title: Altered thyroid function in severely injured patients.
abstract: BACKGROUND
  Hemorrhagic shock profoundly affects the neuroendocrine profile of trauma patients, and we hypothesized that massive resuscitation would negatively impact thyroid function.
  
  
  METHODS
  A prospective, observational study investigating thyroid function in hypotensive trauma patients (systolic blood pressure <90 mm Hg × 2) who survived >48 h was conducted at a Level I center over a 6-mo period. Blood samples for thyroid function were collected at time of presentation to the trauma bay and serially for 48 h. Collected data included demographics, injury data, vital signs, transfusion needs, crystalloid use, and vasopressor requirements. Patients receiving >5 units packed red blood cells (PRBC) within 12 h were compared with those receiving ≤5 units.
  
  
  RESULTS
  Patients who required >5 units of PRBC/12 h had significantly lower total and free T4 levels on initial presentation, and levels remained significantly depressed over the next 48 h when compared with patients who required a less aggressive resuscitative effort. T3 values were markedly suppressed during the initial 48 h post trauma in all patients, but were significantly lower in patients requiring >5 units PRBC. TSH levels remained within the normal range for all time points. Lower trauma admission T4 levels were associated with the need for greater crystalloid resuscitation within the first 24 h.
  
  
  CONCLUSIONS
  Measurements of thyroid function are significantly altered in severely injured patients on initial presentation, and low T4 levels predict the need for large resuscitation. Further research investigating the profile and impact of thyroid function in trauma patients during resuscitation and recovery is warranted.
authors.affiliation: Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Grill
authors.forename: Michelle
authors.initials: M
authors.lastname: Strong
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Jose
authors.initials: J
authors.lastname: Pascual
authors.forename: Heather
authors.initials: H
authors.lastname: Collins
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Sims
mesh_terms: D000293:Adolescent; D000328:Adult; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D013961:Thyroid Gland / Q000503:physiopathology*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D014947:Wounds and Injuries / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D055815:Young Adult
chemical_list: D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine