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Conclusions: It is clear that the name ‘‘NTI’’ during critical illness refers to a syndrome with different faces.
Tolerating the early ‘‘fasting response’’ to critical illness and its concomitant changes in thyroid hormone
parameters appears to be wise and beneficial. This thus applies to the NTI present in the majority of the patients treated in intensive care units. However, the NTI that occurs in prolonged critically ill patients appears different with regard to both its causes and consequences. Future studies should specifically target this selected population of prolonged critically ill patients, and, after excluding iatrogic drug interferences, investigate the effect on outcome of treatment with hypothalamic releasing factors in adequately powered randomized controlled trials.