www.
bergm
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eil.de Amiodarone and radiocontrast agentscorrelate differently with the pattern of NTISA. Urban¹, A. Jeyabalan¹, A. Ackermann¹, Y. Kanthasamy¹, T. Tharmalingam¹, A. Stachon3,R. Köditz¹, R. Gärtner4, E. Conrad-Opel2, H.H. Klein¹, S. Hering5, J. W. Dietrich¹1Medical Hospital 1 and 2Institute for Anesthesiology and Intensive Care, Bergmannsheil University Hospitals, Ruhr University of Bochum, Germany3Department for Laboratory and Transfusion Medicine, Westpfalz-Klinikum Kaiserslautern, Germany4Medical Downtown Hospitals, Ludwig Maximilian University of Munich, Germany. 5Krankenhaus Bietigheim, Bietigheim-Bissingen, Germany
Background
Methods
Results
Conclusions
References
Patients suffering from critical illness frequentlyexhibit a characteristic functional state of thyrotropicfeedback control that is referred to as non-thyroidalillness syndrome (NTIS)1,2,3.This condition is associated with significantlyincreased morbidity and mortality of affectedpatients1,3.While the prevalence of low T3 syndrome isexceptionally high and its relevance for prognosis ofaffected patients is well known, its physiologicalmechanisms are still poorly understood.Here, we investigated the association of drugs orprocedures that expose the organism to a high iodineload, i.e. amiodarone and radiocontrast agents, withprevalence and pattern of NTIS.
In the context of the prospective AQUA FONTISstudy5 we investigated 353 patients with heartdiseases (271 patients with ischemic heartdiseases like myocardial infarction and other formsof acute coronary syndrome, and 82 patients withvalvular heart diseases) that were treated inmedical and heart-surgical intensive care units(ICUs) of the Bergmannsheil University Hospitals inBochum, Germany.Thyroid hormones were determined 24 hours,72 hours, one week, two weeks and three weeksafter admission to ICU. Deiodinase activity wascalculated from T3 and T4 levels4. Urine sampleswere obtained 24 hours after admission to the ICU.
1. De Groot LJ: Non-thyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and inview of current evidence, should be treated with appropriate replacement therapies. Crit Care Clin 2006,22:57-86, vi2. Rothenbuchner G, Loos U, Kiessling WR, Birk J, Pfeiffer EF: The influence of total starvation on thepituitary-thyroid-axis in obese individuals. Acta Endocrinol Suppl (Copenh) 1973, 173:144.3. Van den Berghe G: Dynamic neuroendocrine responses to criticalillness. Front Neuroendocrinol 2002,23:370-391.4. Dietrich JW, Fischer MR, Jauch J, Pantke E, Gärtner R, Pickardt CR: SPINA-THYR: A novel systemstheoretic approach to determine the secretion capacity of the thyroid gland. European Journal of InternalMedicine 1999 , 10(Suppl 1):S34.5. Dietrich, J. W., A. Stachon, B. Antic, H. H. Klein und S. Hering (2008). "The AQUA-FONTIS Study: Protocolof a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardizeddiagnostics and classification of non-thyroidal illness syndrome." BMC Endocrine Disorders 8 (13).6. Ha HR, Stieger B, Grassi G, Altorfer HR, Follath F. Structure-effect relationships of amiodarone analogueson the inhibition of thyroxine deiodination. Eur J Clin Pharmacol. 2000 Feb-Mar;55(11-12):807-14.7. Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med. 1997 Jan 1;126(1):63-73.Review.
In conclusion, amiodarone and radiocontrast agentsare associated with different alterations of thyroidhomeostasis in critically ill patients.The inhibiting influence of amiodarone on the sumactivity of the peripheral 5´-deiodinase seems not tobe due to the iodine load of amiodarone. This may bea consequence of a nonlinear interaction of iodinesupply with deiodation.
Patients that were treated with amiodarone showed asignificantly reduced theoretical sum activity ofperipheral 5´deiodinase in the adjacent evaluationpoints after 72 hours and after one week.Radiocontrast agents were associated with increasedprotein binding of T4 after 24 hours and 72 hours asevaluated by the TT4/FT4 ratio.Radiocontrast agents combined with amiodarone,however, were associated with reduced proteinbinding of T3 after 72 hours and after a week.In a pooled analysis with 57 ambulatory outpatients,iodine excretion correlated with deiodinase activity.However, this correlation was not observed in thesubgroup of critically ill patients.
p= 6.21e-06
rho= -0.52
n. s.
rho= -0.01
322 survived31 diedSurvival 328 not resuscitated25 resuscitated patientsResuscitation
329 without shock24 with shockCardiogenic shock 250 male103 femaleGender
19
Both amiodaroneand radiocontrastagents152
Radiocontrastagents
1822142
No dataAmiodaroneNo iodine loadTreatment
Patient characteristics
p < 0.01 p < 0.05 p = 1.42e-8
p < 0.05 p < 0.05 n. s.
p < 0.05 n. s. n. s. p < 0.05 n. s. n. s.
Iodine excretion
