) expired during their ICU treatment. Both fT3 and fT4 levels were lower in nonsurvivors compared to survivors. Among the thyroid hormones, fT3 had the highest predictive value for ICU mortality, as seen by the largest area under the curve (AUC) value (0.990 ± 0.007) which was even greater than AUC of APACHE-II score (0.824 ± 0.051) and fT4 (0.917 ± 0.049). Univariate logistic regression analysis showed that fT3 (β = 140.560) had the highest predictive potential for ICU mortality compared with APACHE-II score (β = 0.776), fT4 (β = 17.62) and other parameters. Multivariate logistic regression analysis revealed that the combination of fT3 and APACHE-II (R 2 = 0.652) was superior in predicting mortality than APACHE-II alone (R 2 = 0.286). Conclusion: We observed that fT3 was the strongest predictor of ICU mortality compared to all other parameters included in our study. Further, the combination of fT3 levels and APACHE-II scores provided for a higher probability for predicting mortality in ICU patients.

During critical illness, children my experience various changes in their thyroid hormone levels. Such changes are termed non-thyroidal illness syndrome (NTI). The extent of change correlates with the severity of the illness and its outcomes in critically ill patients. This study aimed to investigate the correlation between the severity of shock and thyroid hormone derangement. This prospective observational study included forty patients aged one month to five years who were admitted to the pediatric intensive care unit (PICU) with shock. Thyroid function tests were conducted on admission, after shock reversal, and five days later. NTI patterns were observed in 70% of patients. The PIM2 score showed a significant negative correlation with T3 (r = -0.353, p = 0.026) and FT3 levels on admission (r = -0.417, p = 0.007). Furthermore, after shock reversal, the PIM2 score continued to exhibit significant negative correlations with T4 (r = -0.444, p = 0.004), T3 (r = -0.329, p = 0.038), FT3 (r = -0.355, p = 0.025), and FT4 levels (r = -0.379, p = 0.016). Conclusion: This study underscores the high prevalence of NTI in PICU shock patients and suggests monitoring thyroid hormone levels for outcome prediction and treatment guidance. Further research is needed to optimize NTI management in critically ill children. • The study has revealed dynamic changes in free triiodothyronine (FT3) levels during the process of shock reversal and recovery in children who experienced shock. • A significant negative correlation was found between the Pediatric Index of Mortality 2 (PIM2) score and several thyroid hormone levels, including FT3 on admission and T4, FT3, and FT4 on shock reversal. Keywords Non-thyroidal illness syndrome • Shock • Pediatric intensive care unit • PIM2 Abbreviations BUN Blood urea nitrogen FT3 Free triiodothyronine FT4 Free thyroxine LOS Length of stay MV Mechanical ventilation NTI Non-thyroidal illness syndrome Communicated by Peter de Winter

Background. COVID-19 infection may have multiorgan effects in addition to effects on the lungs and immune system. Recently, studies have found thyroid function abnormalities in COVID-19 cases which were interpreted as euthyroid sick syndrome (ESS) or destructive thyroiditis. Therefore, in this study, we aimed to evaluate the thyroid function status and thyroid autoimmunity in COVID-19 patients. Material and Method. 205 patients were included. The medical history and laboratory parameters at admission were collected from medical records. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and thyroglobulin antibody were measured, and patients were classified according to thyroid function status. Results. 34.1% of the patients were euthyroid. Length of hospitalization ( p < 0.001 ), rate of oxygen demand ( p < 0.001 ), and intensive care unit (ICU) admission ( p = 0.022 ) were lower, and none of the euthyroid p...

Background: This study aimed to assess non-thyroidal illness syndrome (NTIS) as a prognostic determinant in patients with sepsis, severe sepsis, and septic shock by evaluating thyroid hormone (TH) levels. Methodology: A systematic search was performed through electronic databases including PubMed, Embase, Scopus, and Medline. Following medical subject headings (MeSH) and free-text terms: "euthyroid sick syndrome" or "Euthyroid Sick Syndromes" or "non–thyroidal illness syndrome" or "non–thyroidal illness syndrome" or "sick euthyroid syndrome" or "low T3 syndrome" or "low tri-iodothyronine syndrome" AND "sepsis" or "septic shock" or "systemic inflammatory response syndrome" or "septicemia" or "bacteremia". Boolean operators’ combinations were applied to broaden and narrow the search results. Investigators independently reviewed the search results. For the purpose of ...

Background: Sick euthyroid syndrome refers to alterations that occur in thyroid hormone levels in response to any critical illness like sepsis, ARDS, patients on mechanical ventilation and also any ICU patients. This study aimed at the relationship between thyroid hormone level changes and critical illness in ICU patients and predict the mortality based on thyroid hormone levels. Methods: A prospective study was designed to carry out in intensive care unit (ICU), Institute of internal medicine, Rajiv Gandhi government general hospital, Chennai for six months from May to August 2015. A total of 40 patients were selected who fulfilled the selection criteria. Results: APACHE II scores were calculated for all the 40 patients to assess whether thyroid function tests could independently predict the outcome of the patients. Again, the thyroid profile was compared with APACHE II scores in predicting the outcome. Values showed statistically significance. Conclusions: Thyroid profile can be used as an independent factor in predicting the outcome of the patients. Thyroid profile can also increase the sensitivity of APACHE II score in predicting the outcome.

