NONTİROİDAL HASTALIK SENDROMU

Cakir, Bekir; Durmuş, Buğra; Baser, Husniye

doi:10.5505/amj.2021.47542

NONTİROİDAL HASTALIK SENDROMU

Buğra DURMUŞ, (Ankara Şehir Hastanesi, Endokrinoloji Ve Metabolizma Hastalıkları Kliniği, Ankara, Türkiye)

Hüsniye BASER, (Ankara Yıldırım Beyazıt Üniversitesi, Tıp Fakültesi, Endokrinoloji Ve Metabolizma Hastalıkları Bilim Dalı, Ankara, Türkiye)

Bekir CAKİR (Ankara Yıldırım Beyazıt Üniversitesi, Tıp Fakültesi, Endokrinoloji Ve Metabolizma Hastalıkları Bilim Dalı, Ankara, Türkiye)

Ankara Medical Journal

10 0

Yıl: 2021 Cilt: 21 Sayı: 4 Sayfa Aralığı: 687 - 700 Metin Dili: Türkçe DOI: 10.5505/amj.2021.47542 İndeks Tarihi: 15-06-2022

NONTİROİDAL HASTALIK SENDROMU

Öz:

Akut veya kronik hastalıklarda görülen tiroid hormon değişimlerinin her ne kadar patofizyolojisi net anlaşılmasa da vücudun metabolik olarak verdiği adaptif cevap olduğu yaklaşık son 50 yıldır bilinmektedir. Öte yandan primer altta yatan hastalığın prognozu ile ilgili çıkarımlar yaptırabileceği de birçok çalışmada gösterilmiştir. Nontiroidal hastalık olarak tanımlanan bu tiroid hormon değişim paterninin en bilinenleri düşük triiyodotironin (T3) ve artmış revers T3 (rT3) seviyeleridir. Birçok patogenetik mekanizmanın bu değişimlere yol açtığı düşünülse de en bilinenleri deiyodinaz aktivitesindeki, tirotropin (TSH) salgılanmasındaki ve serum taşıyıcı proteinlerinde ve/veya hücresel taşıyıcı reseptörlerindeki değişikliklerdir. Tiroid hormonlarındaki değişimler primer altta yatan hastalığın farklı evrelerinde değişkenlik gösterebilir. Ayrıca farklı klinik durum ya da patolojilerde tiroid hormonları farklı şekillerde etkilenerek ayırıcı tanı güçlüğüne neden olabilir. Klinikte kullanılan birçok ilacın da tiroid hormonlarını farklı düzeylerde ve yönlerde etkilediği bilinmektedir. Değerlendirme yapılırken mevcut durumlar göz önünde bulundurulmalı ve mümkünse serbest tiroksin (sT4) ile TSH başta olmak üzere tam tiroid hormon paneli görülmelidir. Tedavi gerekliliğine, laboratuvar bulguları yanında hastanın klinik prezentasyonu ve öyküsü de dikkate alınarak karar verilmelidir. Yapılan çok sayıda çalışmada rutin tiroid hormon replasmanı, olumlu veya olumsuz yönde net sonuç vermediğinden önerilmemektedir.

Anahtar Kelime:

NONTHYROIDAL ILLNESS SYNDROME

Öz:

