Alev GÜRGÜN, Fırat BAYRAKTAR, Birgül KIRAN, K. Özen BAŞOĞLU, Hikmet Mustafa ÖZHAN, Feza BACAKOĞLU

Can impairments of thyroid function test affect prognosis in patients with respiratory failure?

Tiroid dışı organ disfonksiyonlarında tiroid fonksiyon testi (TFT) bozuklukları saptanabilir ve bunların başında kronik obstrüktif akciğer hastalığı (KOAH)’ndaki akut solunum yetmezliği (SY) gelir. Bu çalışmada; (i) SY olan olgularda TFT bozukluklarını değerlendirmek, (ii) TFT sonuçlarını SY olmayan kontrol grubu ile karşılaştırmak, (iii) tiroid disfonksiyonunun SY’nin klinik gidişine ve prognozuna etkilerini araştırmak amaçlandı. TFT parametreleri, SY olan 65 hastada (yaş ortalaması 65.0 ± 10.0, 49’u erkek) değerlendirildi ve akciğer hastalığı olup SY bulunmayan 18 hasta (yaş ortalaması 64.4 ± 9.8, 13’ü erkek) ile karşılaştırıldı (p> 0.05). Tümünde arteryel kan gazı analizleri, serbest T3 (sT3), serbest T4 (sT4) ve TSH düzeyleri ölçüldü. TFT bozuklukları SY olan 34 (%52.3) hastada ve SY bulunmayan 8 (%44.4) hastada saptandı. Her iki grupta da en sık bulgu, TFT parametrelerinden en az birinde azalma olmasıydı (sırasıyla, %43.1’e karşı %44.4). Solunum yetmezliği grubunda; TFT sonuçları ile cinsiyet, yaş, tanı ve ek hastalıklar arasında anlamlı ilişki saptanmadı. Ancak sT3 ve sT4 düşük olanlarda, invaziv mekanik ventilasyon gereksinimi TFT normal olanlara göre daha fazlaydı (sırasıyla, p= 0.001 ve p= 0.003). Hastanedeki mortalite oranları da, hem sT3 hem de sT4 düşük olanlarda diğerlerinden daha yüksekti (sırasıyla, p= 0.006 ve p= 0.01). SY olan hastalarda, TFT bozukluklarının SY olmayanlardan daha sık gözlenmediği sonucuna vardık. Yine de, düşük sT3 ve sT4 düzeyleri, invaziv mekanik ventilasyon gereksinimini ve mortaliteyi arttırmaktadır.

Tiroid fonksiyon testi bozuklukları solunum yetmezliği olan hastaların prognozunu etkiler mi?

Thyroid function test (TFT) impairments can be detected in extrathyroidal dysfunction, primarily in chronic obstructive pulmonary disease (COPD) with acute respiratory failure (RF). The aims of this study were to: (i) evaluate TFT impairments in patients with RF, (ii) compare TFT results to a control group without RF and (iii) assess the effects of thyroid dysfunction on clinical outcome and prognosis of RF. The TFT parameters were assessed in 65 patients (65.0 ± 10.0 years, 49 males) with RF and compared to 18 patients (64.4 ± 9.8 years, 13 males) with lung disease and no RF (p> 0.05). Arterial blood gas analysis, free T3 (FT3), free T4 (FT4) and TSH levels were all measured. The impairments of TFT were demonstrated in 34 (52.3%) patients with RF and 8 (44.4%) patients without RF (p> 0.05). The most common finding was a decrease in at least one of the TFT parameters in both groups (43.1% vs. 44.4%, respectively). In RF group, there was no significant association between TFT results and gender, age, diagnosis and co-morbid disease. However, need for invasive mechanical ventilation was higher both in patients with low FT3 and low FT4 when compared to those with normal TFT results (p= 0.001 and p= 0.003, respectively). In-hospital mortality rate was also higher both in the patients with low FT3 and low FT4 than the others (p= 0.006 and p= 0.01, respectively). We conclude that TFT impairments are not observed more frequently in patients with RF when compared to the patients without RF. However, low FT3 and FT4 levels increase the rates of invasive mechanical ventilation and mortality.

