Funcion tiroidea del paciente pediatrico criticamente enfermo.

P PAPENDIECK. .; A CHIESA,; IN YA KO,; RODRIGUEZ F,; SALOUM G ,; BALLERINI MG ,; ROPELATO G,; GRUÑEIRO DE PAPENDIECK L

Lima Perú.

Congreso; XX Reunion Anual de SLEP; 2008

SLEP

Hypothalamic pituitary thyroid axis changes during critical illness. Objective, Patients and methods: To describe the thyroid function of the pediatric patient with an acute critical illness, we studied 37 children (median 7.56 years; range 1.1−18.8,62% boys,median weight –0.29 SDS) admitted to the Intensive Care Unit between 7/06 and 5/07. Serum TSH, T4, T3, FT4(ECLIA Roche, Elecsys)and ATPO and ATG antibodies (Immulite/DPC) were determined at admission,48,72hours and weekly up to normalization. Children < 1year, with Down Syndrome, hepatic or renal failure and CNS surgery were excluded. PRISM score was calculated at admission. Data were compared with those of control group (CG): healthy children, FT4 and T4 (n:51), TSH (n:129) and T3 (historical cohort). Results: 4 patients had normal thyroid profile, 1 primary hypothyroidism and 32 (86.5%) low T4, T3 and/or FT4 without increase of TSH. Initial FT4 levels were lower than CG and decreased at 2° – 3° day. TSH levels were lower than CG at admission, 2° and 3° day, rising later. During follow up 2 patients died within 24hs of admission. 3 patients were treated with l-T4 and 1 was referred to other hospital. In 25 of the 26 patients followed up thyroid function recovered completely and one patient died. Conclusions: The study of thyroid function in these patients allowed the evaluation of changes of the thyroid axis during illness and the detection of primary thyroid disease. Most of the patients with a critical acute episode experimented transient central hypothyroidism with complete recovery.To describe the thyroid function of the pediatric patient with an acute critical illness, we studied 37 children (median 7.56 years; range 1.1−18.8,62% boys,median weight –0.29 SDS) admitted to the Intensive Care Unit between 7/06 and 5/07. Serum TSH, T4, T3, FT4(ECLIA Roche, Elecsys)and ATPO and ATG antibodies (Immulite/DPC) were determined at admission,48,72hours and weekly up to normalization. Children < 1year, with Down Syndrome, hepatic or renal failure and CNS surgery were excluded. PRISM score was calculated at admission. Data were compared with those of control group (CG): healthy children, FT4 and T4 (n:51), TSH (n:129) and T3 (historical cohort). Results: 4 patients had normal thyroid profile, 1 primary hypothyroidism and 32 (86.5%) low T4, T3 and/or FT4 without increase of TSH. Initial FT4 levels were lower than CG and decreased at 2° – 3° day. TSH levels were lower than CG at admission, 2° and 3° day, rising later. During follow up 2 patients died within 24hs of admission. 3 patients were treated with l-T4 and 1 was referred to other hospital. In 25 of the 26 patients followed up thyroid function recovered completely and one patient died. Conclusions: The study of thyroid function in these patients allowed the evaluation of changes of the thyroid axis during illness and the detection of primary thyroid disease. Most of the patients with a critical acute episode experimented transient central hypothyroidism with complete recovery.Results: 4 patients had normal thyroid profile, 1 primary hypothyroidism and 32 (86.5%) low T4, T3 and/or FT4 without increase of TSH. Initial FT4 levels were lower than CG and decreased at 2° – 3° day. TSH levels were lower than CG at admission, 2° and 3° day, rising later. During follow up 2 patients died within 24hs of admission. 3 patients were treated with l-T4 and 1 was referred to other hospital. In 25 of the 26 patients followed up thyroid function recovered completely and one patient died. Conclusions: The study of thyroid function in these patients allowed the evaluation of changes of the thyroid axis during illness and the detection of primary thyroid disease. Most of the patients with a critical acute episode experimented transient central hypothyroidism with complete recovery.Conclusions: The study of thyroid function in these patients allowed the evaluation of changes of the thyroid axis during illness and the detection of primary thyroid disease. Most of the patients with a critical acute episode experimented transient central hypothyroidism with complete recovery.