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High Incidence of Decreased Serum Triiodothyronine Concentration in Patients with Nonthyroidal Disease

The Endocrine Research Laboratory, Division of Endocrinology, Department of Medicine Bronx, New York 10467
Montefiiore Hospital and Medical Center Bronx, New York 10467
The Albert Einstein College of Medicine Bronx, New York 10467

Serum thyroxine (T₄) and triiodothyronine (T₃) concentration and binding were measured in 34 clinically euthyroid patients hospitalized for a wide variety of nonthyroidal diseases. Despite clinical euthyroidism, serum T₃ was in the hypothyroid range (<90 ng/100 ml) in 24 of the 34 patients, and the mean serum T₃ of this group, 78.4 ± 38.3 (SD), was significantly decreased from that of control, 134.0 ± 29.3 ng/100 ml. Mean serum T₄ levels were essentially the same in both groups, 7.3 ± 2.0 for the sick patients and 7.2 ± 1.0 µg/100 ml for the controls. Plasma binding of both T₄ and T₃ was decreased in the patient group to 69.9 and 78% of control values, respectively. In accord with previous studies, the mean free T₄ index, proportional to free T₄ concentration, was significantly increased to 10.0 ± 4.1 in the patient group (control, 7.6 ± 1.3). However, the mean free T₃ index of the patient group, 92.9 ± 38.4, remained decreased from that of control, 138.9 ± 34.3. Of the 24 patients with decreased serum T₃ (< 90 ng/100 ml), low T₃ levels could be attributed to decreased plasma binding in 8; in 5, serum T₃ was within the normal range for their advanced age. Mean TSH was greater in the patient group 2.6 ± 1.9, than in the controls, 1.9 ± 1.1 µU/ml. Moreover, the TSH response to administered TRH was moderately exaggerated in 7 patients with low free T₃ index compared to 7 patients with normal free T₃ index. Although significant statistically, neither the basal nor TRH induced TSH levels were in the range generally found in primary hypothyroidism. The data suggest that the high incidence of low serum T₃ (70%) and free T₃ index (32%) in nonthyroidal disease may be related to the catabolic state that accompanies illness rather than to specific disease entities. At the present time, the use of serum T₃ or free T₃ measurements for the diagnosis of hypothyroidism does not appear justified in patients with nonthyroidal disease.

^* Fellow in Endocrinology, Montefiore Hospital andMedical Center.

Supported by: NIH Grant AM 15421–14; NIH GrantCA 16463–01; Research Career Development Award 5KO4 AM19502-02 (M.I.S.); and General Clinical Re-search Center Grant # RR 00053–13.

Received October 17, 1974.

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