medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2019, Número 2

<< Anterior Siguiente >>

Acta Med 2019; 17 (2)


Síndrome eutiroideo enfermo

Ortega CMJ, Seniscal ADA, Díaz GE, Rodríguez WFL

Idioma: Español
Referencias bibliográficas: 39
Paginas: 131-136
Archivo PDF: 185.56 Kb.


RESUMEN

El síndrome eutiroideo enfermo es una entidad de presentación frecuente en pacientes hospitalizados, sobre todo en los críticamente enfermos. Desde su descripción en la década de los setenta, ha sido motivo de estudio, ya que su mecanismo fisiopatológico es complejo. Los cambios en el perfil tiroideo parecen ser secundarios al estado agudo de la enfermedad. En todos los casos, existen alteraciones en la actividad de la desionidasa tiroidea, la unión de hormonas tiroideas a proteínas plasmáticas, la transformación de hormonas tiroideas en tejidos periféricos, la actividad del receptor nuclear de hormonas tiroideas y la secreción de la hormona estimuladora de la tiroides (TSH) y de la hormona liberadora de tirotropina (TRH). Se sabe que su presentación y la disminución de T4 a cifras por debajo de 2 µg/dL aumenta hasta en 80% el riesgo de mortalidad en los pacientes en unidades de terapia intensiva. El tratamiento hormonal de sustitución tiroidea con T3 y/o T4 no ha demostrado un beneficio concreto, y su indicación es motivo de polémica. Se realiza la revisión del tema, comprendida por las características del síndrome, su fisiopatología, cuadro clínico, terapéutica y diagnósticos diferenciales.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Van den Berghe G. Non-thyroidal illness in the ICU: a syndrome with different faces. Thyroid. 2014; 24 (10): 1456-1465.

  2. Boelen A, Kwakkel J, Fliers E. Beyond low plasma T3: local thyroid hormone metabolism during inflammation and infection. Endocr Rev. 2011; 32 (5): 670-693.

  3. Farwell AP. Thyroid hormone therapy is not indicated in the majority of patients with the sick euthyroid syndrome. Endocr Pract. 2008; 14 (9): 1180-1187.

  4. Selvaraj N, Bobby Z, Sridhar MG. Is euthyroid sick syndrome a defensive mechanism against oxidative stress? Med Hypotheses. 2008; 71 (13): 404-405.

  5. Haddady S, Farwell AP. Non-thyroidal illness and the management of thyroid disorders in the Intensive Care Unit. En: Irwin RS, Rippe JM, editors. Intensive care medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2011. pp. 1182-1194.

  6. Van den Berghe G, de Zegher F, Lauwers P. Dopamine and the sick euthyroid syndrome in critical illness. Clin Endocrinol (Oxf). 1994; 41 (6): 731-737.

  7. Boonen E, Van den Berghe G. Endocrine responses to critical illness: Novel insights and therapeutic implications. J Clin Endocrinol Metab. 2014; 99 (5): 1569-1582.

  8. Boelen A, Wiersinga WM, Fliers E. Fasting-induced changes in the hypothalamus-pituitary-thyroid axis. Thyroid. 2008; 18 (2): 123-129.

  9. Hsieh CJ, Wang PW, Wang ST, Liu RT, Tung SC, Chien WY et al. Serum leptin concentrations of patients with sequential thyroid function changes. Clin Endocrinol (Oxf). 2002; 57 (1): 29-34.

  10. Corsonello A, Buemi M, Artemisia A, Giorgianni G, Mauro VN, Corica F. Plasma leptin concentrations in relation to sick euthyroid syndrome in elderly patients with nonthyroidal illnesses. Gerontology. 2000; 46 (2): 64-70.

  11. Benvenga S. Thyroid hormone transport proteins and the physiology of hormone binding. En: Braverman LE, Cooper DS. Werner and Ingbar’s the thyroid: a fundamental and clinical text. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013. pp. 93-103.

  12. Bianco AC, Kim BW. Intracellular pathways of iodothyronine metabolism/implications of deiodination for thyroid hormone action. In: Braverman LE, Cooper DS, editors. Werner and Ingbar’s the thyroid: a fundamental and clinical text. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. pp. 103-126.

  13. Huang SA, Bianco AC. Reawakened interest in type III iodothyronine deiodinase in critical illness and injury. Nat Clin Pract Endocrinol Metab. 2008; 4 (3): 148-155.

  14. Chopra IJ, Santini F, Wu SY, Hurd RE. The role of sulfation and desulfation in thyroid hormone metabolism. En: Wu SY, Visser TJ; Veterans Administration Medical Center (Long Beach, Calif.); Southwest Regional Medical Education Center (É-U). Thyroid hormone metabolism: molecular biology and alternate pathways. Boca Raton: CRC Press; 1994. pp. 119-138.

  15. Fekete C, Gereben B, Doleschall M, Harney JW, Dora JM, Bianco A et al. Lipopolysaccharide induces type 2 iodothyronine deiodinase in the mediobasal hypothalamus: Implications for the nonthyroidal illness syndrome. Endocrinology. 2004; 145 (4): 1649-1655.

  16. Fekete C, Lechan RM. Negative feedback regulation of hypophysiotropic thyrotropin-releasing hormone (TRH) synthesizing neurons: Role of neuronal afferents and type 2 deiodinase. Front Neuroendocrinol. 2007; 28 (2-3): 97-114.

