triiodothyronine--reverse and Chronic-Disease

Increased reverse tritiodothyronine (T(3)) used to be described as a part of euthyroid sick syndrome (ESS). It was demonstrated to be associated with increased mortality in acutely ill patients. It can also be found with low or normal T(3) in non-severely ill subjects but its significance remains unclear.. The Alsanut study included a representative sample of 440 independently-living subjects aged 65 or over constituted between January 1988 and September 1989. Past and current medical history and nutritional data were collected at inclusion. Baseline thyroid hormone (TSH, FT(4), FT(3) and rT(3)) serum levels were measured. Life status was determined on 1 December 2005.. Of the 374 elderly subjects included in the final analysis, 52 had abnormal TSH (43 with hyperthyroidism, nine with hypothyroidism) and 80.7% had died by 1 December 2005. There was no statistical difference in survival between subjects according to thyroid function (P=0.54). Of the 322 elderly subjects with normal TSH, mortality rate was 81.1%. ESS was found in 3.4%, whereas 8.1% of the participants displayed elevated rT(3) with normal FT(3). Time to death was strongly related to rT(3) (P<0.0001) and FT(3) (P<0.0001) in a univariate analysis. After adjusting for other confounding variables, rT(3) was the only thyroid hormone associated with shorter survival (P=0.014).. RT(3) was the only thyroid hormone associated with shorter survival in a representative population of independently-living elderly. In these subjects, isolated elevated rT(3) might be an equivalent of ESS, reflecting declining health.

Topics: Activities of Daily Living; Acute Disease; Aged; Aged, 80 and over; Chronic Disease; Euthyroid Sick Syndromes; Female; France; Humans; Kaplan-Meier Estimate; Male; Pregnanediones; Prevalence; Proportional Hazards Models; Thyrotropin; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

Possible arterio-venous gradients of T4, T3, rT3 and 3,3'-diiodothyronine (3,3'-T2) across the liver and the kidneys were measured in 9 patients with varying degrees of liver failure undergoing diagnostic catheterization. Plasma iodothyronine levels were measured in peripheral, hepatic and renal veins before and at 10-min intervals until 60 min after iv injection of 400 micrograms of TRH. In 2 patients estimated hepatic plasma flow and effective renal plasma flow were determined as well. In these 2 patients, no significant differences between iodothyronine levels in arterial and peripheral venous plasma were found. T4 and T3 levels were not significantly different between peripheral, renal and hepatic veins. Hepatic vein rT3 and 3,3'-T2 concentrations were 10.7 +/- 8.3% (mean +/- SD, P less than 0.005) and 36 +/- 18% (P less than 0.001) lower than those in the peripheral vein (N = 9). Renal vein rT3 was just (6.2 +/- 7.5%, P less than 0.05) lower than rT3 in peripheral vein, whereas 3,3'-T2 was not different between the two veins. Estimates of hepatic and renal plasma flow were in agreement with values from the literature. On the basis of these data approximate hepatic clearance rates of 110 and 380 1/day for rT3 and 3,3'-T2 and a renal clearance rate of about 35 1/day for rT3 were calculated. Sixty min after TRH, plasma T3 was increased to 147 +/- 56% (P less than 0.05) and 3,3'-T2 in peripheral plasma was increased to 142 +/- 36% (P less than 0.025), whereas plasma T4 and rT3 did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Chronic Disease; Diiodothyronines; Female; Humans; Kidney; Liver; Liver Diseases; Male; Middle Aged; Thyroid Hormones; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

