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Endocrine Abstracts (2018) 56 P249 | DOI: 10.1530/endoabs.56.GP249

ECE2018 Guided Posters Thyroid non cancer (9 abstracts)

Abnormal thyroid enzymes in critically ill patients with no known prior thyroid disorder are an independent predictor of mortality

Sherin Elsa Mathews 1 , Naga Kanaparthy 2 & Kamala Kallur 1


1Mount Sinai St Luke’s and Mount Sinai West, New York, New York, USA; 2Westchester Medical Center, Valhalla, New York, USA.


Background: Sick euthyroid syndrome is a well-known condition and no additional treatment is often required. However various authors have postulated that there is an effect of abnormal thyroid function on the outcomes of hospitalized patients. In our study, we chose to study the effect of thyroid function abnormalities and their independent effect on mortality of critically ill patients who had no known prior thyroid diseases.

Methods: Data was obtained from ‘Medical Information Mart for Intensive Care III’ database between 2001 and 2012. All patients whose Thyroid Stimulating hormone (TSH) and Thyroxine (T4) were tested were considered. Patients who had prior thyroid diseases were removed. The rest were split into multiple groups based on their TSH and T4 levels during their ICU stay. The groups are outlined in Table 1. Base outcome group was those with normal TSH and normal T4 (Group Zero - G0). Multinomial logistic regression with length of stay (LOS) and Simplified Acute Physiology Score (SAPS) II as co-variables were run to assess the Relative Risk Ratios (RRR) of 30-day mortality with altered TSH and T4 levels.

Results: Total of 2970 adult ICU admissions who had no underlying thyroid disease were considered for the study. Among them, two groups, G1 (High TSH and High T4) and G8 (Low TSH and Low T4) when compared to the base outcome had a significantly increased RRR of mortality. The RRR for 30-day mortality, among G1 compared to G0 was 3.79 (P=0.021) and 3.67 (P=0.001) in G8 compared to G0.

Table 1 RRR of 30-day mortality of patients admitted to critical care units compared to those with normal thyroid values (adjusted for SAPS II and LOS).
GroupT4TSHRRRP value95% Conf Interval
G0NormalNormalReference
G1LowLow3.80.021(1.2–11.7)
G2LowNormal2.10.031(1.1–4.2)
G3LowHigh2.10.002(1.3–3.3)
G4NormalLow1.20.314(0.8–1.89)
G5NormalHigh1.40.018(1.1–1.9)
G6HighLow0.90.849(0.4–1.9)
G7HighNormal1.70.040(1.02–2.8)
G8HighHigh3.70.001(1.7–7.7)

Conclusion: Among the critically ill patients and specifically for those without prior thyroid illness, we postulate that T4 and TSH can be used as independent predictors of mortality. When both the values are altered, it might signify a more profound metabolic derangement, needing specific attention, as compared to the traditional subclinical hypo and hyperthyroidism.

Volume 56

20th European Congress of Endocrinology

Barcelona, Spain
19 May 2018 - 22 May 2018

European Society of Endocrinology 

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