title: [Assessment of the release of thyroid hormones in septic shock--prognostic significance].
abstract: Septic shock is the reason of human body organs dysfunctions including the hormonal system. There are abnormal thyroid hormones releasing as well. It is also noticed that sepsis caused serious disturbances in pituitary-thyroid axis functions. This is called euthyroid sick syndrom - (ESS).
  
  
  OBJECTIVE
  To qualify the prognostic value of thyroid hormones serum levels changes in patients with septic shock.
  
  
  METHODS
  20 patients with septic shock were included into study. Septic shock was diagnosed according to AACP/SCCM criteria. The study group was divided into two subgroups: survivors (n = 10) and nonsurvivors (n = 10). 20 healthy volunteers were the control group. Blood for analysis was taken at the moment of septic shock recognition and on the 1st, 2nd, 5th and 10th day of the observation between 8 a.m. and 9 a.m. We studied thyrotropin (TSH), free triiodothyronine fraction (fT3) and free thyroxin fraction (fT4) serum levels, APACHE II and APACHE III score, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).
  
  
  RESULTS
  During our study we noticed significant decrease of fT3 and TSH serum levels (respectively 2.36 +/- 0.79 pg/ml and 0.76 +/- 1.12mU/I) according to the control group (respectively 3.28 +/- 0.61 pg/ml and 0.95 +/- 0.46mU/l). Nonsurvivors had significantly lower TSH serum level (0.37 +/- 0.62 mU/I) in comparison to survivors (1.27 +/- 1.45 mU/I) in spite of very similar fT3 serum level (respectively 2.45 +/- 0.87 pg/ml and 2.22 +/- 0.66 pg/ml). It could mean that there were disturbances in the pituitary-thyroid axis function in patients who did not survive. Our study did not show any correlations between thyroid hormones serum levels and APACHE II score, APACHE III score, ALI or ARDS.
  
  
  CONCLUSIONS
  This study show that low TSH serum level could be a significant prognostic factor of death in patient with septic shock especially with low fT3 serum level. The results also suggest that ESS could be a consequence of pituitary TSH releasing disturbances.
authors.affiliation: Klinika Anestezjologii i Intensywnej Terapii Akademii Medycznej w Białymstoku. jecekbor@amb.edu.pl
authors.forename: Jacek
authors.initials: J
authors.lastname: Borkowski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Siemiatkowski
authors.forename: Sławomir
authors.initials: S
authors.lastname: Wołczyński
authors.forename: Sławomir Lech
authors.initials: SL
authors.lastname: Czaban
authors.forename: Monika
authors.initials: M
authors.lastname: Jedynak
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005067:Euthyroid Sick Syndromes / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood* / Q000150:complications*; D017741:Survivors; D013963:Thyroid Hormones / Q000097:blood*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D013963:Thyroid Hormones; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine