Thyroid function tests in patients at the emergency department compared to a prior healthy setting

[helvella]

If T3 (whether total or free) is almost never measured, whether in a health examination, in emergency care or even in those with thyroid disease, you can't make this type of observation.

Yet again, as TSH remained stable despite reduced T3, the status of TSH is undermined.

Thyroid function tests in patients at the emergency department compared to a prior healthy setting

• Rock Bum Kim , Minji Kim , Yoon Young Cho, Soo Kyoung Kim, Jung Hwa Jung, Jaehoon Jung, Chi Yeon Kim, Dawon Kang, Jong Ryeal Hahm

Published: August 20, 2018

doi.org/10.1371/journal.pon...

Abstract

We examined the changes in thyroid hormone levels in patients with an acute clinical condition and compared these to levels in the healthy subjects. Serum total triiodothyronine (T3), thyroid stimulating hormone (TSH), and free thyroxine (fT4) measurements were recorded from 555 patients (mean age: 55.0 years, men: 65.9%) admitted to the emergency department (ED) 1–91 months (median: 34 months) after a regular health examination (HE). Serological data were analyzed; mean change in hormone levels was stratified by emergency classification system and quintiles of changes in inflammatory marker values, such as neutrophil lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (CRP). The mean decrease in T3 levels from HE and ED samples was 10.6 ng/dL (p< 0.001). Mean decrease in T3 levels was 21.6 ng/dL among patients classified as having an infection status and 11.0 ng/dL among patients classified as having an urgency status. A decrease 3.7 ng/dL among emergency patients was observed. TSH and fT4 levels did not change across all groups. When patients were stratified into quintiles according to changes in NLR values, mean decreases in T3 were 6.21, 8.14, 14.37, 12.76, and 21.98 ng/dL and showed significant linear reduction (p<0.001). For quintiles of changed CRP values, mean decreased T3 levels were 10.57, 3.05, 4.47, 7.68, and 28.07 ng/dL. TSH and fT4 were not associated with significant changes (p = 0.100, p = 0.561, respectively). In this study, thyroid function changes in individuals with an acute condition revealed that T3 significantly decreased, more markedly in infectious diseases compared to their healthy counterparts, and decline in T3 measurements correlated with inflammatory markers. TSH and fT4 levels remained stable. It is necessary to consider the severity of acute conditions when abnormal T3 levels are detected in subjects with emergent status.

Full paper freely available here:

journals.plos.org/plosone/a...

[Hennerton]

I am confused. What exactly is this implying? Is it that T3 levels automatically drop in times of illness, particularly when infection is present, or is it that the patients became ill, possibly because their T3 was low and therefore everyone, even people with no thyroid issues, should be regularly checked for good T3 levels? That would be a breakthrough!

I am feeling very dim today, so someone please help. Thank you.

[helvella Administrator in reply to Hennerton]

I think it is very much that T3 levels drop in illness, especially with infection present.

The subjects had "normal" T3 levels in their earlier tests.

[Hennerton in reply to helvella]

Ah yes. That overused word ‘normal ‘ again...

[DippyDame]

T3 Testing, at any time, is a bonus these days!

However, surely there is more useful research re T3 that better deserves funding and time. Cynical, I know!

They must have to check on emergency admission whether each patient is part of the research cohort, otherwise, how do they know who to test.

Emergency depts are just that, the focus should be on the emergency presented....anything else appears to be a distraction.

Did they carry out follow up tests after recovery.

Given the stresses on the body and the various drugs used in an emergency situation is it not reasonable to expect hormonal change?

FT3 is the active hormone/metabolising energy....TSH and FT4 seem less likely subjects for change during trauma/increased energy demand.

Clearly I must be missing something here....or, more likely, suffering from an acute lack of knowledge!

[helvella Administrator in reply to DippyDame]

Just perhaps, in this part of Korea, they test T3 as standard in their emergency departments?

It has long seemed feasible to do something like testing T3 in A&E in Birmingham area, vitamin E in Cardiff, skin elasticity in Dundee, etc. Possibly seemingly irrelevant, unrelated tests. But who knows what might turn up by so doing?

[DippyDame in reply to helvella]

True......the search for knowledge in very obscure places is never ending!