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Cited by 44Thyroid Disorders and TreatmentsAdrenal Hormones and DisordersSepsis Diagnosis and Treatment

Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases – implications for the euthyroid sick syndrome

Mönig, H., Arendt, T., Meyer, M., Kloehn, S., Bewig, B.·1999·Intensive Care Medicine
DOI 10.1007/s001340051088
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Abstract

Objective To determine whether cytokine release or activation of the hypothalamo-pituitary-adrenal (HPA) axis is predominantly involved in the development of the euthyroid sick syndrome (ESS).Design Prospective observational study.Setting Intensive care unit at a tertiary care medical center in Germany.Patients Nine patients with sepsis of different causes and eight patients with acute myocardial infarction.Interventions None.Measurements and results Immediately on admission and on day 7 the following parameters were determined: total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), thyrotropin (TSH), interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), serum cortisol and plasma adrenocorticotropin (ACTH). On admission, concentrations of all thyroid hormones and TSH were significantly lower in septic patients compared to non-septic patients, whereas all cytokines except IL-2 were significantly elevated in the sepsis group. By contrast, there was no difference in serum cortisol and plasma ACTH levels between the two groups. On day 7, T4 and T3 were still lower in the septic group, whereas IL-1 beta, sIL-2R and IL-6 were still elevated. Again, no differences were found with regard to cortisol and ACTH levels.Conclusions Euthyroid sick syndrome occurs very early during the course of septic diseases. Significantly decreased levels of total T4, FT4, T3 and TSH in septic patients suggest central suppression of TSH as well as inhibition of thyroid hormone release in ESS. The HPA axis is activated in septic patients and in non-septic patients and does not contribute to the development of ESS.

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  • Other proinflammatory cytokines including interleukin 1β (IL-1β), soluble interleukin-2 receptor (sIL-2R) and tumor necrosis factor (TNF)α are elevated in septic NTIS patients.

    “Other proinflammatory cytokines including interleukin 1β (IL-1β), soluble interleukin-2 receptor (sIL-2R) and tumor necrosis factor (TNF)α are elevated in septic NTIS patients [50].”

    From An update on non-thyroidal illness syndrome (2021) · cites this paper as [50]

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Authors
Mönig, H., Arendt, T., Meyer, M., Kloehn, S., & Bewig, B.
Affiliations
Christian-Albrechts-Universität zu Kiel (DE)
ORCID
Arendt, T.
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
1999-12
Volume
25
Issue
12
Pages
1402-1406
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s001340051088
OpenAlex
W2053744609
Cited by
44
References
25
Citations by year
2026: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 4 · 2012: 2
FWCI
0.69
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Intensive Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
low T3 syndrome, hypothalamic-pituitary-adrenal axis, sepsis, cytokines, thyroid hormones, thyroid-stimulating hormone, cortisol, ACTH, interleukin-6, IL-1β, TNF-α, acute myocardial infarction
MeSH terms
Adult, Aged, Critical Care, Euthyroid Sick Syndromes, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Thyrotropin, Thyroxine, Cytokines, Sepsis

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