ObjectivesGraves’ disease (GD) has been highlighted as a possible adverse effect of the respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine. However, it is unknown if the SARS-CoV-2 vaccine disrupts thyroid autoimmunity. We aimed to present long-term follow-up of thyroid autoimmunity after the SARS-CoV-2 BNT162b2 mRNA vaccine.MethodsSerum samples collected from seventy Japanese healthcare workers at baseline, 32 weeks after the second dose (pre-third dose), and 4 weeks after the third dose of the vaccine were analyzed. The time courses of anti-SARS-CoV-2 spike immunoglobulin G (IgG) antibody, thyroid-stimulating hormone receptor antibody (TRAb), and thyroid function were evaluated. Anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) were additionally evaluated in thirty-three participants.ResultsThe median age was 50 (IQR, 38-54) years and 69% were female. The median anti-spike IgG antibody titer was 17627 (IQR, 10898-24175) U/mL 4 weeks after the...

Aim: Thyroid functions are affected by many factors functions such as some infections and drugs. This study aimed to investigate how the thyroid function tests were affected after COVID-19 infection and their relationship with euthyroid sick syndrome. Material and Method: Our study was designed as a retrospective and case-control study. The participants consisted of two groups as the control and patient groups. Thyroid function tests (TFT), hemogram and routine biochemistry of the groups were assessed. In addition, the tests of the patient group within the last 6 months before the infection were assessed. The patients' symptoms, presence of a chronic disease, smoking history, and clinical status during COVID-19 infection were recorded. Results: A total of 473 people were included in the study. Of the participants, 54.5% were female. The white blood count (WBC), hemoglobin (HGB), platelet (PLT), and neutrophil (NEU) counts were higher in the patient group. Lymphocyte (LY) and mean platelet volume (MPV) counts were similar. Tyroid stimulating hormone (TSH) and triiodothyronine (T3) values of the patients were higher compared with the control group. The thyroxine (T4) level was similar in the two groups.TSH, T3 and T4 levels of the patient group before COVID-19 were higher than the results just after the quarantine process after COVID-19 infection. Conclusion: Thyroid dysfunction develops in COVID-19 patients within the course of the disease. This condition can be partially explained with the euthyroid sick syndrome. It is also possible with the thyroid gland being the direct or indirect target of the virus.

Purpose To assess the prognostic value of serum TSH in Greek patients with COVID-19 and compare it with that of commonly used prognostic biomarkers. Methods Retrospective study of 128 COVID-19 in patients with no history of thyroid disease. Serum TSH, albumin, CRP, ferritin, and D-dimers were measured at admission. Outcomes were classified as "favorable" (discharge from hospital) and "adverse" (intubation or in-hospital death of any cause). The prognostic performance of TSH and other indices was assessed using binary logistic regression, machine learning classifiers, and ROC curve analysis. Results Patients with adverse outcomes had significantly lower TSH compared to those with favorable outcomes (0.61 versus 1.09 mIU/L, p < 0.001). Binary logistic regression with sex, age, TSH, albumin, CRP, ferritin, and D-dimers as covariates showed that only albumin (p < 0.001) and TSH (p = 0.006) were significantly predictive of the outcome. Serum TSH below the optimal cutoff value of 0.5 mIU/L was associated with an odds ratio of 4.13 (95% C.I.: 1.41-12.05) for adverse outcome. Artificial neural network analysis showed that the prognostic importance of TSH was second only to that of albumin. However, the prognostic accuracy of low TSH was limited, with an AUC of 69.5%, compared to albumin's 86.9%. A Naïve Bayes classifier based on the combination of serum albumin and TSH levels achieved high prognostic accuracy (AUC 99.2%). Conclusion Low serum TSH is independently associated with adverse outcome in hospitalized Greek patients with COVID-19 but its prognostic utility is limited. The integration of serum TSH into machine learning classifiers in combination with other biomarkers enables outcome prediction with high accuracy.

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established.Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients.Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those &gt; 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney test...

Introduction: The term ''euthyroid sick syndrome'' (ESS) has been used to describe a pattern of thyroid hormone changes during the course of critical illness in adult patients without thyroid disease, often associated with reduced thyroid hormone secretion. Objective: To describe the thyroid hormone profile in fullterm newborns critically ill compared with thyroid hormone profile of healthy infants, and determine if alterations could be related to the severity of the disease and outcome. Methods: A cross-sectional, observational, and prospective study of full-term infants admitted to the neonatal intensive care unit (NICU) of the Hospital de Pediatría J.P. Garrahan between July 2007 and April 2008. Serum T3, T4, and thyroid stimulating hormone (TSH) levels were measured at admission and severity of the disease was evaluated through SNAP, lactic acid, respiratory assistance and number of organs affected. Results: Sick newborns showed significantly lower T3 and T4 levels compared with healthy infants wT3:-0.97 mg/dL (95% CI-0.89,-1.13) and T4:-4.37 mg/dL (95% CI-2.95,-5.78)x. Only 29 out of 94 (31%) infants presented a normal *This article was selected from submitted papers on the occasion of the

