title: Preoperative low tri-iodothyronine concentration is associated with worse health status and shorter five year survival of primary brain tumor patients.
abstract: BACKGROUND
  Low tri-iodothyronine syndrome is associated with worse prognosis of severely ill patients. We investigated the association of thyroid hormone levels with discharge outcomes and 5-year mortality in primary brain tumor patients.
  
  
  METHODS
  From January, 2010 until September, 2011, 230 patients (70% women) before brain tumor surgery were evaluated for cognitive (Mini mental State Examination; MMSE) and functional (Barthel index; BI) status, and thyroid function profile. The Low triiodothyronine syndrome was defined as triiodothyronine concentration below the reference range. Unfavorable discharge outcomes were Glasgow outcome scale score of ≤3. Follow-up continued until November, 2015.
  
  
  RESULTS
  Seventy-four percent of patients had Low triiodothyronine syndrome. Lower total tri-iodothyronine concentrations were associated with lower MMSE (p=.013) and BI (p=.023) scores independent of age, gender and histological diagnosis. Preoperative Low tri-iodothyronine syndrome increased risk for unfavorable discharge outcomes adjusting for age, gender and histological diagnosis (OR=2.944, 95%CI [1.314-6.597], p=.009). In all patients, lower tri-iodothyronine concentrations were associated with greater mortality risk (p≤.038) adjusting for age, gender, extent of resection, adjuvant treatment and histological diagnosis. The Low tri-iodothyronine syndrome was associated with greater 5-year mortality for glioma patients (HR=2.197; 95%CI [1.160-4.163], p=.016) and with shorter survival (249 [260] vs. 352 [399] days; p=.029) of high grade glioma patients independent of age, gender, extent of resection and adjuvant treatment.
  
  
  CONCLUSIONS
  The Low tri-iodothyronine syndrome is common in brain tumor patients and is associated with poor functional and cognitive status, and with worse discharge outcomes. The Low tri-iodothyronine syndrome is associated with shorter survival of glioma patients.
authors.affiliation: Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.|Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Adomas
authors.initials: A
authors.lastname: Bunevicius
authors.affiliation: Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.|Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Vytenis Pranas
authors.initials: VP
authors.lastname: Deltuva
authors.affiliation: Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Sarunas
authors.initials: S
authors.lastname: Tamasauskas
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
authors.affiliation: Behavioural medicine institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
authors.forename: Robertas
authors.initials: R
authors.lastname: Bunevicius
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iervasi
authors.affiliation: Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Arimantas
authors.initials: A
authors.lastname: Tamasauskas
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D003071:Cognition; D015536:Down-Regulation; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000073216:Mental Status and Dementia Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000378:metabolism* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood*
chemical_list: D014284:Triiodothyronine
keywords: glioma; meningioma; survival; thyroid; tri-iodothyronine