Yenidoğan Yoğun Bakım Ünitesinde Tiroid Dışı Hastalık Sendromu

Öz

Amaç: Bu çalışmanın amacı yenidoğanlarda tiroid dışı hastalık sendromunun (TDHS) yaygınlığını belirlemek ve yenidoğan sonuçları üzerindeki potansiyel etkilerini araştırmaktır. Ayrıca, TDHS gelişimi ile ilişkili risk faktörlerini belirleyerek, sendromun daha iyi anlaşılmasına katkıda bulunmak amaçlanmaktadır. Materyal ve Metot: Yenidoğan yoğun bakım ünitesinde yatan 337 hastanın verileri retrospektif olarak toplandı. Gebelik yaşı, doğum ağırlığı, Apgar skoru, SNAPPE skoru, doğum şekli, konjenital anomaliler, solunum desteği ve hastanede yatış süresi gibi demografik ve klinik veriler toplanmıştır. Tüm hastalarda tiroid uyarıcı hormon (TSH) ve serbest tiroksin (sT4) düzeyleri ölçülmüştür. Bulgular: Çalışmaya alınan hastaların %4,5’inde TDHS saptanmıştır. TDHS tanısı alan hastalar, daha düşük gebelik haftası, doğum ağırlığı, baş çevresi, boy, ve Apgar skorlarına sahipti. TDHS hastalarının hastane yatış süreleri anlamlı şekilde daha uzun bulunmuş, ancak mekanik ventilasyon süresi ve SNAPPE skorlarında fark gözlenmemiştir. Sonuç: Bu çalışma, kritik hastalık geçiren yenidoğanlarda tiroid fonksiyon bozukluklarının görülebileceğini ve bu grubun tiroid fonksiyonlarının değerlendirilmesinin önemli olduğunu göstermektedir.

Anahtar Kelimeler

• Tiroid dışı hastalık sendromu
• tiroid fonksiyon testleri
• tiroid taraması
• ötiroid hasta sendromu
• yenidoğan yoğun bakım ünitesi

Non-Thyroidal Illness Syndrome in Neonatal Intensive Care Units

Abstract

Objective: This study aims to establish the incidence of non-thyroidal illness syndrome (NTIS) in newborns and investigate its potential impact on neonatal outcomes. Additionally, by identifying the risk factors associated with the development of NTIS, this study aims to deepen the understanding of the condition. Materials and Methods: A total of 337 patients in the neonatal intensive care unit were studied retrospectively. Data on demographic and clinical characteristics, including gestational age, birth weight, head circumference, height, Apgar score, SNAPPE score, presence of congenital anomalies, mode of delivery, respiratory support, and duration of hospitalization, were collected. All patients underwent measurement of TSH and free T4 levels. Results: The study found that 4.5% of patients were diagnosed with NTIS. Patients with NTIS had higher rates of preterm delivery. NTIS patients exhibited lower gestational age, birth weight, head circumference, height, and Apgar scores than non-NTIS patients. NTIS patients had significantly more extended hospital stays, but no differences in mechanical ventilation duration or SNAPPE scores were obtained. Conclusions: This study indicates that thyroid dysfunction can occur in critically ill newborns, highlighting the necessity of evaluating thyroid function in this demographic.

Keywords

• Euthyroid sick syndrome
• neonatal intensive care unit
• non-thyroidal illness syndrome
• thyroid function tests
• thyroid screening

References

1. Perlman JM. Neuro behavioral deficits in prematüre graduates of intensive care-potential medical and neonatal environmental risk factors. Pediatrics. 2001;108(6):1339-1348. doi:10.1542/peds.108.6.1339
2. Gressens P, Rogido M, Paindaveine B, Sola A. The impact of neonatal intensive care practices on the developing brain. J Pediatr. 2002;140(6):646-653. doi:10.1067/mpd.2002.123214
3. Kerr DE, Wenham T, Newell-Price J. Endocrine problems in the critically ill 2: endocrine emergencies. BJA Educ. 2017;17(11):377-382. doi:10.1093/bjaed/mkx023
4. La Franchi SH. Thyroid function in preterm/lowbirth weight infants: Impact on diagnosis and management of thyroid dysfunction. Front Endocrinol (Lausanne). 2021;12:666207. doi:10.3389/fendo.2021.666207
5. Golombek SG. Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients. Semin Perinatol. 2008;32(6):413-418. doi:10.1053/j.semperi.2008.09.010
6. Docter R, Krenning EP, De Jong M, Hennemann G. The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism. Clin Endocrinol (Oxf). 1993;39(5):499-518. doi:10.1111/j.1365-2265.1993.tb02401.x
7. Krug N, Bercker S, Busch T, Friese S, Jahn N, Voelker MT. Non-thyroidal illness syndrome (NTIS) is no independent predictor for mortality in ICU patients. BMC Anesthesiol. 2023;23(1):103. doi:10.1186/s12871-023-02015-1
8. deVries EM, Fliers E, Boelen A. The molecular basis of the non-thyroidal illness syndrome. J Endocrinol. 2015;225(3):R67-R81. doi:10.1530/joe-15-0133