PDF

___

1. Brussel T, Matthay MA, Chernow B. Pulmonary manifestations of endocrine and metabolic disorders. Clin Chest Med 1989; 10: 645-53.
2. Pelttari L, Rauhala E, Polo O, et al. Upper airway obstruction in hypothyroidism. J Intern Med 1994; 236: 177-81.
3. Choutet P, Lamisse F, Ginies G, et al. Laryngeal edema and alveolar hypoventilation as primary manifestations of hypothyroidism. Sem Hop 1980; 56: 782-4.
4. Schlenker EH, Burbach JA. The dystrophic hamster: An animal model of alveolar hypoventilation. J Appl Physiol 1991; 71: 1655-62.
5. Hellermann J, Kahaly G. Cardiopulmonary involvement in thyroid gland diseases. Pneumologie 1996; 50: 375-80.
6. Martinez FJ, Bermudez-Gomez M, Celli BR. Hypothyroidism. A reversible cause of diaphragmatic dysfunction. Chest 1989; 96: 159-63.
7. Siafakas NM, Alexopaulou C, Bouros D. Respiratory muscle function in endocrine diseases. Monaldi Arch Chest Dis 1999; 54: 154-9.
8. Di Napoli M, Reda G, Zannoni G, et al. The euthyroid sick syndrome. Its incidence and clinical significance in an internal medicine department. Minerva 1994; 85: 161-5.
9. Camacho PM, Dwarkanathan AA. Sick euthyroid syndrome. What to do when thyroid function tests are in critically ill patients. Postgrad Med 1999; 105: 215-9.
10. McIver B, Gorman CA. Euthyroid sick syndrome: An overview. Thyroid 1997; 7: 125-32.
11. Bermudez F, Surks MI, Oppenheimer JI. High incidence of decreased serum T3 concentration in patients with nonthyroidal disease. J Clin End Metabol 1975; 41: 27-40.
12. Slag MF, Morley JE, Elson MK, et al. Hypothyroxineemia in critically ill patients as a predictor of high mortality. JAMA 1981; 245: 43-5.
13. Spencer C, Eigen A, Shen D, et al. Specificity of sensitive assays of TSH used to screen for thyroid disease in hospitalized patients. Clin Chem 1987; 33: 1391-6.
14. Samuels MH, Luther M, Henry P, Ridgway EC. Effect of hydrocortisone on pulsatile pituitary glycoprotein secretion. J Clin End Metabol 1994; 78: 211-5.
15. Kaptein EM, Spencer CA, Kamiel MB, Nicoloft JT. Prolonged dopamine administration and thyroid hormone economia in normal and critically ill subjects. J Cli En Metabol 1980; 51: 387-93.
16. Grippi MA. Respiratory failure: An overview. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior RM (eds). Fishman’s Pulmonary Diseases and Disorders. New York: McGraw-Hill Company, 1998: 2525-35.
17. Pechatnikov LM. Significance of hypophyseo-thyroid disorders in chronic obstructive bronchitis. Klin Med (Mosk) 1989; 67: 40-3.
18. Yamamoto T. Delayed respiratory failure during the treatment of myxedema coma. Endocrinol Jpn 1984; 31: 769-75.
19. Kubai S, Kida K, Mizuuchi T, et al. A case of primary hypothyroidism with repeated episodes of respiratory failure. Nippon Ronen Igakkai Zasshi 1991; 28: 58-62.
20. Rajagopal KR, Abbrecht PH, Derderian SS, et al. Obstructive sleep apnea in hypothyroidism. Ann Intern Med 1984; 101: 491-4.
21. Wawrzynska L, Sakowicz A, Filipecki S. Euthyroid sick syndrome in patients with respiratory failure. Pneumonol Allergol Pol 1996; 64(Suppl 2): 193-9.
22. Scoscia E, Baglioni S, Eslami A, et al. Low triiodothyronine (T3) state: A predictor of outcome in respiratory failure? Results of a clinical pilot study. Eur J Endocrinol 2004; 151: 557-60.
23. Okutan O, Kartaloglu Z, Onde ME, et al. Pulmonary function tests and thyroid hormone concentrations in patients with chronic obstructive pulmonary disease. Med Princ Pract 2004; 13: 126-8.
24. Datta D, Scalise P. Hypothyroidism and failure to wean in patients receiving prolonged mechanical ventilation at a regional weaning center. Chest 2004; 126: 1307-12.