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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.

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