9. Goldsmit GS, Valdes M, Herzovich V, et al. Evaluation and clinical application of changes in thyroid hormone and TSH levels in critically ill full-term newborns. J Perinat Med. 2011;39(1):59-64. doi:10.1515/jpm.2010.120
10. Shampo MA, Kyle RA. Virginia Apgar--the Apgar score. Mayo Clin Proc. 1995;70(7):680. doi:10.4065/70.7.680
11. Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr. 2001;138(1):92-100. doi:10.1067/mpd.2001.109608
12. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score, expandedo include extremely prematüre infants. J Pediatr. 1991;119(3):417-423. doi:10.1016/S0022-3476(05)82056-6
13. Demir K, Besci T, Besci Ö, et al. Biochemical indicators of euthyroid sick syndrome in critically ill children. J Pediatr Endocrinol Metab. 2022;35(10):1285-1292. doi:10.1515/jpem-2022-0232
14. Guo J, Hong Y, Wang Z, Li Y. Analysis of the incidence of euthyroid sick syndrome in comprehensive intensive care units and related risk factors. Front Endocrinol (Lausanne). 2021;12. doi:10.3389/fendo.2021.656641
15. Hemmati F, Pishva N. Evaluation of thyroid status of infants in the intensive care setting. Singapore Medical Journal. 2009;50(9):875-878.
16. Rai R, Singh DK, Bhakhri BK. Hypothyroxinemia in sick term neonates and its risk factors in an extramural neonatal intensive care unit: a prospective cohort study. Arch Endocrinol Metab. 2022;66(4):466-471. doi:10.20945/2359-3997000000500
17. Zibitt M, Ange B, Wynter Z, Mundy C, Herrmann S, Stansfield BK. Hypothyroxinemia and weight velocity in preterm infants. J Pediatr Endocrinol Metab. 2024;37(3):236-242. doi:10.1515/JPEM-2023-049
18. Zdraveska N, Kocova M. Thyroid function and dysfunction in preterm infants—Challenges in evaluation, diagnosis and therapy. Clin Endocrinol (Oxf). 2021;95(4):556-570. doi:10.1111/cen.14481
19. Steinke TJ, O’Callahan EL, York JL. Transient hypothyroidism in the newborn: to treat or not to treat. Transl Pediatr. 2017;6(4):34958-34358. doi:10.21037/tp.2017.09.05
20. Aygün E, Semerci SY, Sağlık AÇ, Ertürk EY. Neuro developmental outcome of infants with transient hypothyroxinemia of prematurity in a newborn intensive care unit. J Clin Res Pediatr Endocrinol. 2024;16(1):60-68. doi:10.4274/jcrpe.galenos.2023.2023-6-5
21. Stawerska R, Nowak-Bednarek M, Talar T, et al. The prevalence of hypothyroxinemia in premature newborns. Front Endocrinol (Lausanne). 2022;13. doi:10.3389/fendo.2022.940152
22. Yoon SA, Chang YS, Ahn SY, Sung SI, Park WS. Incidence and severity of transient hypothyroxinaemia of prematurity associated with survival without composite morbidities in extremely low birth weight infants. Sci Rep. 2019;9(1):9628. doi:10.1038/s41598-019-46108-9
23. Improda N, Capalbo D, Poloniato A, et al. Perinatal asphyxia and hypothermic treatment from the endocrine perspective. Front Endocrinol (Lausanne). 2023;14. doi:10.3389/fendo.2023.1249700
24. Ahmad Fikri ZA, Ramli N, Ibrahim NR, Van Rostenberghe HA, Cheng KY. Effect of birth asphyxia on the thyroid hormone in term newborns delivered in Hospital Universiti Sains Malaysia (Hospital USM). Malaysian J Med Health Sci. 2024;20(supp3):47-51. doi:10.47836/mjmhs20.s3.7
25. Pereira D, Procianoy RS. Effect of perinatal asphyxia on thyroid-stimulating hormone and thyroid hormone levels. Acta Paediatr. 2007;92(3):339-345. doi:10.1111/j.1651-2227.2003.tb00556.x
26. El-Nawawy A, Elwafa RAHA, Khalil Abouahmed A, Rasheed RA, Omar OM. Evaluation of non-thyroidal illness syndrome in shock patients admitted to pediatric intensive care unit in a developing country. Eur J Pediatr. 2024;183(2):769-778. doi:10.1007/s00431-023-05338-w
27. Xu MX, Liu G, Cao LJ, et al. Association of non-thyroidal illness syndrome with interleukin-6 and interleukin-10 in critically ill children with sepsis. Zhongguo Dang Dai Er Ke Za Zhi. 2020;22(11):1215-1220. doi:10.7499/j.issn.1008-8830.2004137