Nonthyroidal illness syndrome(NTIS)is a common finding in critically ill patients,characterized by disruptions in the hypothalamus-pituitary-thyroid axis,resulting in altered levels of thyroxine(T4),triiodothyronine(T...Nonthyroidal illness syndrome(NTIS)is a common finding in critically ill patients,characterized by disruptions in the hypothalamus-pituitary-thyroid axis,resulting in altered levels of thyroxine(T4),triiodothyronine(T3),and reverse T3.This condition,often considered to be an adaptive response aimed at conserving energy,can become maladaptive in prolonged critical illness,contributing to poor outcomes in intensive care unit patients.The pathophysiology of NTIS involves cytokine-driven alterations in thyroid hormone(TH)metabolism,impaired hormone transport,and reduced receptor sensitivity,which-collectively-suppress thyroid function.Despite these insights,the therapeutic role of TH replacement in patients with NTIS remains uncertain.Low doses of levothyroxine and T3 have been trialed,particularly in patients with cardiovascular comorbidities,but clinical studies report conflicting results regarding their impact on mortality and overall patient outcomes.While some evidence suggests potential benefits of T3 administration in specific subgroups,such as patients with septic shock or severe coronavirus disease 2019,robust clinical trials have yet to conclusively demonstrate improved survival or recovery.The heterogeneity in NTIS presen-tation and treatment protocols,as well as the complex nature of TH regulation in critically ill patients,complicates efforts to establish clear guidelines for hormone therapy.Future research should prioritize individualized approaches,optimizing hormone dosing and timing,while aiming to elucidate the long-term effects of such interventions on critically ill patients to improve morbidity and mortality outcomes.展开更多
A Capillary electrophortic enzyme linked immunoassay with electrochemical detection (CE-EIA-ED) has been developed. The method can be used to determine thyroxine with a limit of 3.8×10-9 mol/L.
BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have...BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.展开更多
文摘Nonthyroidal illness syndrome(NTIS)is a common finding in critically ill patients,characterized by disruptions in the hypothalamus-pituitary-thyroid axis,resulting in altered levels of thyroxine(T4),triiodothyronine(T3),and reverse T3.This condition,often considered to be an adaptive response aimed at conserving energy,can become maladaptive in prolonged critical illness,contributing to poor outcomes in intensive care unit patients.The pathophysiology of NTIS involves cytokine-driven alterations in thyroid hormone(TH)metabolism,impaired hormone transport,and reduced receptor sensitivity,which-collectively-suppress thyroid function.Despite these insights,the therapeutic role of TH replacement in patients with NTIS remains uncertain.Low doses of levothyroxine and T3 have been trialed,particularly in patients with cardiovascular comorbidities,but clinical studies report conflicting results regarding their impact on mortality and overall patient outcomes.While some evidence suggests potential benefits of T3 administration in specific subgroups,such as patients with septic shock or severe coronavirus disease 2019,robust clinical trials have yet to conclusively demonstrate improved survival or recovery.The heterogeneity in NTIS presen-tation and treatment protocols,as well as the complex nature of TH regulation in critically ill patients,complicates efforts to establish clear guidelines for hormone therapy.Future research should prioritize individualized approaches,optimizing hormone dosing and timing,while aiming to elucidate the long-term effects of such interventions on critically ill patients to improve morbidity and mortality outcomes.
基金supported by the National Natural Science Foundation of Chinathe Natural Science Foundation of Shandong Provincethe Key State Laboratory of Electroanalytical Chemistry,Changchun Institute of Applied Chemistry,Chinese Academy of Sciences
文摘A Capillary electrophortic enzyme linked immunoassay with electrochemical detection (CE-EIA-ED) has been developed. The method can be used to determine thyroxine with a limit of 3.8×10-9 mol/L.
基金National Natural Science Foundation of China,No.82270881 and No.82200928National High-Level Hospital Clinical Research Funding,No.BJ-2023-124 and No.BJ-2023-130.
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.