Aim: In our study, we aimed to evaluate the prevalence of euthyroid sick syndrome among patients with COVID-19, and the relationship between the possible change in free-triiodothyronine/free-thyroxine (fT3/fT4) ratio and the biochemical parameters used during the follow-up of COVID-19. Material and Methods: A total of 114 sequential patients between 18-65 years of age, who were treated in the internal medicine service allocated to patients with COVID-19, were included in the study. fT3, fT4, thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies, and thyroglobulin antibodies antibody levels were analyzed. fT3/fT4 ratio was calculated. Results: According to the results, only isolated low fT3 levels were found in 39.5% (45/114) of the patients, while 25.4% (29/114) had both low TSH and fT3 levels, 31.6% (36/114) had autoimmune thyroid disease, and 3.5% (4/114) had normal results in the thyroid function tests. The fT3/fT4 ratio was also determined to be low in all groups. However, no significant correlation was found between the low fT3/fT4 ratio and the parameters used in monitoring COVID-19. Discussion: We believe that studies with a wider scope of participants are needed for testing the reduction in fT3/fT4 ratio with other biochemical parameters in patients with COVID-19 and without known thyroid disease.

Objective: The current study was aimed at analyzing sarcoplasmic reticulum Ca 2+ ATPase (Serca2) and ryanodine receptor type 2 (Ryr2) gene expression in rats subjected to surgery that induced HF and were subsequently treated with T4 using physiological doses. Materials and methods: HF was induced in 18 male Wistar rats by clipping the ascending thoracic aorta to generate aortic stenosis (HFS group), while the control group (9-sham) underwent thoracotomy. After 21 weeks, the HFS group was subdivided into two subgroups. One group (9 Wistar rats) with HF received 1.0 µg of T4/100 g of body weight for five consecutive days (HFS/T4); the other group (9 Wistar rats) received isotonic saline solution (HFS/S). The animals were sacrificed after this treatment and examined for signs of HF. Samples from the left ventricles of these animals were analyzed by RT-qPCR for the expression of Serca2 and Ryr2 genes. Results: Rats with HF developed euthyroid sick syndrome (ESS) and treatment with T4 restored the T3 values to the Sham level and increased Serca2 and Ryr2 gene expression, thereby demonstrating a possible benefit of T4 treatment for heart function in ESS associated with HF. Conclusion: The T4 treatment can potentially normalize the levels of T3 as well elevated Serca2 and Ryr2 gene expression in the myocardium in heart failure rats with euthyroid sick syndrome.

Background: Pa ents with coronavirus disease 2019 (COVID-19) par cularly cri cally ill pa ents may present with various thyroid abnormali es. However, data regarding thyroid func on tests (TFTs) among noncri cal pa ents with COVID-19 are scarce. This study aimed to assess thyroid func ons and their associa ons with the severity of illness among non-cri cally ill hospitalized pa ents with COVID-19. Methods: This cross-sec onal study assessed TFTs in 87 (aged 18-65 years) RT-PCR-confirmed COVID-19 pa ents admi ed to a ter ary-care hospital in Bangladesh. Diagnosis of non-cri cal illness and severity (mild, moderate, and severe) were defined by WHO's interim guidance. Pa ents having known thyroid dysfunc ons or taking drugs that may affect thyroid func ons were excluded from the study. Serum TSH, FT4, and FT3 were measured by chemiluminescent immunoassay. Results: Majority of the pa ents (72%) had normal thyroid func on. Among the abnormali es, the highest frequency was isolated hyperthyroxinemia (12.6%) and the rest were subclinical hypothyroidism (6.9%), subclinical thyrotoxicosis (4.6%), thyrotoxicosis (2.3%), isolated tri-iodothyroninemia (1.1%), and hypothyroidism (1.1%). Serum TSH, FT4, and FT3 levels were similar across the spectrum of noncri cal illness. No significant correla on was found between the inflammatory markers (C-reac ve protein, ferri n, and D-dimer) and TSH levels. Conclusions: More than one-fourth of non-cri cally ill hospitalized pa ents with COVID-19 presented with a spectrum of thyroid abnormali es with isolated hyperthyroxinemia being the most common. However, TFTs had no significant associa ons with the severity of illness among noncri cally ill pa ents with COVID-19.

Thyroid hormone abnormalities are common in critically ill patients. For over three decades, a mild form of these abnormalities has been described in patients with several diseases under outpatient care. These alterations in thyroid hormone economy are a part of the nonthyroidal illness and keep an important relationship with prognosis in most cases. The main feature of this syndrome is a fall in free triiodothyronine (T3) levels with normal thyrotropin (TSH). Free thyroxin (T4) and reverse T3 levels vary according to the underlying disease. The importance of recognizing this condition in such patients is evident to physicians practicing in a variety of specialties, especially general medicine, to avoid misdiagnosing the much more common primary thyroid dysfunctions and indicating treatments that are often not beneficial. This review focuses on the most common chronic diseases already known to present with alterations in serum thyroid hormone levels. A short review of the common pat...

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established.Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients.Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those &gt; 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney test...

