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OBJECTIVE: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. METHODS: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. RESULTS: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. CONCLUSION: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

OBJETIVO: Avaliar a síndrome do doente eutireóideo como fator prognóstico em pacientes na unidade de terapia intensiva, detectar fatores que possam influenciar a mortalidade e desenvolver uma equação para calcular a probabilidade de morte. MÉTODOS: Este foi um estudo de coorte longitudinal, observacional e não concorrente realizado na unidade de terapia intensiva da Fundação Santa Casa de Misericórdia do Pará. Realizou-se coleta de 20mL de sangue em 100 adultos sem endocrinopatia previamente documentada para a dosagem do hormônio estimulante da tireoide, da tetraiodotironina livre, da tri-iodotironina livre e da tri-iodotironina reversa. RESULTADOS: A maioria dos pacientes era do sexo feminino, com idades entre 20 e 29 anos. A maioria dos pacientes que morreram era mais velha (idade mediana de 48 anos), e 97,5% deles possuíam a síndrome do doente eutireóideo.A síndrome do doente eutireóideo esteve relacionada à morte, às comorbidades, à idade e ao tempo de internação (mediana de 7,5 dias) na unidade de terapia intensiva. A baixa dosagem de hormônio estimulante da tireoide estava associada à morte. Os pacientes com dosagem da tri-iodotironina livre menor que 2,9pg/mL tinham maior probabilidade de morrer e, naqueles que morreram, a dosagem de tri-iodotironina reversa era maior que 0,2ng/mL. A tri-iodotironina livre apresentou maior sensibilidade e acurácia, e a tri-iodotironina reversa teve maior especificidade para prever a mortalidade. Com base nos resultados e pontos de corte, desenvolveu-se uma fórmula de regressão logística múltipla para calcular a probabilidade de morte. CONCLUSÃO: Sugere-se verificar oportunamente a dosagem da triiodotironina livre e reversa em pacientes graves e aplicar a equação proposta.

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Several non-thyroid factors such as age, breed, concomitant diseases and use of certain drugs might influence the diagnosis of hypothyroidism in dogs. Changes in the concentrations of thyroid hormones due to non-thyroid illnesses are named euthyroid sick syndrome. The aim of this study was to evaluate the influence of visceral leishmaniasis on thyroid function in dogs without clinical signs of hypothyroidism, with or without azotemia. Positive animals for leishmaniasis were divided into six groups (absence or presence of hypoalbuminemia, normal or increased creatinine, normal or increased urea). The effect on these groups was evaluated on the thyroid-stimulating hormone (TSH), total thyroxine (TT4) and free thyroxine (FT4) concentrations. Dogs that were positive for leishmaniasis, by ELISA test, presented thyroid-stimulating hormone serum concentrations greater than seronegative animals, while total thyroxine and free thyroxine in dogs with leishmanisis were lower (P≤0.01) when compared to healthy dogs. However, the results were within the values for euthyroid animals. In seropositive dogs for leishmaniasis, TT4 showed statistically significant difference (P≤0.04) in the group with hypoalbuminemia compared to the group with normoalbuminemia, respectively, 1,01ug/dL and 1.4 g/dL. Based on this study, we could conclude that positive dogs for visceral leishmaniasis have not presented euthyroid sick syndrome, although when compared to healthy dogs, FT4 and TT4 were reduced and TSH increased

Vários fatores extratireoidianos como idade, raça, doenças concomitantes e fármacos podem influenciar na função e no diagnóstico do hipotireoidismo em cães. As alterações nas concentrações dos hormônios tireoidianos decorrentes de doenças não tireoidianas é denominada de síndrome do eutireoideo doente. O objetivo deste estudo foi avaliar a influência da leishmaniose visceral na função da tireoide em cães sem sinais de hipotireoidismo, com ou sem azotemia. Os animais positivos para leishmaniose foram divididos em seis grupos (albumina nornal ou diminuída, creatinina normal ou elevada, uréia normal ou elevada) e foi avaliado o efeito nesses grupos das concentrações séricas do hormônio estimulante da tireoide (TSH), tiroxina total (TT4) e da tiroxina livre (FT4). Os cães positivos para leishmaniose, pelo teste de ELISA, apresentaram concentrações séricas de TSH mais elevadas do que os animais soronegativos, enquanto que as concentrações de TT4 e FT4 em cães com leishmaniose foram menores (P <0,01) quando comparadas com as dos cães saudáveis. No entanto, os resultados estavam no intervalo dos valores para os animais eutireoideos. Nos cães seropositivos para leishmaniose, a TT4 apresentou diferença estatística significativa (P <0,04) no grupo com hipoalbuminemia em relação ao grupo com normoalbuminemia, respectivamente, 1,01ug/dL e 1,4ug/dL. Concluiu-se que os cães positivos para a leishmaniose visceral não desenvolveram síndrome do doente eutireóide, embora as concentrações de TT4 e a FT4 estivessem reduzida e de TSH elevada em relação aos cães sem leishmaniose

