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 Peeters, R. P. Articles by Van den Berghe, G. Search for Related Content PubMed PubMed Citation Articles by Peeters, R. P. Articles by Van den Berghe, G. Related Collections Thyroid

Serum 3,3',5'-Triiodothyronine (rT₃) and 3,5,3'-Triiodothyronine/rT₃ Are Prognostic Markers in Critically Ill Patients and Are Associated with Postmortem Tissue Deiodinase Activities

Department of Internal Medicine (R.P.P., H.v.T., E.K., T.J.V.), Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands; and Department of Intensive Care Medicine (P.J.W., G.V.d.B.), Catholic University of Leuven, B-3000 Leuven, Belgium

Address all correspondence and requests for reprints to: Greet Van den Berghe, M.D., Ph.D., Department of Intensive Care Medicine, Catholic University of Leuven, B-3000 Leuven, Belgium. E-mail: greta.vandenberghe{at}med.kuleuven.ac.be.

Introduction and Methods: Critical illness is associated with reduced TSH and thyroid hormone secretion, and with changes in peripheral thyroid hormone metabolism, resulting in low serum T₃ and high rT₃. In 451 critically ill patients who received intensive care for more than 5 d, serum thyroid parameters were determined on d 1, 5, 15, and last day (LD). All patients had been randomized for intensive or conventional insulin treatment. Seventy-one patients died, and postmortem liver and skeletal muscle biopsies were obtained from 50 of them for analysis of deiodinase (D1–3) activities.

Results: Insulin treatment did not affect thyroid parameters. On d 1, rT₃ was higher and T₃/rT₃ was lower in nonsurvivors as compared with survivors (P = 0.001). Odds ratio for survival of the highest vs. the lowest quartile was 0.3 for rT₃ and 2.9 for T₃/rT₃. TSH, T₄, and T₃ were lower in nonsurvivors from d 5 until LD (P < 0.001). TSH, T₄, T₃, and T₃/rT₃ increased over time in survivors, but decreased or remained unaltered in nonsurvivors. Liver D1 activity was positively correlated with LD serum T₃/rT₃ (R = 0.83, P < 0.001) and negatively correlated with rT₃ (R = –0.69, P < 0.001). Both liver and skeletal muscle D3 activity were positively correlated with LD serum rT₃ (R = 0.32, P = 0.02 and R = 0.31, P = 0.03).

Conclusion: In critically ill patients who required more than 5 d of intensive care, rT₃ and T₃/rT₃ were already prognostic for survival on d 1. On d 5, T₄, T₃, but also TSH levels are higher in patients who will survive. Serum rT₃ and T₃/rT₃ were correlated with postmortem tissue deiodinase activities.

This article has been cited by other articles:

				S. J. Lee, J. G. Kang, O. H. Ryu, C. S. Kim, S.-H. Ihm, M. G. Choi, H. J. Yoo, and K. S. Hong The relationship of thyroid hormone status with myocardial function in stress cardiomyopathy Eur. J. Endocrinol., May 1, 2009; 160(5): 799 - 806. [Abstract] [Full Text] [PDF]

				E Forestier, S Vinzio, R Sapin, J L Schlienger, and B Goichot Increased reverse triiodothyronine is associated with shorter survival in independently-living elderly: the Alsanut study Eur. J. Endocrinol., February 1, 2009; 160(2): 207 - 214. [Abstract] [Full Text] [PDF]

				B. Gereben, A. M. Zavacki, S. Ribich, B. W. Kim, S. A. Huang, W. S. Simonides, A. Zeold, and A. C. Bianco Cellular and Molecular Basis of Deiodinase-Regulated Thyroid Hormone Signaling Endocr. Rev., December 1, 2008; 29(7): 898 - 938. [Abstract] [Full Text] [PDF]

				R. Dalan, M. K.-S. Leow, and D. C.-E. Ng High iodine (substrate) turnover Graves' disease: the intriguing 'rapid responder' variant of thyrotoxicosis Ann Clin Biochem, November 1, 2008; 45(6): 612 - 615. [Abstract] [Full Text] [PDF]

				Y. Debaveye, B. Ellger, L. Mebis, T. J. Visser, V. M. Darras, and G. Van den Berghe Effects of Substitution and High-Dose Thyroid Hormone Therapy on Deiodination, Sulfoconjugation, and Tissue Thyroid Hormone Levels in Prolonged Critically Ill Rabbits Endocrinology, August 1, 2008; 149(8): 4218 - 4228. [Abstract] [Full Text] [PDF]

				A Boelen, J Kwakkel, W M Wiersinga, and E Fliers Chronic local inflammation in mice results in decreased TRH and type 3 deiodinase mRNA expression in the hypothalamic paraventricular nucleus independently of diminished food intake J. Endocrinol., December 1, 2006; 191(3): 707 - 714. [Abstract] [Full Text] [PDF]

				J. Kohrle, F. Jakob, B. Contempre, and J. E. Dumont Selenium, the Thyroid, and the Endocrine System Endocr. Rev., December 1, 2005; 26(7): 944 - 984. [Abstract] [Full Text] [PDF]

				R. P. Peeters, M. H. A. Kester, P. J. Wouters, E. Kaptein, H. van Toor, T. J. Visser, and G. Van den Berghe Increased Thyroxine Sulfate Levels in Critically Ill Patients as a Result of a Decreased Hepatic Type I Deiodinase Activity J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6460 - 6465. [Abstract] [Full Text] [PDF]

				R. P. Peeters, S. van der Geyten, P. J. Wouters, V. M. Darras, H. van Toor, E. Kaptein, T. J. Visser, and G. Van den Berghe Tissue Thyroid Hormone Levels in Critical Illness J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6498 - 6507. [Abstract] [Full Text] [PDF]

				Y. Debaveye, B. Ellger, L. Mebis, E. Van Herck, W. Coopmans, V. Darras, and G. Van den Berghe Tissue Deiodinase Activity during Prolonged Critical Illness: Effects of Exogenous Thyrotropin-Releasing Hormone and Its Combination with Growth Hormone-Releasing Peptide-2 Endocrinology, December 1, 2005; 146(12): 5604 - 5611. [Abstract] [Full Text] [PDF]