Context and Objectives: The objective of this study was to elucidate the influence of disease severity, deiodination, sulfation, thyroid hormone binding, and dopamine use on thyroid function in euthyroid sick syndrome. Setting: The study was performed at a university-affiliated pediatric intensive care unit (PICU). Design: This was an observational cohort study. Patients: Sixty-nine children with meningococcal sepsis were studied. Main Outcome Measures: Differences in thyroid function among nonsurvivors, shock survivors, and sepsis survivors on PICU admission were the main outcome measures. Results: The main study group consisted of 45 non-dopamine-treated children. All children had decreased total T 3 (TT 3)/rT 3 ratios without elevated TSH. T 4 sulfate levels were decreased in 88%. Nonsurvivors had paradoxically higher TT 3 /rT 3 ratios than shock survivors (0.71 vs. 0.30); this ratio also correlated with shorter duration of disease (r ϭ Ϫ0.43). TT 4 and T 4-binding globulin (TBG) levels declined with increasing disease severity. TBG levels correlated inversely with elastase levels (r ϭ Ϫ0.46). Only TSH levels were significantly lower in 24 dopamine-treated children compared with non-dopamine-treated children (0.65 vs. 0.84), whereas other thyroid hormones did not significantly differ. Both higher TT 3 /rT 3 ratios and lower TT 4 levels were predictive for mortality, but this disappeared when IL-6 was entered into the regression model. Conclusions: All children with meningococcal sepsis showed signs of euthyroid sick syndrome. Alterations in peripheral thyroid hormone metabolism related inversely to the duration of disease and seemed to be enacted by profound induction of type 3 deiodinase rather than by down-regulation of type 1. Lower TT 4 levels were related to increased turnover of TBG by elastase. Dopamine was found to suppress only TSH secretion, not other thyroid hormone levels, on PICU admission. Both the TT 3 /rT 3 ratio and TT 4 levels were predictive for mortality, but were not superior to IL-6.

In patients with ALF, TSH and total thyroid hormone levels differed significantly between SR patients and NSR patients. This might be related to diminished liver-derived transport proteins, such as albumin, in more severe forms of ALF. Thyroid parameters may serve as additional indicators of ALF severity.

SummaryReasons for performing the study: Hypothalamic‐pituitary‐thyroid (HPT) axis dysfunction is associated with morbidity and mortality in critically ill people. To date, investigations of HPT axis in critically ill foals are limited.Objectives: To document the occurrence of low thyroid hormone concentrations (presumptive nonthyroidal illness syndrome; NTIS) in critically ill newborn foals and investigate whether NTIS is associated with severity of disease and outcome.Hypothesis: NTIS occurs frequently in foals with sepsis and is associated with sepsis score and outcome. Reverse T3 (rT3) concentrations will be increased in septic foals and highest in nonsurvivors.Methods: Thyroid hormones (total and free thyroxine [TT4 and fT4], total and free tri‐iodothyronine [TT3 and fT3], reverse T3 [rT3]) were prospectively measured in healthy, sick nonseptic and septic foals. Clinical and laboratory information was retrieved from the medical records. Hormones were measured by validated radio...

Background: While therapy for patients with decompensated congestive heart failure (CHF) often leaves patients feeling better, there are no ohjective measures of improvement that correlate with the short-term outcomes of mortality and readmission. Because B-type natriuretic peptide (BNP) reflects both left ventricular stretch as well as neurohormonal modulation, we hypothesized that this peptide would be useful in assessing therapeutic responses and outcomes in patients admitted with decompensated CHF. Methods: BNP was measured daily (Biosite Diagnostics, La Jolla, CA) during parenteml treatment (inotropes, vasodilators, diuretics) of 72 patients admitted with decompensated NYHA class IV CHF. BNP levels were analyzed in relation to subsequent outcomes (death and 30 day readmission). Results: Of the 72 patients admitted with decompensated CHF, 22 endpoints occurred (death n = 12, readmission: n = 10). In patients without end-points, BNP decreased during treatment ((-)448 pg/ml). In patients who died or were later readmitted, BNP levels increased during hospitalization ((+)590 pg/ml, P < 0.001). despite improvement in NYHA classification. Multivariate analysis revealed discharge BNP to be highly predictive of endpoints. ROC analysis revealed 2 cut-points, a discharge BNP of 21220 pg/ml which had an odds-ratio 25.1 for endpoints and a positive predictive value of 75%, and discharge BNP level 5 430 pg/ml which had a negative predictive value of 96 percent for endpoints. Conclusions: In patients admitted with decompensated CHF, changes in BNP levels during treatment are strong predictors for mortality and early readmission. The results of this study further suggest that therapy for decompensated heart failure should be tailored to decreasing the BNP level during hospitalization.

Background: A "sick euthyroid" syndrome occurs in patients with severe decompensated chronic heart failure (CHF) and other chronic illnesses and is related to adverse prognosis, but it has not been described in patients with compensated CHF. The aim of this study was to determine whether manifestations of the sick euthyroid syndrome occur in patients with compensated CHF caused by ischemic heart disease. Methods and Results: Thyroid hormonal responses to thyrotropin-releasing hormone (TRH) stimulation were compared in 8 patients with New York Heart Association class I/II CHF considered secondary to ischemic heart disease and 7 control patients after serial 10-minute blood sampling over 3-hour periods. Secretory dynamics of TRH-induced thyroid-stimulating hormone (TSH) release were compared by using deconvolution analysis. Changes in serum thyroxine (T 4), triiodothyronine (T 3), reverse T3 (rT 3), and rT 3 /T 4 concentration ratios were compared. Patients with CHF had lower baseline serum T 3 concentrations (P < .001), with lower maximum serum T 3 (P < .01) and higher maximum serum rT 3 (P < .05) concentrations after TRH stimulation but similar estimated TRH-induced TSH secretory burst amplitude, mass, and 3-hour production rates, compared with control patients. Conclusions: Patients with compensated CHF display the derangements in thyroid hormone metabolism of impaired peripheral conversion of T 4 and T 3 and increased production of rT 3 in the presence of normal dynamic function of the hypothalamic-pituitary-thyroid axis, which are consistent with early manifestations of a sick euthyroid state.