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Several non-thyroid factors such as age, breed, concomitant diseases and use of certain drugs might influence the diagnosis of hypothyroidism in dogs. Changes in the concentrations of thyroid hormones due to non-thyroid illnesses are named euthyroid sick syndrome. The aim of this study was to evaluate the influence of visceral leishmaniasis on thyroid function in dogs without clinical signs of hypothyroidism, with or without azotemia. Positive animals for leishmaniasis were divided into six groups (absence or presence of hypoalbuminemia, normal or increased creatinine, normal or increased urea). The effect on these groups was evaluated on the thyroid-stimulating hormone (TSH), total thyroxine (TT4) and free thyroxine (FT4) concentrations. Dogs that were positive for leishmaniasis, by ELISA test, presented thyroid-stimulating hormone serum concentrations greater than seronegative animals, while total thyroxine and free thyroxine in dogs with leishmanisis were lower (P≤0.01) when compared to healthy dogs. However, the results were within the values for euthyroid animals. In seropositive dogs for leishmaniasis, TT4 showed statistically significant difference (P≤0.04) in the group with hypoalbuminemia compared to the group with normoalbuminemia, respectively, 1,01ug/dL and 1.4 g/dL. Based on this study, we could conclude that positive dogs for visceral leishmaniasis have not presented euthyroid sick syndrome, although when compared to healthy dogs, FT4 and TT4 were reduced and TSH increased(AU)

Vários fatores extratireoidianos como idade, raça, doenças concomitantes e fármacos podem influenciar na função e no diagnóstico do hipotireoidismo em cães. As alterações nas concentrações dos hormônios tireoidianos decorrentes de doenças não tireoidianas é denominada de síndrome do eutireoideo doente. O objetivo deste estudo foi avaliar a influência da leishmaniose visceral na função da tireoide em cães sem sinais de hipotireoidismo, com ou sem azotemia. Os animais positivos para leishmaniose foram divididos em seis grupos (albumina nornal ou diminuída, creatinina normal ou elevada, uréia normal ou elevada) e foi avaliado o efeito nesses grupos das concentrações séricas do hormônio estimulante da tireoide (TSH), tiroxina total (TT4) e da tiroxina livre (FT4). Os cães positivos para leishmaniose, pelo teste de ELISA, apresentaram concentrações séricas de TSH mais elevadas do que os animais soronegativos, enquanto que as concentrações de TT4 e FT4 em cães com leishmaniose foram menores (P <0,01) quando comparadas com as dos cães saudáveis. No entanto, os resultados estavam no intervalo dos valores para os animais eutireoideos. Nos cães seropositivos para leishmaniose, a TT4 apresentou diferença estatística significativa (P <0,04) no grupo com hipoalbuminemia em relação ao grupo com normoalbuminemia, respectivamente, 1,01ug/dL e 1,4ug/dL. Concluiu-se que os cães positivos para a leishmaniose visceral não desenvolveram síndrome do doente eutireóide, embora as concentrações de TT4 e a FT4 estivessem reduzida e de TSH elevada em relação aos cães sem leishmaniose(AU)

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A síndrome do eutireoidiano doente (SED) é uma entidade caracterizada pela queda das concentrações sanguíneas de triiodotironina nas formas total e livre e aumento da forma reversa. Ocorre principalmente em pacientes portadores de doenças graves e agudas, particularmente dentre aqueles internados em unidade de terapia intensiva. Há descrição desta síndrome em portadores de Diabetes Mellitus, particularmente sob controle glicêmico inadequado. Objetivos: Avaliar as alterações dos hormônios tireoidianos em portadores de DM sob cuidado ambulatorial e a correlação entre concentrações de hormônios tireoidianos e controle glicêmico, presença de complicações crônicas (neuropatia, nefropatia, retinopatia) e marcadores de inflamação sistêmica subclínica, bem como sua relação com presença de eventos cardiovasculares. Metodologia: Estudo transversal avaliando 52 pacientes com diabetes tipo 2 e 52 indivíduos sem diabetes, entre 40 e 75 anos de idade, pareados por sexo, idade e índice de massa corporal. Avaliaram-se dados clínicos e antropométricos, concentrações séricas de hormônios tireoidianos e proteína C reativa, bem como exames laboratoriais que refletem o perfil lipídico e controle glicêmico. Resultados: Cerca de 73% dos pacientes com diabetes e 40% dos indivíduos sem DM apresentaram concentrações séricas diminuídas de T3 total; 25% dos pacientes e apenas 2% dos indivíduos sem DM apresentaram concentrações diminuídas de T3 livre. As concentrações séricas de T3 total (p<0,001), T3 livre (p<0,001) e T4 total (p=0,006) estavam diminuídas em comparação aos de indivíduos sem diabetes. As concentrações de T3 reverso não apresentaram diferença entre os dois grupos. Pacientes com diabetes apresentaram T4 livre mais elevado (p=0,033).