Although the pathophysiology of thyroid hormone changes observed in acute or chronic diseases is not clearly understood, it has been known for about the last 50 years that the body has an adaptive metabolic response. On the other hand, it has also been shown in many studies that it can make inferences about the prognosis of the primary underlying disease. The most known of this thyroid hormone change pattern, defined as a non-thyroid disease, are low triiodothyronine (T3) and increased reverse T3 (rT3) levels. Although many pathogenetic mechanisms are thought to lead to these changes, the most known are changes in deiodinase activity, thyrotropin (TSH) secretion, and serum carrier proteins and/or cellular carrier receptors. Changes in thyroid hormones can vary at different stages of the primary underlying disease. In addition, in different clinical conditions or pathologies, thyroid hormones are affected in different ways, causing difficulty in the differential diagnosis. Many drugs used in the clinic are also known to affect thyroid hormones at different levels and directions. Current conditions should be taken into account when evaluating, and if possible, a full panel of thyroid hormones, especially TSH with free thyroxine (sT4), should be seen. The need for treatment should be decided by taking into account laboratory findings as well as the patient's clinical presentation and history. In many studies, routine thyroid hormone replacement is not recommended, as it does not give a positive or negative net result.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Lee S, Farwell AP. Euthyroid Sick Syndrome. Comprehensive Physiology. 2016;6(2):1071-80 (doi:10.1002/cphy.c150017).
2. Fliers E, Bianco A, Langouche L, Boelen A. Endocrine and metabolic considerations in critically ill patients 4. Lancet Diabetes Endocrinol. 2015;3(10):816-25.
3. Farwell AP. Nonthyroidal illness syndrome. Current Opinion in Endocrinology, Diabetes and Obesity. 2013;20(5):478-84.
4. de Vries EM, Fliers E, Boelen A. The molecular basis of the non-thyroidal illness syndrome. J Endocrinol. 2015;225(3):R67-81.
5. Pappa TA, Vagenakis AG, Alevizaki M. The nonthyroidal illness syndrome in the non–critically ill patient. European journal of clinical investigation. 2011;41(2):212-20.
6. Mebis L, Van den Berghe G. The hypothalamus-pituitary-thyroid axis in critical illness. Neth J Med. 2009;67(10):332-40.
7. Warner MH, Beckett GJ. Mechanisms behind the non-thyroidal illness syndrome: An update. The Journal of endocrinology. 2009;205(1):1-13.
8. Mebis L, Paletta D, Debaveye Y, et al. Expression of thyroid hormone transporters during critical illness. European journal of endocrinology. 2009;161(2):243.
9. Chopra IJ. Euthyroid sick syndrome: is it a misnomer? The Journal of Clinical Endocrinology & Metabolism. 1997;82(2):329-34.
10. Peeters RP, Wouters PJ, van Toor H, Kaptein E, Visser TJ, Van den Berghe G. Serum 3, 3′, 5′-triiodothyronine (rT3) and 3, 5, 3′-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. The Journal of Clinical Endocrinology & Metabolism. 2005;90(8):4559-65.
11. De Groot LJ. Non-thyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, should be treated with appropriate replacement therapies. Critical care clinics. 2006;22(1):57-86.
12. Langouche L, Jacobs A, Van den Berghe G. Nonthyroidal illness syndrome across the ages. Journal of the Endocrine Society. 2019;3(12):2313-25.
13. Fekete C, Lechan RM. Negative feedback regulation of hypophysiotropic thyrotropin-releasing hormone (TRH) synthesizing neurons: role of neuronal afferents and type 2 deiodinase. Frontiers in neuroendocrinology. 2007;28(2-3):97-114.
14. Boelen A, Kwakkel J, Fliers E. Beyond low plasma T3: local thyroid hormone metabolism during inflammation and infection. Endocrine reviews. 2011;32(5):670-93.
15. Fliers E, Guldenaar SE, Wiersinga WM, Swaab DF. Decreased hypothalamic thyrotropin-releasing hormone gene expression in patients with nonthyroidal illness. The Journal of Clinical Endocrinology & Metabolism. 1997;82(12):4032-6.
16. Van den Berghe G, Wouters P, Weekers F, et al. Reactivation of pituitary hormone release and metabolic improvement by infusion of growth hormone-releasing peptide and thyrotropin-releasing hormone in patients with protracted critical illness. The Journal of Clinical Endocrinology & Metabolism. 1999;84(4):1311-23.
17. Maiden MJ, Torpy DJ. Thyroid hormones in critical illness. Critical care clinics. 2019;35(2):375-88.
18. Van Der Deure WM, Peeters RP, Visser TJ. Molecular aspects of thyroid hormone transporters, including MCT8, MCT10, and OATPs, and the effects of genetic variation in these transporters. Journal of molecular endocrinology. 2010;44(1):1.
19. Visser WE, Friesema EC, Visser TJ. Minireview: thyroid hormone transporters: the knowns and the unknowns. Molecular endocrinology. 2011;25(1):1-14.
20. Sugiyama D, Kusuhara H, Taniguchi H, et al. Functional characterization of rat brain-specific organic anion transporter (Oatp14) at the blood-brain barrier: high affinity transporter for thyroxine. Journal of Biological Chemistry. 2003;278(44):43489-95.
21. Heuer H, Maier MK, Iden S, et al. The monocarboxylate transporter 8 linked to human psychomotor retardation is highly expressed in thyroid hormone-sensitive neuron populations. Endocrinology. 2005;146(4):1701-6.
22. Oetting A, Yen PM. New insights into thyroid hormone action. Best practice & research Clinical endocrinology & metabolism. 2007;21(2):193-208.
23. Bartalena L, Bogazzi F, Brogioni S, Grasso L, Martino E. Role of cytokines in the pathogenesis of the euthyroid sick syndrome. European journal of endocrinology. 1998;138(6):603-14.
24. Sarne D. Effects of the environment, chemicals and drugs on thyroid function. Endotext [Internet]. 2016.
25. Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749-61.
26. Türkiye Endokrinoloji ve Metabolizma Derneği(TEMD) Tiroid Hastalıkları Tanı ve Tedavi Kılavuzu. Tiroid ve İlaçlar. Ankara: Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş. (Türkiye Klinikleri) 2020:14-21.
27. Maehira F, Luyo GA, Miyagi I, et al. Alterations of serum selenium concentrations in the acute phase of pathological conditions. Clinica chimica acta. 2002;316(1-2):137-46.
28. Moura Neto A, Zantut-Wittmann DE. Abnormalities of Thyroid Hormone Metabolism during Systemic Illness: The Low T3 Syndrome in Different Clinical Settings. Int J Endocrinol. 2016;2016:2157583 (doi:10.1155/2016/2157583).
29. Plikat K, Langgartner J, Buettner R, et al. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit. Metabolism. 2007;56(2):239-44.
30. Chuang C-P, Jong Y-S, Wu C-Y, Lo H-M. Impact of triiodothyronine and N-terminal pro-B-type natriuretic peptide on the long-term survival of critically ill patients with acute heart failure. The American journal of cardiology. 2014;113(5):845-50.
31. Kaptein EM. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. Endocrine reviews. 1996;17(1):45-63.
32. Burmeister LA. Reverse T3 does not reliably differentiate hypothyroid sick syndrome from euthyroid sick syndrome. Thyroid. 1995;5(6):435-41.
33. Spencer C, Eigen A, Shen D, et al. Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clinical chemistry. 1987;33(8):1391-6.
34. Franklyn J, Black E, Betteridge J, Sheppard M. Comparison of second and third generation methods for measurement of serum thyrotropin in patients with overt hyperthyroidism, patients receiving thyroxine therapy, and those with nonthyroidal illness. The Journal of Clinical Endocrinology & Metabolism. 1994;78(6):1368-71.
35. Douglas S Ross M. Thyroid function in nonthyroidal illness. [Internet]. 2021; https://www.uptodate.com/contents/thyroid-function-in-nonthyroidal-illness?search=nonthyroidal%20illnes&source=search_result&selectedTitle=1~25&usage_type=default&display_rank=1].
36. Sharma S, Agrawal P, Kabadi U, Griffin JE. Euthyroid Sick Syndrome. Primary Care Reports. 2008.
37. Sir RV, Dagdiya S, Badole S. Sick euthyroid syndrome. [Internet]. 2018; https://www.slideshare.net/shibu989/sick-euthyroid-syndrome].
38. McDermott MT. Non-thyroidal Illness Syndrome (Euthyroid Sick Syndrome). In: McDermott MT, ed. Management of Patients with Pseudo-Endocrine Disorders: A Case-Based Pocket Guide. Cham: Springer International Publishing; 2019:331-9.
39. Rothberger GD, Gadhvi S, Michelakis N, Kumar A, Calixte R, Shapiro LE. Usefulness of serum triiodothyronine (T3) to predict outcomes in patients hospitalized with acute heart failure. The American journal of cardiology. 2017;119(4):599-603.
40. Liu J, Wu X, Lu F, Zhao L, Shi L, Xu F. Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia. Scientific reports. 2016;6(1):1-8.
41. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. New England Journal of Medicine. 2011;365(6):506-17.
42. Langouche L, Vander Perre S, Marques M, et al. Impact of early nutrient restriction during critical illness on the nonthyroidal illness syndrome and its relation with outcome: a randomized, controlled clinical study. The Journal of Clinical Endocrinology & Metabolism. 2013;98(3):1006-13.
43. McKeever L, Peterson SJ, Lateef O, et al. Higher caloric exposure in critically ill patients transiently accelerates thyroid hormone activation. The Journal of Clinical Endocrinology & Metabolism. 2020;105(2):523-33.
44. Ataoğlu HE, Ahbab S, Serez MK, et al. Prognostic significance of high free T4 and low free T3 levels in non-thyroidal illness syndrome. European journal of internal medicine. 2018;57:91-5.
45. Wang B, Liu S, Li L, et al. Non-thyroidal illness syndrome in patients with cardiovascular diseases: a systematic review and meta-analysis. International journal of cardiology. 2017;226:1-10.
46. Xiong H, Yan P, Huang Q, et al. A prognostic role for non-thyroidal illness syndrome in chronic renal failure: a systematic review and meta-analysis. International Journal of Surgery. 2019;70:44-52.
47. Feng H-L, Li Q, Cao W-K, Yang J-M. Changes in thyroid function in patients with liver failure and their clinical significance: A clinical study of non-thyroidal illness syndrome in patients with liver failure. Hepatobiliary & Pancreatic Diseases International. 2020;19(6):561-6.
48. Karadag F, Ozcan H, Karul AB, Yilmaz M, Cildag O. Correlates of non-thyroidal illness syndrome in chronic obstructive pulmonary disease. Respiratory medicine. 2007;101(7):1439-46.
49. Yasar ZA, Kirakli C, Yilmaz U, Ucar ZZ, Talay F. Can non-thyroid illness syndrome predict mortality in lung cancer patients? A prospective cohort study. Hormones and Cancer. 2014;5(4):240-6.
50. Keşkek ŞÖ, Kurşun Ö, Ortoğlu G, Bankir M, Tüzün Z, Saler T. Obesity without comorbidity may also lead to non-thyroidal illness syndrome. Advances in clinical and experimental medicine: official organ Wroclaw Medical University. 2018;27(11):1515-20.
51. Rashidi H, Ghaderian SB, Latifi SM, Hoseini F. Impact of diabetic ketoacidosis on thyroid function tests in type 1 diabetes mellitus patients. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S57-S9.
52. Taroza S, Rastenytė D, Podlipskytė A, Kazlauskas H, Mickuvienė N. Nonthyroidal illness syndrome in Ischaemic stroke patients is associated with increased mortality. Experimental and Clinical Endocrinology & Diabetes. 2020;128(12):811-8.
53. Schwarz Y, Percik R, Oberman B, Yaffe D, Zimlichman E, Tirosh A. Sick Euthyroid Syndrome on Presentation of Patients With COVID-19: A Potential Marker for Disease Severity. Endocrine Practice. 2021;27(2):101-9.
54. Dickerman AL, Barnhill JW. Abnormal thyroid function tests in psychiatric patients: a red herring? American Journal of Psychiatry. 2012;169(2):127-33.

