Kaplan MM, Larsen PR, Crantzf R, Dzau VJ, Rossing TH, Haddow JE. High Incidence of Decreased Serum Triiodothyronine Concentration in Patients With Nonthyroidal Disease. doi: 10.1210/jcem.īermudez F, Surks MI, Oppenheimer JH. Clinical Review 86: Euthyroid Sick Syndrome: Is it a Misnomer? J Clin Endocrinol Metab (1997) 82(2):329–34. Non Thyroidal Illness: To Treat or Not to Treat? Ann Endocrinol (Paris) (2007) 68(4):224–8. SARS-CoV-2 (2019-nCoV) coronavirus bioelectrical impedance analysis hydration nonthyroidal illness syndrome sodium/potassium exchangeable ratio.Ĭopyright © 2022 Sciacchitano, Capalbo, Napoli, Anibaldi, Salvati, De Vitis, Mancini, Coluzzi and Rocco. New primary endpoints should be identified to adequately validate the efficacy of TH treatment and to obtain a clear answer to the question raised some years ago. Despite several available IRCTs, it is still unclear whether NTIS should be treated or not. NTIS is a frequent finding in critical ill patients. We also found great variability in the primary outcomes, such as prevention of neurological alterations, reduction of oxygen requirements, restoration of endocrinological and clinical parameters and reduction of mortality. We observed a marked heterogeneity among the IRCTs, in terms of type of TH supplementation, route of administration, dosages and duration of treatment. In particular, we analyzed the type of TH supplementation, the route of administration, the dosages and duration of treatment and the outcomes chosen to evaluate the results. After a careful selection, we extracted data from four metanalyses, performed in different clinical conditions and diseases. We performed a review of the metanalyses focused on NTIS in critically ill patients. In this review, we analyze the reasons why TH treatment did not furnish convincing results regarding possible beneficial effects in reported IRCTs. Since many interventional randomized clinical trials (IRCT)s were not conclusive, current guidelines do not recommend treatment for these patients. Whether patients with NTIS should receive treatment with thyroid hormones (TH)s is still debated. In this way, it’s theorized that ESS may be the body’s “adaptive” way to conserve energy in response to acute illness.Nonthyroidal Illness Syndrome (NTIS) occurs in approximately 70% of patients admitted to Intensive Care Units (ICU)s and has been associated with increased risk of death. Specifically, triiodothyronine (T3) and thyroxine (T4) can be reduced, and the conversion of T4 into T3 – the active thyroid hormone – is also slowed. As a way to help throttle back the speed of the metabolism, cytokines and other inflammatory mediators in the body reduce levels of thyroid hormones. While the mechanism behind ESS is not well understood, it’s theorized that in the face of an acute illness – known as a nonthyroidal illness, or NTI – the body goes into metabolic overdrive, and speeds up the process of muscle loss and more rapidly burns calories. ESS is also known as nonthyroidal illness syndrome (NTIS), sick euthyroid syndrome (SES), low T3 low T4 syndrome, and thyroid allostasis in critical illness, tumors, uremia, and starvation, or TACITUS. Euthyroid sick syndrome (ESS) refers to abnormal thyroid levels – resulting from an acute illness – in a patient with no preexisting or current dysfunction in the thyroid gland.
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