The non-thyroidal illness is an entity characterized by reduced serum levels of total and free triiodothyronine and a rise in its reverse form. It occurs mainly in critically ill patients. There are descriptions of this syndrome in patients with Diabetes Mellitus, especially those under inadequate glycemic control. Objectives: Evaluate the abnormalities in thyroid hormone levels in individuals with diabetes under standard outpatient care and the correlation of thyroid hormone levels with glycemic control, presence of chronic complications (neuropathy, nephropathy and retinopathy) and subclinical systemic inflammation, as well as its relation with the presence of previous cardiovascular events. Methodology: Cross sectional study involving 52 patients with type 2 diabetes and 52 individuals without the diabetes, between 40 and 75 years of age paired by age, gender and body mass index. We evaluated clinical and anthropometric data, serum levels of thyroid hormones and Creactive protein, as well as laboratory parameters that reflect the lipid profile and glycemic control. Results: Approximately 73% of the patients with diabetes and 40% of individuals without diabetes presented reduced serum levels of total T3. Nearly 25% of the patients and only 2% of the individuals without diabetes presented reduced levels of free T3. The levels of total T3 (p<0.001), free T3 (p<0.001) and total T4 (p=0.006) were lower in patients with diabetes compared with those without diabetes. The levels of reverse T3 did not present any difference between both groups. Patients with diabetes presented higher levels of free T4 (p=0.033). The levels of reverse T3 were significantly different only when comparing individuals with previous cardiovascular events with those without this characteristic (p=0.002 for patients with diabetes and p=0.037 for individuals without diabetes). The prevalence of cardiovascular disease was 25%.

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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 full-term 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 [T3: -0.97 µg/dL (95% CI -0.89, -1.13) and T4: -4.37 µg/dL (95% CI -2.95, -5.78)]. Only 29 out of 94 (31%) infants presented a normal profile; 37 (39%) infants showed isolated low T3 levels, 20 (21%) infants had low T3 and T4 levels and eight (9%) infants had low TSH, T3, and T4. Of this latter group, five of eight (62%) children died suggesting a significantly higher risk of death for patients with low T3 associated with low T4 and TSH [Risk ratio (RR) 10.75 95% CI 3.93, 29]. CONCLUSIONS: Full-term sick newborns frequently have lower thyroid hormone levels than healthy ones. These observed thyroid hormones changes might be related to the underlying disease and could be used as a prognostic marker of the severity and fatal outcome of the patient.

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OBJETIVO: Descrever o perfil hormonal tireoidiano em pacientes com síndromes coronarianas agudas (SCA), e nos grupos: 1) angina instável e/ou infarto agudo do miocárdio sem supradesnivelamento de segmento ST (AI/IAM sem supra ST); 2) infarto agudo do miocárdio com supradesnivelamento do segmento (IAM com supra ST), e nos pacientes que evoluíram ou não a óbito conforme os grupos. MÉTODOS: Foram estudados prospectivamente setenta pacientes portadores de SCA, internados na unidade coronariana do Hospital dos Servidores do Estado/RJ. As amostras sangüíneas foram coletadas nos primeiro, quarto e sétimo dias de internação. Exame clínico e eletrocardiograma foram realizados no período de internação. RESULTADOS: Dos 70 pacientes admitidos, 13 (18,6 por cento) apresentaram a "síndrome do eutireoidiano doente" (SED), que consiste na queda do hormônio T3 e ou T3 livre, aumento do hormônio T3 reverso (rT3) e inalteração dos hormônios TSH, T4 e T4 livre. Nos pacientes do grupo IAM com supra ST, observaram-se elevação precoce e maiores médias do hormônio tireoidiano T3 reverso (rT3) e menores médias dos hormônios T3 e T3 livre. Nos coronariopatas que evoluíram a óbito, observamos achados hormonais condizentes com os encontrado na SED, com valores médios expressivos dos hormônios rT3 e T3. CONCLUSÃO: Os resultados apresentados neste estudo mostram a importância do reconhecimento da "síndrome do eutireoidiano doente" nos pacientes coronariopatas, sugerindo associação com pior prognóstico nos pacientes com síndrome coronariana aguda.

