Non-Thyroidal Illness Syndrome in A Pediatric Intensive Care Unit During COVID-19 Era

Document Type : original article

Authors

1 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background: Non-thyroidal illness syndrome (NTIS) is defined as a condition that occurs during acute illness. In this study, we evaluated thyroid function tests in pediatric patients with coronavirus disease 2019 (COVID-19) infection who were admitted to the pediatric intensive care unit (PICU) and compared them with children admitted to the PICU due to other disorders
Materials and Methods: This was a cross-sectional study where all patients between the ages of 1 month and 16 years admitted to the COVID-19 referral Hospital PICUs were evaluated over a 6 month period. A checklist was used to gather patient information. Thyroid hormones evaluated included; measurements of free T3, T3, T4 and TSH on the first day of admission Data was analyzed using the SPSS 21 statistical package.
Results: A total of 73 patients were evaluated during the 6 month study period. 40 (54.8%) of them were male and 53(45.2%) were female. The mean age of the study population was 5.9±4.3 years.13 patients were admitted due to SARS-Cov-19 infection.
Thyroid function consistent with Non thyroidal illness syndrome was observed in 25(34.2%) of these patients. The level of T3 and FT3 in patients with COVID-19 were significantly lower than in patients without COVID-19 infection (P<0.05). Body temperature in patients with abnormal thyroid tests was significantly higher than in patients with normal thyroid tests (P=0.040).
Conclusion: We found that one-third of children admitted to the PICU had NTIS. We suggest that FT3 can be a marker of COVID-19 patient severity, as its lower levels were observed in pediatric patients admitted to the PICU.

Keywords

References

  1. Boelen A, Kwakkel J, Fliers E. Beyond low plasma T3: local thyroid hormone metabolism during inflammation and infection. Endocrine reviews. 2011 Oct 1;32(5):670-93.
  2. Scoscia E, Baglioni S, Eslami A, Iervasi G, Monti S, Todisco T. Low triiodothyronine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study. European journal of endocrinology. 2004 Nov;151(5):557-60.
  3. Bertoli A, Valentini A, Cianfarani MA, Gasbarra E, Tarantino U, Federici M. Low FT3: a possible marker of frailty in the elderly. Clinical interventions in aging. 2017 Feb 10:335-41.
  4. Lee S, Farwell AP. Euthyroid sick syndrome. Comprehensive Physiology. 2016 Apr 1;6(2):1071-80.
  5. El-Mekkawy MS, El-Demerdash AS, Barseem NF. Euthyroid Sick Syndrome Is Predictive of Illness Severity in Pediatric Sepsis. The Egyptian Journal of Hospital Medicine. 2023 Apr 1;91(1):4772-9.
  6. Wadman M, Couzin-Frankel J, Kaiser J, Matacic C. A rampage through the body.2020.
  7. Naguib R. Potential relationships between COVID-19 and the thyroid gland: an update. Journal of International Medical Research. 2022 Feb;50(2):03000605221082898.
  8. Chen W, Tian Y, Li Z, Zhu J, Wei T, Lei J. Potential interaction between SARS-CoV-2 and thyroid: a review. Endocrinology. 2021 Mar 1;162(3):bqab004.
  9. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. jama. 2020 Apr 7;323(13):1239-42.
  10. Chen T, Wu DI, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. bmj. 2020 Mar 26;368.
  11. Calcaterra V, Zuccotti G. changes in thyroid function in children with multisystem inflammatory syndrome related to COVID-19 observed over a 1-year follow-up period. Thyroid. 2023 May;33(5):650-2.
  12. Duntas LH, Jonklaas J. COVID-19 and thyroid diseases: a bidirectional impact. Journal of the Endocrine Society. 2021 Aug 1;5(8):bvab076.
  13. Lee YJ, Lee HY, Ahn MB, Kim SK, Cho WK, Lee JW, et al. Thyroid dysfunction in children with leukemia over the first year after hematopoietic stem cell transplantation. Journal of Pediatric Endocrinology and Metabolism. 2018 Nov 27;31(11):1241-7.
  14. Akbaş T, Sahin İE, Ozturk A. Alterations in thyroid hormones in brain-dead patients are related to non-thyroidal illness syndrome. Endokrynologia Polska. 2018;69(5):545-9.
  15. Gutch M, Kumar S, Gupta KK. Prognostic value of thyroid profile in critical care condition. Indian journal of endocrinology and metabolism. 2018 May 1;22(3):387-91.
  16. Fliers E, Boelen A. An update on non-thyroidal illness syndrome. Journal of endocrinological investigation. 2021 Aug;44(8):1597-607.
  17. Van den Berghe G. Non-thyroidal illness in the ICU: a syndrome with different faces. Thyroid. 2014 Oct;24(10):1456-65.
  18. Staruszkiewicz M, Pituch-Noworolska A, Skoczen S. SARS-CoV-2 and thyroid diseases. Journal of Translational Autoimmunity. 2023 Dec 1;7:100214.
  19. Fastiggi M, Meneghel A, Gutierrez de Rubalcava Doblas J, Vittadello F, Tirelli F, Zulian F, et al. Prognostic role of euthyroid sick syndrome in MIS-C: results from a single-center observational study. Frontiers in Pediatrics. 2023 Aug 10;11:1217151.
  20. Zou R, Wu C, Zhang S, Wang G, Zhang Q, Yu B, et al. Euthyroid sick syndrome in patients with COVID-19. Frontiers in Endocrinology. 2020 Oct 7;11:566439.
  21. Liu J, Wu X, Lu F, Zhao L, Shi L, Xu F. Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia. Scientific reports. 2016 Mar 1;6(1):22271.
  22. Giovanella L, Ruggeri RM, Ovčariček PP, Campenni A, Treglia G, Deandreis D. Prevalence of thyroid dysfunction in patients with COVID-19: a systematic review. Clinical and translational imaging. 2021 Jun;9(3):233-40.
  23. Chen M, Zhou W, Xu W. Thyroid function analysis in 50 patients with COVID-19: a retrospective study. Thyroid. 2021 Jan;31(1):8-11.
  24. Llamas M, Garo ML, Giovanella L. Low free-T3 serum levels and prognosis of COVID-19: systematic review and meta-analysis. Clinical Chemistry and Laboratory Medicine (CCLM). 2021 Nov 25;59(12):1906-13.
  25. Suvarna JC, Fande CN. Serum thyroid hormone profile in critically III children. The Indian Journal of Pediatrics. 2009 Dec;76(12):1217-21.
  26. Yanni GN, Destariani CP, Lubis AN, Deliana M. Thyroid hormone profile in children with sepsis: does euthyroid sick syndrome exist?. Open Access Macedonian Journal of Medical Sciences. 2019 Apr 14;7(7):1110.
Journal of Pediatric Perspectives
Volume 14, Issue 2
February 2026
Pages 19912-19919

Files

Share

How to cite

Statistics