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Altered Thyroid Hormone Levels in Patients with Systemic Inflammatory Reaction Syndrome

Author: ShaoYiChuan
Tutor: LuYingLi
School: Zhejiang University
Course: Internal Medicine
Keywords: Systemic inflammatory response syndrome Euthyroid sick syndrome Cytokines Thyroid hormone
CLC: R58
Type: Master's thesis
Year: 2004
Downloads: 72
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Abstract

Background and Purpose: systemic inflammatory response syndrome (SIRS) against the body under the systemic inflammatory response in a variety of factors, including the activation of the immune system and cell media release, can cause serious tissue damage, Evolution to multi-dirty is dysfunction syndrome (MODS). Cytokines play a leading role in pathophysiological changes in the SIRS gradually attention in recent years on the endocrine system. Cytokines may act on the hypothalamus - pituitary - thyroid axis, causing abnormal levels of thyroid hormone. A lot of non-thyroid systemic disease, trauma, surgery can cause abnormal levels of thyroid hormone in the body called euthyroid sick syndrome (ESS). ESS mechanism is not clear, the role of cytokines which has attracted the attention of many scholars. Our study patients with SIRS changes in thyroid hormone levels, to investigate the occurrence regularity of ESS in SIRS patients, provide clinical evidence for the study of the impact of the inflammatory response and cytokines on thyroid hormone, to provide a scientific basis for further revealing the pathogenesis of ESS. Subjects and Methods: Study subjects: from July 2003 to January 2004 admitted to our hospital intensive care unit for 50 patients with SIRS patients. Inclusion criteria: SIRS diagnosis. Exclude people with thyroid disease and affect the thyroid function of drug cases have recently taken. Based on the occurrence of MODS divided into two groups, MODS Fry diagnosis according to the 1991 standard. Zhejiang University, a master's degree thesis research methods: (1) all cases to take morning fasting blood chemiluminescence batch number measurement of thyroid function full: total triiodo thyronine (TT3), total four iodine thyronine (bite ), free the three triiodothyronine (FT3), free four triiodothyronine (FT4), thyroid-stimulating hormone (TSH) levels. 2. Collect all cases within 24 hours prior to the full set of the thyroid function was measured clinical indicators, combined with the patient's age and past history, calculated acute physiology and chronic health evaluation n (APACHEll) score. Record the outcome of all cases. Records of all cases from the onset of full time to the detection of thyroid function (referred to as sick time). 3. Statistical processing. The statistical analysis of data using SPSS 10.0 software. p lt; 0 .05, there is a significant difference; P lt; 0.01, there is a highly significant difference. Two-sided test. Results: 1.50 cases of SIRS patients ESSFT4 TSH level no significant difference in the occurrence rate of 90%. Ding 1,3, male and female, TT4, FT3, (P gt; 0 .05). 2 according to APACHEH ratings in all cases were divided into three groups, APACHEn rated lt; l5 divided into Group A, 15 17 is divided into Group B, gt; divided into Group C l5. Group B and group C TT3 were significantly lower than the A group of Indian lt; 0 .05, p lt; 0.01); TT4 level of C group was significantly lower than the A group and B group India lt; 0.05, p lt; 0. 01); the bamboo 3/TT4 of group B was significantly lower than the A group of Indian lt; 0 .01), group C the TT3, Ting T4 was higher, but there was no significant difference (P gt; o.os). Age, duration of disease among the three groups, there was no significant difference (P gt; 0.05). 3.TT3, TT3 Ting T4 and sick time was the number of negative correlation (r = 0.308, 0.316, p lt; 0 .05). Bamboo 4, FT3, FT4, TsH level and duration of disease no significant correlation (P gt; 0.os). 4.TSH reduction in 12 cases, no cases of elevated TSH. Compared to the normal group with TSH, low TSH group T3 and T4 levels lower rated higher in APACHEn, MODS occurrence and outcome of patients deterioration large proportion, but there was no significant difference (p gt; 0.05). 5.T3, T4 while reducing by TT3 levels significantly lower than T3 reduce to T4 of low patient (p lt; 0.01), groups the prevalence of time there was no significant difference between printed GT; 0.05). T3, T4 and reduce slightly larger proportion by disease progression, but there was no significant difference (p gt; 0.05) a 6.MODs group TT3, TT4, FT3 levels were significantly lower in the MODs group (p lt; 0.05) . T3, T4 and reduce cases MoDS group proportion was significantly higher than those without the MODs group (p lt; 0 .05). Zhejiang University, a master's degree thesis conclusions: l, systemic inflammatory response syndrome (SIRS) patients, normal the high incidence of thyroid sick syndrome (ESS). SIRS patients in the occurrence of multiple organ dysfunction syndrome (MODS), the the ESS incidence is higher and more severe. 2.SIRS patient's pituitary TSH secretion function by inhibiting, and may have severe inflammatory response, inhibition is more pronounced. The TSH reduce poor prognosis. 3.SIRS patient's ESS T3 reduce the most common, critically ill SIRS patients can occur at the same time T4 decreased. Incidence in SIRS early stage T3 levels decline. Increase of sick time, T3 levels gradually further reduced.

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