OBJECTIVE: To describe thyroid hormone profile in patients with acute coronary syndromes (ACS), divided into two groups: 1) unstable angina and/or non-ST-segment elevation acute myocardial infarction (UA/NSTEMI); 2) ST-segment elevation acute myocardial infarction (STEMI), as well as in patients that progressed or not to death, according to the groups. METHODS: Seventy ACS patients admitted to the coronary care unit of the Hospital dos Servidores do Estado, Rio de Janeiro, were prospectively studied. Blood samples were collected on day 1 and on days 4 and 7 following admission. Clinical evaluation and electrocardiograms were performed during hospitalization. RESULTS: Of the 70 patients admitted, 13 (18.6 percent) had "euthyroid sick syndrome" (ESS), a condition characterized by decreased serum T3 and/or free T3, increased serum reverse T3 (rT3), plus normal serum TSH, T4, and free T4. Patients belonging to the STEMI group showed early elevations, in addition to higher mean reverse T3 (rT3) and lower mean T3 and free T3 levels. In coronary heart disease patients that progressed to death, hormonal findings were consistent with those found in the ESS, with more expressive rT3 and T3 mean values. CONCLUSION: Our results show the importance of recognizing the "euthyroid sick syndrome" in coronary heart disease patients, suggesting an association with poorer prognosis in patients with acute coronary syndrome.

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OBJECTIVE: To describe thyroid hormone profile in patients with acute coronary syndromes (ACS), divided into two groups: 1) unstable angina and/or non-ST-segment elevation acute myocardial infarction (UA/NSTEMI); 2) ST-segment elevation acute myocardial infarction (STEMI), as well as in patients that progressed or not to death, according to the groups. METHODS: Seventy ACS patients admitted to the coronary care unit of the Hospital dos Servidores do Estado, Rio de Janeiro, were prospectively studied. Blood samples were collected on day 1 and on days 4 and 7 following admission. Clinical evaluation and electrocardiograms were performed during hospitalization. RESULTS: Of the 70 patients admitted, 13 (18.6%) had "euthyroid sick syndrome" (ESS), a condition characterized by decreased serum T3 and/or free T3, increased serum reverse T3 (rT3), plus normal serum TSH, T4, and free T4. Patients belonging to the STEMI group showed early elevations, in addition to higher mean reverse T3 (rT3) and lower mean T3 and free T3 levels. In coronary heart disease patients that progressed to death, hormonal findings were consistent with those found in the ESS, with more expressive rT3 and T3 mean values. CONCLUSION: Our results show the importance of recognizing the "euthyroid sick syndrome" in coronary heart disease patients, suggesting an association with poorer prognosis in patients with acute coronary syndrome.

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The association of hyperthyroxinemia and euthyroidism is frequent and characterized by high plasma thyroxin concentrations, normal TSH values and absence of clinical signs of hyperthyroidism. We report an asymptomatic 28 years old male presenting with a serum total plasma thyroxin of 18.5 micrograms/dl (N 6.1-12.5), a free thyroxin of 2.9 ng/dl (N 0.8-1.4), a TSH of 3.4 microIU/ml (N 0.5-5), and a triiodothyronine of 128 ng/dl (N 80-180). Laboratory assessment did not find high thyroxin binding globulin, albumin or prealbumin concentrations or antithyroxin antibodies. The thyroxin binding capacity of albumin was elevated to 58.2 micrograms/dl (N 11.5-34.1). TSH responded normally to TRH stimulus and was suppressed with exogenous triiodothyronine, which caused an hyperthyroid syndrome. We concluded that this patient had a familial dysalbuminemia.

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The association of hyperthyroxinemia and euthyroidism is frequent and characterized by high plasma thyroxin concentrations, normal TSH values and absence of clinical signs of hyperthyroidism. We report an asymptomatic 28 years old male presenting with a serum total plasma thyroxin of 18.5 µg/dl (N 6.1-12.5), a free thyroxin of 2.9 ng/dl (N 0.8-1.4), a TSH of 3.4 µIU/ml (N 0.5-5), and a triiodothyronine of 128 ng/dl (N 80-180). Laboratory assessment did not find high thyroxin binding globulin, albumin or prealbumin concentrations or antithyroxin antibodies. The thyroxin binding capacity of albumin was elevated to 58.2 µg/dl (N 11.5-34.1). TSH responded normally to TRH stimulus and was suppressed with exogenous triiodothyronine, which caused an hyperthyroid syndrome. We concluded that this patient had a familial dysalbuminemia

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