Thyroid function in critically ill patients

Fliers, Eric; Bianco, Antonio C; Langouche, Lies; Boelen, Anita

doi:10.1016/s2213-8587(15)00225-9

Cited by 441Thyroid Disorders and TreatmentsAdrenal Hormones and DisordersClinical Nutrition and Gastroenterology

Thyroid function in critically ill patients

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Fliers, Eric, Bianco, Antonio C, Langouche, Lies, Boelen, Anita·2015·The Lancet Diabetes & Endocrinology

DOI 10.1016/s2213-8587(15)00225-9PMC PMC4979220

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Abstract

Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and macronutrient restriction, which might be beneficial. Pathogenesis of NTIS in long-term critical illness is more complex and includes suppression of hypothalamic thyrotropin-releasing hormone, accounting for persistently reduced secretion of thyroid-stimulating hormone despite low plasma thyroid hormone. In some cases distinguishing between NTIS and severe hypothyroidism, which is a rare primary cause for admission to the ICU, can be difficult. Infusion of hypothalamic-releasing factors can reactivate the thyroid axis in patients with NTIS, inducing an anabolic response. Whether this approach has a clinical benefit in terms of outcome is unknown. In this Series paper, we discuss diagnostic aspects, pathogenesis, and implications of NTIS as well as its distinction from severe, primary thyroid disorders in patients in the ICU.

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Crossref · 10.1016/s2213-8587(15)00225-9

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Non-thyroidal illness can occur in many unwell patients and is present in almost all critically ill patients, including those with severe psychiatric illness.
“Non-thyroidal illness can occur in many unwell patients and is present in almost all critically ill patients, including those with severe psychiatric illness.141”
From Hypothyroidism (2024) · cites this paper as [141]
The Introduction describes non-thyroidal illness syndrome (NTIS) across a range of diseases, and the Non-thyroidal illness section says it is present in most, if not all, critically ill patients. That section defines critical illness as a life-threatening disorder requiring vital-organ support; our copy does not specifically address patients with severe psychiatric illness. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The results of TH treatment in critical illness have been largely negative in terms of clinical benefit.
“The results of TH treatment in critical illness have been largely negative in terms of clinical benefit (for review, see Fliers et al.) [83].”
From An update on non-thyroidal illness syndrome (2021) · cites this paper as [83]
The central lowering of T4 could be harmful.
“By contrast, the central lowering of T4 could be harmful (for review see Fliers et al., [83].”
From An update on non-thyroidal illness syndrome (2021) · cites this paper as [83]
Although thyroid function changes due to critical illness are associated with worse outcomes and thus have prognostic significance, there is no robust evidence that thyroid hormone replacement therapy is beneficial in critically ill patients.
“Although thyroid function changes due to critical illness are associated with worse outcomes and thus have prognostic significance, there is no robust evidence that thyroid hormone replacement therapy is beneficial in critically ill patients.141”
From Hypothyroidism (2024) · cites this paper as [141]
The biochemical hallmark of the euthyroid sick syndrome is very low T3 concentrations in the presence of normal or slightly decreased TSH.
“The biochemical hallmark of the euthyroid sick syndrome is very low T3 concentrations in the presence of normal or slightly decreased TSH ( Figure 1 ) ( Table 2 ) (41, 42), and thus a T3 measurement should be performed if euthyroid sick syndrome is suspected.”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [41]

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[32]Berger MM Reymond MJ Shenkin A Effect of selenium supplements on the low T3 syndrome after trauma: a randomized trial Intensive Care Med 1996 22 575 81 8814474

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Authors: Fliers, E., Bianco, A. C., Langouche, L., & Boelen, A.
Affiliations: Amsterdam UMC Location University of Amsterdam (NL)
Rush University Medical Center (US)
KU Leuven (BE)
Corresponding author: Boelen, Anita
ORCID: Fliers, Eric
Bianco, Antonio C
Langouche, Lies
Boelen, Anita
Venue: The Lancet Diabetes & Endocrinology
Publisher: Elsevier BV
Published: 2015-10
Volume: 3
Issue: 10
Pages: 816-825
ISSN: 2213-8587 (ISSN-L)
DOI: 10.1016/s2213-8587(15)00225-9
PMC: PMC4979220
OpenAlex: W1541671351
Cited by: 441
References: 94
Citations by year: 2026: 54 · 2025: 39 · 2024: 47 · 2023: 44 · 2022: 51 · 2021: 61 · 2020: 46 · 2019: 35 · 2018: 26 · 2017: 25 · 2016: 10 · 2015: 3
FWCI: 3.21
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet Diabetes & Endocrinology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Lirias (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (R01DK077148)
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 › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords: low T3 syndrome, thyroid function, critically ill patients, intensive care unit, thyroid-stimulating hormone, triiodothyronine, thyroxine, severe hypothyroidism, hypothalamic releasing factors, hypothalamic-pituitary-thyroid axis, pathogenesis, prognosis
MeSH terms: Euthyroid Sick Syndromes, Humans, Hypothalamo-Hypophyseal System, Thyroid Gland, Thyrotropin, Thyrotropin-Releasing Hormone, Thyroxine, Critical Illness

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Thyroid function in critically ill patients

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