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Journal of Diabetology | Volume 3
May 16-17, 2019 | Prague, Czech Republic
Diabetes and Endocrinology
27th International Conference on
J Diabetol, Volume 3
Euthyroid sick syndrome is a manifestation of transient
hypothalamic-pituitary dysfunction along with altered
thyroid hormone metabolism. It is not prudent to rely solely
on a single thyroid test in the evaluation of thyroid function
of patients with critical illness, and a careful assessment of
multiple tests may be needed. It is reasonable to delay the
final diagnosis for several days to weeks, or after recovery
from the acute illness, to determine the appropriate thyroid
status. Thyroid hormones have been used in the setting
of NTI in various settings with T4 and T3 replacement
and remain controversial in the absence of prospective
studies to demonstrate benefit. Assessing thyroid function
in patients with severe illness such as those in the ICU is
difficult. Many of them have low serum concentrations of
thyroxine (T4), free T4, and triiodothyronine (T3), free T3,
and their serum thyrotropin (TSH) concentrations also are
frequently low. Thyroid function tests need not be assessed
in seriously ill patients unless there is a strong suspicion
of thyroid dysfunction. Also, measurement of serum TSH
alone is inadequate for the evaluation of thyroid function
and, in this scenario, free T4 and free T3 along with TSH
are recommended. However, these tests frequently fail to
differentiate between euthyroid sick syndrome and central
hypothyroidism. Determination of serumreverse T3(RT3) may
be helpful since RT3 is almost always elevated in euthyroid sick
syndrome while being low in central hypothyroidism. Treating
patients with critical illness with low serum T3 and/or low T4
concentrations with no other clinical signs of hypothyroidism
is not commonly recommended. Patients may receive
thyroid hormone replacement if there is additional
evidence to suggest a diagnosis of hypothyroidism (such
as a TSH over 20 mU/L with low free T4 and/or history,
symptoms, and signs of hypothyroidism), in which case
cautious administration of thyroid hormone is appropriate.
Therefore, thyroid functions should not be assessed in
critically ill patients in the absence of a suspicion of thyroid
dysfunction as these abnormalities are not a true reflection of
actual hormonal activity at the cellular level and treatment of
these patients with thyroid hormones is of little benefit and
sometimes may be detrimental. In this presentation, several
clinical disorders manifesting altered thyroid hormone levels
noted with euthyroid syndrome are described. Moreover,
presence of hyperglucagonemia as well as its relationship
with thyroid hormonemetabolismand hypothalamic pituitary
thyroid axis in these disorders is documented. Finally, role
of glucagon is established in both altered thyroid hormone
metabolism and altered hypothalamic pituitary thyroid axis
documented in euthyroid sick syndrome by determination of
serum thyroid hormones and TSH concentrations in response
to glucagon administration in dogs, normal human subjects
as well as subjects with clinical disorders. Moreover, influence
of TSH in conversion of T4 into T3 in nonthyroidal peripheral
tissues is also demonstrated in athyreotic dogs and human
subjects.
Speaker Biography
Udaya M Kabadi is a graduate of Seth G.S. Medical College, the University
of Bombay in Bombay, India. He completed his internal medicine residency
at KEM Hospital Parel in Bombay and a medicine residency at Jewish
Memorial Hospital and Beth Israel Medical Center in New York, He also
completed a fellowship in endocrinology and metabolism at VA Medical
Center and Beth Israel Medical Center in New York, New York. He is board
certified in internal medicine, endocrinology and metabolism and geriatric
medicine by the American Board of Internal Medicine. He is a fellow of the
Royal College of Physicians of Canada, the American College of Physicians
and the American College of Endocrinology. He has been a chief editor,
associate editor andmember of editorial boards of several medical journals.
He is currently an adjunct professor of Medicine at the University of Iowa
CollegeofMedicine, IowaCityaswellasDesMoinesUniversity,DesMoines,
Iowa. He has over 200 publications in peer-reviewed journals. He has
presentations to his credit, at regional, national, and international arenas.
He has been selected as ‘Teacher of the Year’ many times by students,
residents, and fellows in training. He has been involved in research in the
area of carbohydrate metabolism and diabetes, thyroid disorders and
osteoporosis as well as in clinical practice and education for several years.
e:
Udaya M Kabadi1,2
1Broadlawns Medical Center, USA
2University of Iowa, USA
Euthyroid Sick Syndrome: Role of glucagon