Extensive burns lead to a severe systemic metabolic response consisting in an early ''ebb'' phase and a later ''flow'' phase. The ''flow'' phase is characterized by hypercatabolism, lasting at least 9 months [1]. This condition is thought to be an adaptive mechanism promoting survival evoked by the endocrine system [2]. In fact the ''flow'' phase is based on activation of gluconeogenesis and protein degradation, which b u r n s 3 4

Objective Following the evolution of COVID-19 pandemic, reports pointed on a high prevalence of thyroiditis-related thyrotoxicosis. Interpretation of thyroid tests during illness, however, is hampered by changes occurring in the context of non-thyroidal illness syndrome (NTIS). In order to elucidate these findings, we studied thyroid function in carefully selected cohorts of COVID-19 positive and negative patients. Design Cohort observational study. Methods We measured TSH, FT4, T3 within 24 h of admission in 196 patients without thyroid disease and/or confounding medications. In this study, 102 patients were SARS-CoV-2 positive; 41 admitted in the ICU, 46 in the ward and 15 outpatients. Controls consisted of 94 SARS-CoV-2 negative patients; 39 in the ICU and 55 in the ward. We designated the thyroid hormone patterns as consistent with NTIS, thyrotoxicosis and hypothyroidism. Results A NTIS pattern was encountered in 60% of ICU and 36% of ward patients, with similar frequencies betw...

Background The pediatric logistic organ dysfunction-2 (PELOD-2) score is recommended by the Indonesian Pediatric Society Emergency and Intensive Care Working Group as an indicator of life-threatening organ dysfunction for sepsis in children. However, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score in determining life-threatening organ dysfunction, which has not been adjusted for pediatric patients. Objective To assess the accuracy of the pediatric SOFA score in diagnosing sepsis in children admitted to the pediatric intensive care unit (PICU) at Mohammad Hoesin Hospital, Palembang, South Sumatera. Methods The study was conducted in children with organ dysfunction caused by infection admitted in PICU, from April to December 2019. Subjects were included by consecutive sampling, according to the following inclusion criteria: all patients aged 1 month to 18 years who me...

Blood thyroid function tests (TFT) are routinely used to screen for thyroid disorders in several clinical settings. TFT on hospital admission may also be useful prognostic predictors of acute IS: according to recent evidence, poststroke outcome is better in patients with lower thyroid function and worse in those with higher thyroid function. However, previous reports are few and mostly compared patients with thyroid disorders to euthyroid patients. Thyroid disorders are known risk factors for cerebrovascular disease. However, hyperthyroidism is related to cardioembolic IS whereas hypothyroidism is related to atherosclerotic risk factors. Therefore, findings from available studies of TFT might just reflect the worse prognosis of cardioembolic IS compared to other IS subtypes. Another limitation of previous studies is the lack of information for older persons, who represent three quarters of all IS patients. In this paper, we investigated whether serum thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) measured on Stroke Unit (SU) admission are associated with early outcomes of acute IS in 775 euthyroid patients aged ≥65 years (mean age 80.1 ± 8.7 years). Two composite outcomes were investigated: poor functional outcome (death during SU stay or disability at SU discharge), and unfavorable discharge setting (death during SU stay, transfer from SU to other acute hospital unit or transfer from SU to long-term care-facilities as opposed to direct discharge home). Analyses were performed using logistic regression models. Curvilinear associations were tested including TFT as polynomial terms. Models were adjusted for demographics, prestroke, and IS-related confounders. We found that lower TSH had a complex curvilinear association with poor functional outcome and that the shape of the associations changed with age. At age 65, the curve was U-shaped: outcome risk decreased with increasing TSH, reached its minimum at TSH near 3.00 mUI/L and then started to rise. Between ages 70 and 75, however, the shape of the curve straightened and, starting from age 80 took an inverted U-shape: outcome risk rose with increasing TSH, reached its maximum at TSH values that progressively shifted upward with increasing age (from 1.70 mU/L at age 80 to about 2.20 mUI/ L at age 90), then started to decrease. A linear inverse association was found between FT3 and unfavorable discharge setting. Our study suggests that measurement of TFT on SU admission can provide independent prognostic information for early outcomes of acute IS in older euthyroid patients.

Changes in thyroid hormone levels, mostly as non-thyroidal illness syndrome (NTIS), have been described in many diseases. However, the relationship between acute liver failure (ALF) and thyroid hormone levels has not yet been clarified. The present study evaluates potential correlations of select thyroid functional parameters with ALF. 84 consecutively recruited ALF patients were grouped according to the outcome of ALF (spontaneous recovery: SR; transplantation or death: NSR). TSH, free thyroxine (fT4), free triiodothyronine (fT3), T4, and T3 were determined. More than 50% of patients with ALF presented with abnormal thyroid parameters. These patients had greater risk for an adverse outcome than euthyroid patients. SR patients had significantly higher TSH, T4, and T3 concentrations than NSR patients. Albumin concentrations were significantly higher in SR than in NSR. In vitro T3 treatment was not able to rescue primary human hepatocytes from acetaminophen induced changes in mRNA exp...