APA	Durmuş B, Baser H, Cakir B (2021). NONTİROİDAL HASTALIK SENDROMU. , 687 - 700. 10.5505/amj.2021.47542
Chicago	Durmuş Buğra,Baser Husniye,Cakir Bekir NONTİROİDAL HASTALIK SENDROMU. (2021): 687 - 700. 10.5505/amj.2021.47542
MLA	Durmuş Buğra,Baser Husniye,Cakir Bekir NONTİROİDAL HASTALIK SENDROMU. , 2021, ss.687 - 700. 10.5505/amj.2021.47542
AMA	Durmuş B,Baser H,Cakir B NONTİROİDAL HASTALIK SENDROMU. . 2021; 687 - 700. 10.5505/amj.2021.47542
Vancouver	Durmuş B,Baser H,Cakir B NONTİROİDAL HASTALIK SENDROMU. . 2021; 687 - 700. 10.5505/amj.2021.47542
IEEE	Durmuş B,Baser H,Cakir B "NONTİROİDAL HASTALIK SENDROMU." , ss.687 - 700, 2021. 10.5505/amj.2021.47542
ISNAD	Durmuş, Buğra vd. "NONTİROİDAL HASTALIK SENDROMU". (2021), 687-700. https://doi.org/10.5505/amj.2021.47542

