Nonthyroidal Illness Syndrome: To Treat or Not to Treat? Have We Answered the Question? A Review of Metanalyses

[helvella]

Despite a gigantic number of papers, huge numbers of studies, trials, etc., we keep ending up in the same place.

Don't know - needs more research.

So much research ends up not answering its own questions, nor meaningfully contributing to reviews and future research.

We see some of the same mistakes repeatedly - failing to measure FT3 as well as FT4, or only doing TSH.

Considering that the answer seems often literally to be the difference between life and death, it is a tragedy. One that is being repeatedly endlessly around the world.

Front Endocrinol (Lausanne).2022; 13: 850328.

Published online 2022 May 10. doi: 10.3389/fendo.2022.850328

PMCID: PMC9128382

PMID: 35620389

Nonthyroidal Illness Syndrome: To Treat or Not to Treat? Have We Answered the Question? A Review of Metanalyses

Salvatore Sciacchitano, 1 , 2 , † Carlo Capalbo, 3 , 4 , † Christian Napoli, 5 , † Paolo Anibaldi, 6 Valentina Salvati, 7 , † Claudia De Vitis, 1 , † Rita Mancini, 1 , † Flaminia Coluzzi,

8 , 9 , * , † and Monica Rocco 5 , 8 , †

Abstract

Background and Objective

Nonthyroidal Illness Syndrome (NTIS) occurs in approximately 70% of patients admitted to Intensive Care Units (ICU)s and has been associated with increased risk of death. Whether patients with NTIS should receive treatment with thyroid hormones (TH)s is still debated. Since many interventional randomized clinical trials (IRCT)s were not conclusive, current guidelines do not recommend treatment for these patients. In this review, we analyze the reasons why TH treatment did not furnish convincing results regarding possible beneficial effects in reported IRCTs.

Methods

We performed a review of the metanalyses focused on NTIS in critically ill patients. After a careful selection, we extracted data from four metanalyses, performed in different clinical conditions and diseases. In particular, we analyzed the type of TH supplementation, the route of administration, the dosages and duration of treatment and the outcomes chosen to evaluate the results.

Results

We observed a marked heterogeneity among the IRCTs, in terms of type of TH supplementation, route of administration, dosages and duration of treatment. We also found great variability in the primary outcomes, such as prevention of neurological alterations, reduction of oxygen requirements, restoration of endocrinological and clinical parameters and reduction of mortality.

Conclusions

NTIS is a frequent finding in critical ill patients. Despite several available IRCTs, it is still unclear whether NTIS should be treated or not. New primary endpoints should be identified to adequately validate the efficacy of TH treatment and to obtain a clear answer to the question raised some years ago.

Keywords: nonthyroidal illness syndrome, SARS-CoV-2 (2019-nCoV) coronavirus, bioelectrical impedance analysis, hydration, sodium/potassium exchangeable ratio

Paper freely accessible here:

ncbi.nlm.nih.gov/pmc/articl...

[jimh111]

Metanalyses are pretty useless, the outcome depends on the parameters the authors setup, about as neutral as an 'official enquiry'.

We not get a review (aka a metanalysis) of metalyses.

Garbage in, garbage out.

[helvella Administrator Thyroid UK in reply to jimh111]

Even fairly subtle differences between studies can confound any attempt to perform meta-analyses unless they ignore them - with the potential for very significant misinterpretation, and false inferences.

[Lulu2607 in reply to helvella]

Totally agree. We are fed lots of scientific research findings that are often questionable due to samples and methodology. There's quite a fashion in the media for stating the findings of correlational studies as proven facts which I find particularly annoying.