Appropriate management of moyamoya syndrome associated with Graves' disease is undetermined because of the rarity of this combination. Patients tend to present with cerebrovascular events such as transient ischemic attack (TIA) in a thyrotoxic state, which is relieved by proper antithyroid therapy. Four patients with moyamoya syndrome associated with Graves' disease were successfully treated with revascularization surgery on 5 hemispheres among 58 consecutive patients (2-62 years old, mean 34.4 years) with moyamoya disease in 80 hemispheres treated from March 2004 to May 2007. Three patients presented with TIA, and one patient presented with intracerebral hemorrhage. Three patients were thyrotoxic at the onset of the cerebrovascular events. All patients underwent revascularization surgery after normalization of thyroid function. Euthyroid state was strictly maintained perioperatively. One patient developed symptomatic cerebral hyperperfusion, which was resolved by blood pressure control. Postoperative courses of the other patients were uneventful, and all 4 patients have remained neurologically stable after discharge. Cerebrovascular reconstruction surgery is a successful treatment option for moyamoya syndrome associated with Graves' disease. Timing of surgery during the euthyroid state and perioperative management considering the thyroid function and the cerebral hemodynamic change are the keys to successful surgical treatment.

Background Thyroid hormone stimulates the regulation of β-adrenergic receptors in order to increase the inotropic effect of the heart myocardium. Euthyroid sick syndrome is a disorder of non-metabolic thyroid function, which is characterized by a decrease in triiodothyronine (T3) levels in patients with non-thyroid systemic disease, such as sepsis. Low serum T3 hormone level is a potentially high-risk factor for mortality from sepsis. Objective To assess for a relationship between decreased serum T3 levels and mortality in pediatric sepsis patients admitted in the PICU. Methods This study used a nested case-control design. The subjects were children aged 1 month-18 years who were diagnosed with sepsis in the pediatric intensive care unit at Sanglah Hospital, Denpasar, Bali, from September 2017 to January 2019. Results A total of 90 children were included, of whom 44 died and 46 survived. Median age was 10.5 (IQR 44) months in subjects who died and 9 (IQR 50) months in those who surv...

Background: A "sick euthyroid" syndrome occurs in patients with severe decompensated chronic heart failure (CHF) and other chronic illnesses and is related to adverse prognosis, but it has not been described in patients with compensated CHF. The aim of this study was to determine whether manifestations of the sick euthyroid syndrome occur in patients with compensated CHF caused by ischemic heart disease. Methods and Results: Thyroid hormonal responses to thyrotropin-releasing hormone (TRH) stimulation were compared in 8 patients with New York Heart Association class I/II CHF considered secondary to ischemic heart disease and 7 control patients after serial 10-minute blood sampling over 3-hour periods. Secretory dynamics of TRH-induced thyroid-stimulating hormone (TSH) release were compared by using deconvolution analysis. Changes in serum thyroxine (T 4), triiodothyronine (T 3), reverse T3 (rT 3), and rT 3 /T 4 concentration ratios were compared. Patients with CHF had lower baseline serum T 3 concentrations (P < .001), with lower maximum serum T 3 (P < .01) and higher maximum serum rT 3 (P < .05) concentrations after TRH stimulation but similar estimated TRH-induced TSH secretory burst amplitude, mass, and 3-hour production rates, compared with control patients. Conclusions: Patients with compensated CHF display the derangements in thyroid hormone metabolism of impaired peripheral conversion of T 4 and T 3 and increased production of rT 3 in the presence of normal dynamic function of the hypothalamic-pituitary-thyroid axis, which are consistent with early manifestations of a sick euthyroid state.

Mediterranean spotted fever has long been considered as a benign disease, but associated with septic shock and encephalitis, becomes malignant and potentially fatal. We present the case of a 77 year-old man admitted into the emergency room after tick bite in abdominal region and fever 39.6°C. After admission, a maculopapular rash appears with the achievement of palms and soles associated with behavioral changes and adult respiratory distress syndrome. In intensive care CSF examination revealed 6 nuclear elements and a protein level of 94 mg/dL, and electroencephalogram supported the existence of encephalitis. Rickettsia serology by indirect immunofluorescence showed IgG> 1/640 and IgM=1/80. Septic shock, responded to antibiotic therapy and patient was discharged to long term care. This case demonstrates that a benign and common disease suffered a poor outcome owing to the accelerated clinical course with acute onset and rapid deterioration.

