Euthyroid sick syndrome in pulmonary tuberculosis before and after treatment.
Alterations of circulating thyroid hormones are frequently present in chronic nonthyroidal illnesses and may predict prognosis. Pulmonary tuberculosis, a common treatable debilitating disease, may provide a useful model for detailed evaluation of changes of thyroid hormones in relation to subsequent recovery or mortality. Over a period of 12 months, we performed a prospective study of 40 consecutive Chinese patients aged over 50 years and admitted with newly diagnosed pulmonary tuberculosis. Blood samples were drawn for serial thyroid function tests [free thyroxine (T4), free triiodothyronine (T3) and thyroid-stimulating hormone] before treatment and at 1, 2 and 4 months afterwards. Mortality was determined up to 12 months of follow-up. The euthyroid sick syndrome occurred in 63% of patients at presentation. Twelve of 25 euthyroid sick patients died as compared to one of 15 patients with normal baseline thyroid function tests (P < 0.02). Among euthyroid sick patients, those who died had significantly lower free T3 concentration at presentation than those who survived (P < 0.05). An undetectable free T3 concentration at presentation was associated with a subsequent mortality of 75% (9 of 12). Of the survivors, all patients demonstrated a significant rise in serum free T4 concentrations following treatment, which was apparent by 1 month. These data suggest that an undetectable free T3 concentration at presentation reflects severity of illness and predicts a subsequent high mortality.
D000368:Aged; D000369:Aged, 80 and over; D005067:Euthyroid Sick Syndromes / Q000097:blood / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017741:Survivors; D013963:Thyroid Hormones / Q000097:blood*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D013963:Thyroid Hormones