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VOLUME 25 , ISSUE 10 ( October, 2021 ) > List of Articles

Original Article

Thyroid Function, Reverse Triiodothyronine, and Mortality in Critically Ill Clinical Patients

Carlos DG da Silveira, Flávio PJ de Vasconcelos, Edmilson B Moura, Bruno TG da Silveira, Flávio FP Amorim, Lumie S Shintaku, Rosália B de Santana, Pedro LP Argotte, Sheila F da Silva, Marcelo de Oliveira Maia, Fabio F Amorim

Citation Information : da Silveira CD, de Vasconcelos FP, Moura EB, da Silveira BT, Amorim FF, Shintaku LS, de Santana RB, Argotte PL, da Silva SF, Maia MD, Amorim FF. Thyroid Function, Reverse Triiodothyronine, and Mortality in Critically Ill Clinical Patients. Indian J Crit Care Med 2021; 25 (10):1161-1166.

DOI: 10.5005/jp-journals-10071-24001

License: CC BY-NC 4.0

Published Online: 21-06-2022

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: To evaluate the association of thyroid hormones changes, including increased reverse triiodothyronine (rT3) level, with critically ill clinical patients' mortality. Patients and methods: This study analyzed the observational data prospectively collected over 8 months (2018) in an adult intensive care unit (ICU) in Brasilia, Brazil. All consecutive ICU-admitted clinical patients were included. Thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), free triiodothyronine (fT3), rT3, and thyroid-stimulating hormone (TSH) were collected within 48 hours of ICU admission. Patients with hypothyroidism or hyperthyroidism who were previously diagnosed were excluded. Results: Of 353 included patients, age was 68.5 ± 19.0 years, sequential organ failure assessment (SOFA) score was 3.3 ± 2.9, and Acute Physiology and Chronic Health Evaluation II (APACHE II) was 17.1 ± 7.9. ICU mortality was 17.6% (n = 62). Non-survivor patients had a higher incidence of increased rT3 (69.3 vs 59.2%, p = 0.042), lower incidence of low T4 (4.8 vs 9.7%, p = 0.045), and increased age (75.2 ± 16.3 years vs 67.1 ± 19.3 years, p = 0.001), SOFA (3.0 ± 0.4 vs 2.8 ± 2.6, p <0.001), and APACHE II (23.5 ± 7.5 vs 15.7 ± 7.2, p <0.001). Alterations in other thyroid hormones did not show association with mortality. Increased rT3 [odds ratio (OR): 2.436; 95% confidence interval (CI): 1.023–5.800; p = 0.020] and APACHE II (OR: 1.083, 95% CI: 1.012–1.158; p = 0.044) were associated with ICU mortality in the multivariate analysis. Conclusion: Increased rT3 was independently associated with increased ICU mortality. In contrast, other thyroid hormone alterations did not show an association with mortality. Determining rT3 levels may be a helpful test to identify an increased risk for ICU mortality in clinical patients.

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