This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by den Brinker, M. Articles by Hokken-Koelega, A. C. S. Search for Related Content PubMed PubMed Citation Articles by den Brinker, M. Articles by Hokken-Koelega, A. C. S. Related Collections Thyroid

Euthyroid Sick Syndrome in Meningococcal Sepsis: The Impact of Peripheral Thyroid Hormone Metabolism and Binding Proteins

Department of Pediatrics, Divisions of Endocrinology (M.d.B., V.H.B., A.C.S.H.-K.) and Pediatric Intensive Care (M.d.B., K.F.M.J., J.A.H.), Erasmus MC-Sophia Children’s Hospital, and Departments of Internal Medicine (T.J.V., Y.B.d.R.) and Epidemiology and Biostatistics (W.C.J.H.), Erasmus MC, 3000 CB Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: Drs. Marieke den Brinker or Anita C. S. Hokken-Koelega, Erasmus MC-Sophia Children’s Hospital, Department of Pediatrics, Divisions of Endocrinology and Pediatric Intensive Care, Room SP-3435, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: m.denbrinker{at}erasmusmc.nl or a.hokken{at}erasmusmc.nl.

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 T₃ (TT₃)/rT₃ ratios without elevated TSH. T₄ sulfate levels were decreased in 88%. Nonsurvivors had paradoxically higher TT₃/rT₃ ratios than shock survivors (0.71 vs. 0.30); this ratio also correlated with shorter duration of disease (r = –0.43). TT₄ and T₄-binding globulin (TBG) levels declined with increasing disease severity. TBG levels correlated inversely with elastase levels (r = –0.46). 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 TT₃/rT₃ ratios and lower TT₄ 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 TT₄ 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 TT₃/rT₃ ratio and TT₄ levels were predictive for mortality, but were not superior to IL-6.

This article has been cited by other articles:

				A. L. de Souza and A. C. Seguro Two centuries of meningococcal infection: from Vieusseux to the cellular and molecular basis of disease J. Med. Microbiol., November 1, 2008; 57(11): 1313 - 1321. [Abstract] [Full Text] [PDF]