Objectives. In this study, we explore the associations of decreased thyroid hormone levels with inflammation, wasting and survival in biochemically euthyroid patients with end-stage renal disease (ESRD). Design. After exclusion of 23 patients with thyroidstimulating hormone (TSH) values outside the normal range (0.1-4.5 mIU L)1), 187 clinically and biochemically euthyroid incident ESRD stage 5 patients starting dialysis were followed for a median of 20 (range 1-60) months. Measurements of total and free forms of thyroid hormones, s-albumin, hs-CRP, interleukin (IL)-6, vascular adhesion molecule (VCAM)-1 and insulin-like growth factor 1 (IGF-1) were performed at baseline. Results. In this population, 17 out of 210 patients (8%) were defined as subclinically hypothyroid. Multivariate analysis, according to receiver operating characteristic (ROC) curves, showed that mortality was best predicted by total triiodothyronine (T3). When using the cutoff levels derived from ROC, low T3 levels were associated with increased inflammation (higher hs-CRP, IL-6 and VCAM-1) and lower concentration of both s-albumin and IGF-1. Finally, low T3 but not low free triiodothyronine was associated with worse all-cause (Likelihood ratio = 45.4; P < 0.0001) and cardiovascular mortality (Likelihood ratio = 47.8; P < 0.0001) after adjustment for confounding factors. Conclusion. This study showed that low T3 levels are independent predictors of all-cause and also cardiovascular disease mortality in biochemically euthyroid patients, perhaps due to an intimate association with inflammation. Based on these results, the use of T3 levels in studies assessing the relationship between thyroid dysfunction and mortality risk is recommended.

A babesiose é uma enfermidade emergente, de distribuição mundial, causada por protozoários do gênero Babesia, que afeta animais domésticos e animais selvagens, bem como em humanos. O objetivo deste estudo foi determinar a ocorrência de Babesia canis vogeli em cães na cidade de São Luís-MA, Brasil. Foram coletadas amostras de sangue de 65 animais para exame direto, por meio do esfregaço sanguíneo e diagnóstico molecular, por meio do PCRun. Dentre os 65 animais analisados por meio do diagnóstico direto, nenhum foi positivo para Babesia spp. enquanto pela PCRun, constatou-se que 5 (7,69%) estavam infectados por B. canis vogeli, demonstrando a presença dessa espécie em cães provenientes de ambiente urbano na cidade de São Luís. Concluiu-se que a PCR é uma técnica mais sensível e específica para esse diagnóstico, podendo ser utilizada para definir com maior precisão a infecção de cães por B. canis vogeli. Este estudo confirmou a presença de B. C. vogeli em cães na cidade de São Luís-MA. Palavras chave: B. canis vogeli, cães, diagnóstico direto, PCR Molecular detection of Babesia canis vogeli in dogs in the city of São Luís-MA, Brazil ABSTRACT. Babesiosis is an emerging, worldwide disease caused by protozoa of the genus Babesia, which infects domestic animals and wildlife, as well as humans. The objective of this study was to determine the occurrence of Babesia canis vogeli in dogs in the city of São Luís-MA, Brazil. Blood samples were collected from 65 animals for direct examination, through blood smear and molecular diagnosis, through PCRun. Among the 65 animals analyzed by direct diagnosis, none were positive for Babesia spp. while PCRun showed that 5 (7.69%) were infected by B. canis vogeli, demonstrating the presence of this species in dogs from an urban environment in the city of São Luís. It was concluded that PCR is a more sensitive and specific for this diagnosis, and can be used to define more precisely the infection of dogs by B. canis vogeli. This study confirmed the presence of B. C. vogeli in dogs in the city of.

Koroner baypas ameliyatı yapılan olgularda dopamin infüzyonunun tiroid hormonlarına etkisini araştırmak GEREÇ VE YÖNTEM: Bu gözlemsel çalışmaya preoperatif dönemde tiroid bezi hastalığı bulunmayan olgular alınmıştır. Dopamin infüzyonu yapılmayan olgular kontrol grubu: GRUP I (S=16), dopamin infüzyonu yapılan olgular ise 3 gruba ayrılmıştır. Sırasıyla 2,5-7,5μg/kg/dak dozda dopamin infüzyonu alan olgular GRUP-II (S=11), 10-20μg/kg/dak dozda dopamin infüzyonu alan olgular GRUP-III (S=12), 20 μg/kg/dak ve daha yüksek dozda dopamin infüzyonu alan 10 olgu GRUP IV (%21) olarak tanımlanmıştır. Kan örnekleri postoperatif en az 48 saat dopamin infüzyonu yapılan olgulardan, preoperatif dönemde ve postoperatif 2. 8. 16. 24. 48. ve 72. saatlerde alınarak; serum T3, serbest ST3, tiroksin (T4), serbest tiroksin (ST4) ve TSH düzeylerine bakılmıştır. BULGULAR: Çalışmaya; ortalama yaşı 62+11 olan, 26 erkek, 23 kadın olgu alınmıştır. Gruplar arasında akut myokard infarktüsü, sol ana koroner lezyonu, greft sayıları arasında anlamlı fark olmadığı, sol ventrikül ejeksiyon fraksiyonları (SVEF) GRUP-III ve IV'de belirgin olarak daha düşük olduğu saptanmıştır. GRUP I ve II'de ölüm gözlenmezken, GRUP III'te 2 hasta, GRUP IV'te ise 6 hasta çalışma sırasında kaybedilmiştir. Olguların tiroid hormon özdengesi(homeostaz) ndeki değişiklikler değerlendirildiğinde; GRUP-I ve II'de T3 ve FT3 düzeyleri postoperatif erken dönemde düşmüştür ve en düşük düzeylere postoperatif 16 ncı saatte ulaşılmıştır. 24 ncü saatte tekrar yükselmeye başlamıştır ve 72 nci saatte preoperatif düzeylere yükselmiştir. T4, FT4 ve TSH düzeyleri postoperatif 2.nci saatte anlamlı düşmüştür. Yetmiş ikinci saatte preoperatif dönemdeki düzeylere yükselmiştir. GRUP-III ve IV'de postoperatif dönemde tiroid hormon düzeyleri sürekli düşük seyretmiş ve 72 nci saatte en düşük değerlere ulaşmıştır.

