Approach to a Quantitative Follow-up of Non-thyroidal Illness Syndrome

Ruhr University of Bochum590 enrolled

Overview

AQUA FONTIS is a unicentric, multidisciplinary, prospective cross-section and longitudinal study that aims at the development of a more clear-cut diagnostic definition and classification of non-thyroidal illness syndrome (NTIS).

Detailed Description: Non-thyroidal illness syndrome (NTIS), also referred to as euthyroid sick syndrome (ESS) or thyroid allostasis in critical illness, tumors, uremia and starvation (TACITUS), is a complex endocrine condition that may occur in critically ill patients. It is associated with significantly increased morbidity and mortality. NTIS is characterised by three components that may occur single or in combination: 1. central hypothyroidism (transient thyrotropic insufficiency) 2. impaired protein binding of thyroid hormones and 3. reduced formation of T3 and increased conversion to rT3 (low-T3-syndrome). Despite of long lasting research to some of its details NTIS is still poorly characterized in an integrative view. Additionally, it lacks a clinically usable classification. Given the fact that patients with NTIS are faced with poor prognosis, several studies have been conducted in the past evaluating the question of possible treatment. However, they didn't yield unambiguous results, maybe due to the fact that these studies did not differentiate among the distinct components of NTIS. Therefore, this study is intended to develop a clear-cut definition and classification of NTIS in order to set a foundation for future therapeutic studies. This study recruits critically ill patients treated in medical and surgical intensive care units of the Bergmannsheil University hospitals for evaluation of integrative thyrotropic control and follow-up. From these data the correlation of individual prognosis with laboratory-defined components of NTIS will be determined. This project is intended to: 1. deliver a prognostical aid by providing a differentiated classification, 2. to contribute to a standardised, rational and inexpensive diagnostical procedure and 3. to lay the foundation for future therapeutic trials by identifying subgroups that may benefit from therapy.

Study Type

OBSERVATIONAL

Enrollment

590

Conditions

Euthyroid Sick Syndromes Non-thyroidal Illness Syndrome Low T3 Syndrome TACITUS

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * Severe illness requiring intensive care * Stay of at least 24 hours at the ICU Exclusion Criteria: * Substituted hypothyroidism or substitution in case of thyroid carcinoma * Hyperthyroidism that is treated with thyrostatic agents and exhibits a THS level not below the reference region * Manifest AIDS disease

Locations (6)

Department for medical informatics, biometry and epidemiology, Ruhr-University of Bochum

Bochum, North Rhine-Westphalia, Germany

Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum

Bochum, North Rhine-Westphalia, Germany

Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum

Bochum, North Rhine-Westphalia, Germany

Outcomes

Primary Outcomes

Assessment of the significance of an innovative physiological index approach (SPINA) in differential diagnosis between NTIS and latent thyrotoxicosis.

Diagnostic accuracy (sensitivity, specificity and AUCs of ROC analysis) of the thyroid's calculated secretory capacity (GT) for differentiation between NTIS and subclinical hyperthyroidism.

Time frame: Three weeks after admission to ICU (evaluation point 1.5) and additionally on day of discharge from the hospital (evaluation point 1.999)

Secondary Outcomes

Correlation of variables that quantify distinct components of NTIS with independent predictors of evolution, survival or pathophysiological condition and influencing or disturbing factors like medication.

Time frame: 24 hours (evaluation point 1.1), 72 hours (evaluation point 1.2) and further on weekly (evaluation points 1.3 to 1.5) after admission to the intensive care unit up to the day of discharge from hospital (evaluation point 1.999)

Data from ClinicalTrials.gov

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