Carrillo-Esper R, Peña-Pérez CA, Zárate-Vega V, Garcilazo-Reyes Y, Lee-Cervantes D, González-Noris PY

Language: Spanish
References: 71
Page: 217-228
PDF size: 214.78 Kb.

ABSTRACT

Thyroid dysfunction is a common and unrecognized entity in the critically ill. These patients develope changes within the thyroid axis known as the low T3 syndrome or non-thyroideal illnes syndrome, characterized by low circulating T3 and increase in reverse T3. In the chronic phase of critical illness, pulsatile secretion of thyroid stimulating hormone and circulating T4 levels are low. The pathophysiology is complex and involves cytokines, peripheral and central alterations in the thyroid axis, changes in thyroid hormone binding proteins and nuclear receptors, thyroid hormone uptake and activity of the type-1 and 3 deiodinase enzymes and during the chronic phase suppressed hypothalamic thyrotropin-releasing hormone expression. The aim of this paper is an update of thyroid dysfunction in the critically ill, emphasizing key issues such as anatomy and physiology principles, of thyroid gland, hypothyroidism, myxedema coma, non-thyroideal illnes syndrome and diagnostic and therapeutic approach.

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