title: Pituitary-thyroid function in patients with septic shock and its relation with outcome.
abstract: OBJECTIVE
  To study the time course of thyroid function abnormalities and their relation to outcome in patients with septic shock.
  
  
  METHODS
  Prospective study in a cohort of consecutive patients.
  
  
  METHODS
  Intensive Care Unit in a University Hospital.
  
  
  METHODS
  We studied 27 patients (mean age 50 +/- 19 years, Apache II score 18.4 +/- 5.2, 15 survivors) diagnosed of septic shock. Total T4 (T4) and total T3 (T3) (RIA) were determined on days 1 and 5 after admission. We also measured TSH (ultrasensitive RIA) at 08.00, 20.00 and 01.00 hours (on days 1 and 5), and the TSH response to TRH (400 microg intravenous) on days 2 and 6. Data are mean +/- SD.
  
  
  RESULTS
  Whereas low thyroid hormones concentrations were present on day 1 in all patients, only survivors presented a significant increase in T3 and T4 on day 5. Basal TSH levels and the area under the curve of the TSH response to TRH on day 2 were significantly higher in survivors than in non survivors (0.89 +/- 0.63 vs. 0.34 +/- 0.42 microIU/ml, and 229 + 157 vs. 101 + 101). The normal nocturnal (01.00 hr) surge of TSH (the difference between TSH concentrations at 8 am and at 1 am) was abolished in both survivors and non survivors on day 1 but it was recovered on day 5 only in survivors.
  
  
  CONCLUSIONS
  Our data indicate that patients with septic shock present an altered hypothalamic-pituitary-thyroid axis, and that survivors thyroid function differs from that of non survivors shortly after diagnosis. Survivors are characterised by a greater TSH response to TRH, indicating a less deranged hypothalamic-pituitary-thyroid axis. Thyroid function improves in survivors, but not in non survivors, during the course of their illness.
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Leon-Sanz
authors.forename: J A
authors.initials: JA
authors.lastname: Lorente
authors.forename: L
authors.initials: L
authors.lastname: Larrodera
authors.forename: P
authors.initials: P
authors.lastname: Ros
authors.forename: J
authors.initials: J
authors.lastname: Alvarez
authors.forename: A E
authors.initials: AE
authors.lastname: Esteban
authors.forename: L
authors.initials: L
authors.lastname: Landin
mesh_terms: D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D007037:Hypothyroidism / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology*; D017741:Survivors; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism; D013973:Thyrotropin-Releasing Hormone; D016896:Treatment Outcome
chemical_list: D013963:Thyroid Hormones; D013973:Thyrotropin-Releasing Hormone; D013972:Thyrotropin