title: Thyroid hormone alterations in trauma patients requiring massive transfusion: An observational study.
abstract: BACKGROUND
  Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported.
  
  
  METHODS
  A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.
  
  
  RESULTS
  Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL; P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 µIU/mL) were higher than at admission (1.48±0.5 µIU/mL) in group C (P<0.05).
  
  
  CONCLUSIONS
  Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hifumi
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Okada
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kiriu
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
authors.forename: Eiju
authors.initials: E
authors.lastname: Hasegawa
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ogasawara
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Koido
authors.affiliation: Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi, 400-8506, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Inoue
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawakita
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hagiike
authors.affiliation: Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
keywords: Free triiodothyronine; Massive transfusion; Non-thyroidal illness syndrome; Thyroid hormone; Trauma