APA	Durmuş B, Baser H, Cakir B (2021). NONTİROİDAL HASTALIK SENDROMU. Ankara Medical Journal, 21(4), 687 - 700. 10.5505/amj.2021.47542
Chicago	Durmuş Buğra,Baser Husniye,Cakir Bekir NONTİROİDAL HASTALIK SENDROMU. Ankara Medical Journal 21, no.4 (2021): 687 - 700. 10.5505/amj.2021.47542
MLA	Durmuş Buğra,Baser Husniye,Cakir Bekir NONTİROİDAL HASTALIK SENDROMU. Ankara Medical Journal, vol.21, no.4, 2021, ss.687 - 700. 10.5505/amj.2021.47542
AMA	Durmuş B,Baser H,Cakir B NONTİROİDAL HASTALIK SENDROMU. Ankara Medical Journal. 2021; 21(4): 687 - 700. 10.5505/amj.2021.47542
Vancouver	Durmuş B,Baser H,Cakir B NONTİROİDAL HASTALIK SENDROMU. Ankara Medical Journal. 2021; 21(4): 687 - 700. 10.5505/amj.2021.47542
IEEE	Durmuş B,Baser H,Cakir B "NONTİROİDAL HASTALIK SENDROMU." Ankara Medical Journal, 21, ss.687 - 700, 2021. 10.5505/amj.2021.47542
ISNAD	Durmuş, Buğra vd. "NONTİROİDAL HASTALIK SENDROMU". Ankara Medical Journal 21/4 (2021), 687-700. https://doi.org/10.5505/amj.2021.47542