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Submitted on May 6, 2005
Accepted on September 9, 2005
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Laboratory of Comparative Endocrinology, Zoological Institute, K.U. Leuven, B-3000 Leuven, Belgium; Department of Intensive Care Medicine, K.U. Leuven, B-3000 Leuven, Belgium
* To whom correspondence should be addressed. E-mail: greta.vandenberghe{at}med.kuleuven.ac.be.
Context: Pronounced alterations in serum thyroid hormone levels occur during critical illness. Triiodothyronine (T3) decreases and reverse T3 (rT3) increases, the magnitudes of which are related to the severity of disease. It is unclear whether these changes are associated with decreased tissue T3 concentrations and, thus, reduced thyroid hormone bioactivity.
Patients and study questions: We therefore investigated in 79 patients who died after intensive care and who did or did not receive thyroid hormone treatment, if total serum thyroid hormone levels correspond to tissue levels in liver and muscle. Furthermore, we investigated the relation between tissue thyroid hormone levels, deiodinase activities, and monocarboxylate transporter 8 (MCT8) expression.
Results: Tissue iodothyronine levels were positively correlated with serum levels, indicating that the decrease in serum T3 during illness is associated with decreased levels of tissue T3. Higher serum T3 levels in patients who received thyroid hormone treatment were accompanied by higher levels of liver and muscle T3, with evidence for tissue specific regulation. Tissue rT3 and the T3/rT3 ratio were correlated with tissue deiodinase activities. MCT8 expression was not related to the ratio of the serum over tissue concentration of the different iodothyronines.
Conclusion: Our results suggest that, in addition to changes in the hypothalamus-pituitary-thyroid axis, tissue-specific mechanisms are involved in the reduced supply of bioactive thyroid hormone in critical illness.
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