Background: While therapy for patients with decompensated congestive heart failure (CHF) often leaves patients feeling better, there are no ohjective measures of improvement that correlate with the short-term outcomes of mortality and readmission. Because B-type natriuretic peptide (BNP) reflects both left ventricular stretch as well as neurohormonal modulation, we hypothesized that this peptide would be useful in assessing therapeutic responses and outcomes in patients admitted with decompensated CHF. Methods: BNP was measured daily (Biosite Diagnostics, La Jolla, CA) during parenteml treatment (inotropes, vasodilators, diuretics) of 72 patients admitted with decompensated NYHA class IV CHF. BNP levels were analyzed in relation to subsequent outcomes (death and 30 day readmission). Results: Of the 72 patients admitted with decompensated CHF, 22 endpoints occurred (death n = 12, readmission: n = 10). In patients without end-points, BNP decreased during treatment ((-)448 pg/ml). In patients who died or were later readmitted, BNP levels increased during hospitalization ((+)590 pg/ml, P < 0.001). despite improvement in NYHA classification. Multivariate analysis revealed discharge BNP to be highly predictive of endpoints. ROC analysis revealed 2 cut-points, a discharge BNP of 21220 pg/ml which had an odds-ratio 25.1 for endpoints and a positive predictive value of 75%, and discharge BNP level 5 430 pg/ml which had a negative predictive value of 96 percent for endpoints. Conclusions: In patients admitted with decompensated CHF, changes in BNP levels during treatment are strong predictors for mortality and early readmission. The results of this study further suggest that therapy for decompensated heart failure should be tailored to decreasing the BNP level during hospitalization.

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established.Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients.Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those &gt; 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney test...

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established.Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients.Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those &gt; 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney test...

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established.Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients.Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those &gt; 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney test...

Koroner baypas ameliyatı yapılan olgularda dopamin infüzyonunun tiroid hormonlarına etkisini araştırmak GEREÇ VE YÖNTEM: Bu gözlemsel çalışmaya preoperatif dönemde tiroid bezi hastalığı bulunmayan olgular alınmıştır. Dopamin infüzyonu yapılmayan olgular kontrol grubu: GRUP I (S=16), dopamin infüzyonu yapılan olgular ise 3 gruba ayrılmıştır. Sırasıyla 2,5-7,5μg/kg/dak dozda dopamin infüzyonu alan olgular GRUP-II (S=11), 10-20μg/kg/dak dozda dopamin infüzyonu alan olgular GRUP-III (S=12), 20 μg/kg/dak ve daha yüksek dozda dopamin infüzyonu alan 10 olgu GRUP IV (%21) olarak tanımlanmıştır. Kan örnekleri postoperatif en az 48 saat dopamin infüzyonu yapılan olgulardan, preoperatif dönemde ve postoperatif 2. 8. 16. 24. 48. ve 72. saatlerde alınarak; serum T3, serbest ST3, tiroksin (T4), serbest tiroksin (ST4) ve TSH düzeylerine bakılmıştır. BULGULAR: Çalışmaya; ortalama yaşı 62+11 olan, 26 erkek, 23 kadın olgu alınmıştır. Gruplar arasında akut myokard infarktüsü, sol ana koroner lezyonu, greft sayıları arasında anlamlı fark olmadığı, sol ventrikül ejeksiyon fraksiyonları (SVEF) GRUP-III ve IV'de belirgin olarak daha düşük olduğu saptanmıştır. GRUP I ve II'de ölüm gözlenmezken, GRUP III'te 2 hasta, GRUP IV'te ise 6 hasta çalışma sırasında kaybedilmiştir. Olguların tiroid hormon özdengesi(homeostaz) ndeki değişiklikler değerlendirildiğinde; GRUP-I ve II'de T3 ve FT3 düzeyleri postoperatif erken dönemde düşmüştür ve en düşük düzeylere postoperatif 16 ncı saatte ulaşılmıştır. 24 ncü saatte tekrar yükselmeye başlamıştır ve 72 nci saatte preoperatif düzeylere yükselmiştir. T4, FT4 ve TSH düzeyleri postoperatif 2.nci saatte anlamlı düşmüştür. Yetmiş ikinci saatte preoperatif dönemdeki düzeylere yükselmiştir. GRUP-III ve IV'de postoperatif dönemde tiroid hormon düzeyleri sürekli düşük seyretmiş ve 72 nci saatte en düşük değerlere ulaşmıştır.

Human Immunodeficiency virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) are associated with dysfunction of many endocrine organs and their axis. HIV infectivity leads to altered metabolism, poor oral intake and increased prevalence of weight loss and wasting which may have a role in thyroid dysfunction. Overt thyroid dysfunction occurs at similar rates as the general population while subclinical disease such as nonthyroidal illness (sick euthyroid syndrome), subclinical hypothyroidism and isolated low T4 levels are more frequent. Moreover, HAART therapy can complicate thyroid function further through drug interactions and the immune reconstitution inflammatory syndrome (IRIS). In this review we report the common thyroid dysfunctions associated with HIV before and after HAART therapy. We discuss presentation, diagnostic work up, treatment and follow up in each condition.