ātients with end-stage chronic renal failure (CRF) and those receiving dialysis therapy have normal or decreased serum total T4 (TT4), reduced serum total T3 (TT3), and normal total reverse T3 (TrT3) levels. Those with nonrenal nonthyroidal illnesses or malnutrition have low TT4 and TT3 but elevated TrT3 values. To evaluate the mechanism(s) for the normal TrT3 levels in CRF, we performed intravenous bolus kinetic studies of rT3 and T4 in patients with CRF, in those treated with chronic hemodialysis, in patients with nonrenal nonthyroidal illnesses, and in normal subjects. The CRF patients were selected to have good nutritional status as indicated by normal serum transferrin, relative body weight, and body mass index values. The CRF patients had normal TrT3, TT4, and free T4 values, increased free fraction of rT3, free rT3, and thyroxine-binding globulin levels, and decreased TT3 concentrations. Noncompartmental analysis of the rT3 kinetics indicated normal production rate, reduced cellular clearance rate, and increased pool size and residence time values in both the CRF and nonrenal patients. In CRF, the serum clearance rate was normal, but the fractional rate of exit, permeability, extravascular binding, and the apparent volume of distribution were increased. In contrast, the nonrenal patients had reduced serum clearance rate, permeability, and extravascular binding, whereas the fractional rate of exit and apparent volume of distribution were not significantly altered. The T4 kinetics in CRF paralleled those of the nonrenal patients, with a reduced fractional rate of exit and permeability in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Body Weight; Chronic Disease; Female; Humans; Infections; Kidney Failure, Chronic; Kinetics; Liver Diseases; Male; Middle Aged; Nutritional Physiological Phenomena; Renal Dialysis; Respiratory Insufficiency; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse; Uremia

We studied various tests of thyroid function in sick patients with nonthyroidal illness (NTI) in order to determine the utility of each test for differentiating these patience from a group with hypothyroidism. We evaluated each test in 22 healthy volunteers who served as controls, 20 patients with hypothyroidism, 14 patients admitted to medical intensive care unit whose serum T4 was less than 5 micrograms/dl, 13 patients with chronic liver disease, 32 patients on chronic hemodialysis for renal failure, 13 ambulatory oncology patients receiving chemotherapy, 16 pregnant women, 7 women on estrogens, and 20 hyperthyroid patients. On all samples, we measured serum T4, the free T4 index by several methods, free T4 by equilibrium dialysis, free T4 calculated from thyronine-binding globulin (TBG) RIA, free T4 by three commercial kits (Gammacoat, Immophase, and Liquisol), T3, rT3, and TSH (by 3 different RIAs). Although all of the methods used for measuring free T4 (including free T4 index, free T4 by dialysis, free T4 assessed by TBG, and free T4 assessed by the 3 commercial kits) were excellent for the diagnosis of hypothyroidism, hyperthyroidism, and euthyroidism in the presence of high TBG, none of these methods showed that free T4 was consistently normal in patients with NTI; with each method, a number of NTI patients had subnormal values. In the NTI groups, free T4 measured by dialysis and the free T4 index generally correlated significantly with the commercial free T4 methods. Serum rT3 was elevated or normal in NTI patients and low in hypothyroid subjects. Serum TSH provided the most reliable differentiation between patients with primary hypothyroidism and those with NTI and low serum T4 levels.

Topics: Alpha-Globulins; Chronic Disease; Female; Humans; Hyperthyroidism; Hypothyroidism; Kidney Failure, Chronic; Liver Diseases; Neoplasms; Pregnancy; Radioimmunoassay; Reagent Kits, Diagnostic; Renal Dialysis; Thyroid Function Tests; Thyrotropin; Thyroxine; Thyroxine-Binding Proteins; Triiodothyronine; Triiodothyronine, Reverse

The relationship between chronic hepatosplenic schistosomiaisis (CHES) and circulating thyroid hormones as well as the TSH response to TRH were investigated in 41 hospitalized CHES patients and compared to those in 11 patients with non-CHES cirrhosis with severe hepatic failure. CHES patients were subdivided into 3 groups depending on the severity of parenchymal dysfunction, based upon a composite clinical and laboratory index. Angiographic and hemodynamic studies of CHES patients revealed altered hepatic arteriograms, suggesting a decreased arterial blood flow associated with an increased venous blood flow from the portal system. A significantly reduced serum concentration of total T4 (but not free T4) was only found in the cirrhotic patients. Compared to CHES groups I and II, CHES group III patients and the non-CHES cirrhotics had significantly lower mean serum T3 levels of 80 +/- 12 and 52 +/- 8 ng/dl, respectively. The serum rT3 concentration was elevated (69 +/- 6.2 ng/dl) only in the cirrhotic patients. Both basal and peak TSH levels after TRH were within the normal range for all 4 groups of patients. The basal (40.7 +/- 8.3 ng/ml) and peak (85.5 +/- 13.7 ng/ml) serum PRL levels T4-binding globulin after TRH administration were only elevated in the cirrhotic group. Although the mean T4-binding globulin values were lower in CHES group III (17.5 +/- 3.2 micrograms/ml) and in the non-CHES cirrhotic group (18.3 +/- 2.1 micrograms/ml) compared to those in groups I (21.8 +/- 2.2 micrograms/ml) and II (20.4 +/- 2.3 micrograms/ml), the differences between groups were not statistically significant. It was concluded that hemodynamic changes without parenchymal failure have little, if any, effect on the hepatic T4 5'-monodeiodination to T3, and that the low T3 and high rT3 state does not modify the pituitary secretion of TSH, presumably by a local (at the thyrotroph level) normal conversion of T4 to T3, even at very low peripheral T3 concentrations.