  17. Hennemann G, Krenning EP. The kinetics of thyroid hormone transporters and their role in non-thyroidal illness and starvation. Best Pract Res Clin Endocrinol Metab. 2007; 21 (2): 323-338.

  18. Oetting A, Yen PM. New insights into thyroid hormone action. Best Pract Res Clin Endocrinol Metab. 2007; 21 (2): 193-208.

  19. Feingold K, Kim MS, Shigenaga J, Moser A, Grunfeld C. Altered expression of nuclear hormone receptors and coactivators in mouse heart during the acute-phase response. Am J Physiol Endocrinol Metab. 2004; 286 (2): E201-E207.

  20. Williams GR, Franklyn JA, Neuberger JM, Sheppard MC. Thyroid hormone receptor expression in the “sick euthyroid” syndrome. Lancet. 1989; 2 (8678-8679): 1477-1481.

  21. Spencer CA. Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Mayo Clin Proc. 1988; 63 (12): 1214-1222.

  22. Chuang CP, Jong YS, Wu CY, Lo HM. Impact of triiodothyronine and N-terminal pro-B-type natriuretic peptide on the long-term survival of critically ill patients with acute heart failure. Am J Cardiol. 2014; 113 (5): 845-850.

  23. Novitzky D. Novel actions of thyroid hormone: the role of triiodothyronine in cardiac transplantation. Thyroid. 1996; 6 (5): 531-536.

  24. Economidou F, Douka E, Tzanela M, Nanas S, Kotanidou A. Thyroid function during critical illness. Hormones (Athens). 2011; 10 (2): 117-124.

  25. Iglesias P, Díez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol. 2009; 160 (4): 503-515.

  26. Drechsler C, Schneider A, Gutjahr-Lengsfeld L, Kroiss M, Carrero JJ, Krane V et al. Thyroid function, cardiovascular events, and mortality in diabetic hemodialysis patients. Am J Kidney Dis. 2014; 63 (6): 988-996.

  27. Meuwese CL, Carrero JJ, Cabezas-Rodríguez I, Heimburger O, Barany P, Lindholm B et al. Nonthyroidal illness: a risk factor for coronary calcification and arterial stiffness in patients undergoing peritoneal dialysis? J Intern Med. 2013; 274: 584-593.

  28. Byerley LO, Heber D. Metabolic effects of triiodothyronine replacement during fasting in obese subjects. J Clin Endocrinol Metab. 1996; 81 (3): 968-976.

  29. Acker CG, Flick R, Shapiro R, Scantlebury VP, Jordan ML, Vivas C et al. Thyroid hormone in the treatment of posttransplant acute tubular necrosis (ATN). Am J Transplant. 2002; 2 (1): 57-61.

  30. Becker RA, Vaughan GM, Ziegler MG, Seraile LG, Goldfarb IW, Mansour EH et al. Hypermetabolic low triiodothyronine syndrome of burn injury. Crit Care Med. 1982; 10 (12): 870-875.

  31. Acker CG, Singh AR, Flick RP, Bernardini J, Greenberg A, Johnson JP. A trial of thyroxine in acute renal failure. Kidney Int. 2000; 57 (1): 293-298.

  32. Boelen A, Kwakkel J, Platvoetter Schiphorst M, Mentrup B, Baur A, Koehrle J et al. Interleukin-18, a proinflammatory cytokine, contributes to the pathogenesis of non-thyroidal illness mainly via the central part of the hypothalamus-pituitary-thyroid axis. Eur J Endocrinol. 2004; 151 (4): 497-502.

  33. Fliers E, Guldenaar SE, Wiersinga WM, Swaab DF. Decreased hypothalamic thyrotropin-releasing hormone gene expression in patients with nonthyroidal illness. J Clin Endocrinol Metab. 1997; 82 (12): 4032-4036.

  34. Frey A, Kroiss M, Berliner D, Seifert M, Allolio B, Güder G et al. Prognostic impact of subclinical thyroid dysfunction in heart failure. Int J Cardiol. 2013; 168: 300-305.

  35. Pingitore A, Galli E, Barison A, Iervasi A, Scarlattini M, Nucci D et al. Acute effects of triiodothyronine (T3) replacement therapy in patients with chronic heart failure and low-T3 syndrome: a randomized, placebo-controlled study. J Clin Endocrinol Metab. 2008; 93 (4): 1351-1358.

  36. Cooper DK, Novitzky D, Wicomb WN, Basker M, Rosendale JD, Myron Kauffman H. A review of studies relating to thyroid hormone therapy in brain-dead organ donors. Front Biosci (Landmark Ed.). 2009; 14: 3750-3770.

  37. Novitzky D, Cooper DK, Rosendale JD, Kauffman HM. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation. 2006; 82 (11): 1396-1401.

  38. Dikdan GS, Mora-Esteves C, Koneru B. Review of randomized clinical trials of donor management and organ preservation in deceased donors: opportunities and issues. Transplantation. 2012; 94 (5): 425-441.

  39. Krysiak R, Kędzia A, Kowalcze K, Okopień B. Euthyroid sick syndrome: an important clinical problem. 2017; 70 (2 pt 2): 376-385.




2020     |     www.medigraphic.com