Akhil Krishna1 , Mohammed Naseem Yakoobali2 , Sunil Prasobh Prabhakaran3
BACKGROUND Patients with critical illness can have changes in thyroid hormone metabolism along with changes within the hypothalamus-pituitary-thyroid axis, even though there is no previous history of thyroid disease. Such changes have been named as “Sick Euthyroid Syndrome” or “Non-Thyroidal Illness Syndrome (NTIS)”. Such alterations in thyroid function can be seen in patients with sepsis and they are known to affect the prognosis of the disease. The most common abnormality in sick euthyroid syndrome is low serum T3. This study aims to find the proportion and pattern of sick euthyroid syndrome in patients with sepsis. METHODS This was a hospital based cross sectional study done in the Department of Internal Medicine in a tertiary care centre in south Kerala. 100 patients with diagnosis of sepsis were selected based on American College of Chest Physician / Society of Critical Care Medicine 2001 Consensus Conference definitions, and included in the study. Serum levels of total T3, total T4 and TSH were measured and the proportion of patients with various abnormalities in thyroid hormone levels and the pattern of abnormalities were analysed. RESULTS The mean age of study group was 67.9 years (with standard deviation of 7.184). Female to male ratio was 1.08:1. Proportion of sick euthyroid syndrome in patients with sepsis was 71 %. Low T3 was seen in 69 % patients, low T4 in 11 % and low TSH in 11 %. TSH was above reference range in 3 % patients. The most common pattern of sick euthyroid syndrome was low T3 with normal T4 and TSH in 54 % patients. Low T3 with low T4 and normal TSH was seen in 6 % patients; low T3, T4, TSH in 5 % patients; low T3, elevated TSH, normal T4 in 3 % patients; low TSH with normal T3 and T4 in 2 % patients and low T3, low TSH and normal T4 in 1 % patients. CONCLUSIONS Proportion of sick euthyroid syndrome in sepsis was 71 % and the most common pattern was low T3 with normal T4 and TSH seen in 54 % patients.