Topics: Chronic Disease; Female; Humans; Liver Circulation; Liver Cirrhosis; Liver Diseases, Parasitic; Male; Schistosomiasis; Splenic Diseases; Thyroid Gland; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

In four groups of subjects free of thyroid disease, the following determinations were made: serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3(rT3) and diiodothyronine (T2), and calculated indices of free thyroxine (FT4) and free triiodothyronine (FT3). Group A comprised healthy subjects aged 16-64; Group B, 24 healthy elderly subjects aged 68-95; Group C, 23 elderly patients with mild well-controlled chronic illnesses, aged 70-85; Group D, 40 nursing home residents aged 66-100. Serum T4 and T2 concentrations and the FT4 index were not affected by age; the rT3 concentration was slightly but significantly elevated only in Group D patients. Serum T3 concentration was significantly lower in all groups of elderly subjects and decreased FT3 index measurements were detected after age 75. It was concluded that old age, without complicating illness, is accompanied only by a decrease in the serum level of T3 and the FT3 index; values for other iodothyronines are unchanged. Clinicians should consider the age-related changes in T3 and FT3 values when interpreting thyroid function tests.

Topics: Adolescent; Adult; Aged; Aging; Chronic Disease; Diiodothyronines; Female; Humans; Immunologic Techniques; Iodine Radioisotopes; Male; Middle Aged; Thyroid Function Tests; Thyroid Gland; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

Concentrations of thyroid hormones and thyrotropin (TSH) were measured in sera of clinically euthyroid patients with various liver diseases and compared with normal controls. The mean serum concentration of 3,3',5'-triiodothyronine (reverse T3, rT3) was significantly increased in patients with decompensated liver cirrhosis (p less than 0.01). This increase seemed to be dependent upon the hepatic damage, although it was not significant in patients with acute hepatitis, chronic hepatitis and compensated liver cirrhosis. The mean serum concentration of 3,3',5-triiodothyronine (T3) was significantly decreased in patients with decompensated liver cirrhosis (p less than 0.05). However, in patients with acute hepatitis, chronic hepatitis and compensated liver cirrhosis, the mean concentration of T3 was above the normal. The mean value of rT3/T3 ratios in patients with acute hepatitis, chronic hepatitis and compensated liver cirrhosis were similar to that of normal controls, but in patients with decompensated liver cirrhosis, the mean value of rT3/T3 ratios was markedly higher than that of normal controls. The rT3/T3 ratios have little or no correlation with some standard liver function tests. These results suggest that marked alterations of peripheral conversion of thyroxine (T4) to rT3 or T3 may be found only in a state of decompensated liver cirrhosis among the various liver diseases.

Topics: Acute Disease; Adolescent; Adult; Aged; Chronic Disease; Hepatitis; Humans; Liver Cirrhosis; Liver Function Tests; Thyroid Hormones; Thyrotropin; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

Depressed triiodothyronine and elevated reverse triiodothyronine levels are commonly seen in patients with acute and chronic illness and in patients receiving markedly hypocaloric diets. To investigate the role of nutritional adequacy in causing the altered thyroid hormone levels found in severe illness, we studied patients with bacterial sepsis who were receiving a variety of nutritional regimens. Thirteen patients received only 5% dextrose in water (600-1000 kcal/day), 7 of whom were in shock. Seven patients received total parenteral nutrition (2500-3500 kcal/day). Analysis of thyroid hormone levels in these groups and in controls shows that a large component of the alteration in thyroid hormone levels found in patients with severe illness is due to the caloric deprivation associated with such severe illness.

Topics: Acute Disease; Adult; Aged; Bacteria; Chronic Disease; Female; Humans; Male; Middle Aged; Nutritional Physiological Phenomena; Sepsis; Thyrotropin; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse

Topics: Chronic Disease; Hepatitis; Humans; Liver Cirrhosis; Liver Neoplasms; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse