Abstract
Objective
Thyroxine (T4) is deiodinated to triiodothyronine (T3) by the hepatic type I iodothyronine deiodinase, a selenoprotein that is sensitive to selenium (Se) deficiency. After severe injury, T4 deiodination is decreased, leading to the low T3 syndrome. Injury increases free radical production, which inactivates the iodothyronine deiodinase. The aims were to study the Se status after major trauma and to investigate its relation to the low T3 syndrome.
Design
Preliminary prospective descriptive study.
Setting
Intensive care unit at a university teaching hospital.
Patients and methods
11 patients aged 41±4 years (mean±SEM), with severe multiple injuries (Injury Severity Score 29±2 points). A balance study was performed from day 1 to day 7. Serum and urine samples were collected from the time of admission until day 7, then on days 10, 15, 20, 25 and 30. Nonparametric tests and Pearson's correlation coefficients were used for analysis.
Results
Cumulated Se losses were 0.88±0.1 μmol/24h. Serum Se was decreased from admission to day 7. T3, free T3, and the T3/T4 ratio were low until day 5, being lowest on day 2; T4 and thyroid stimulating hormone were normal. Serum Se was correlated with T3 (r=0.55,p=0.0001), and with free T3 (r=0.35).
Conclusion
Se status is altered after trauma, with decreased Se serum levels upon admission to the ICU but with no major Se losses. Se is probably redistributed to the tissues. The correlation between Se and T3, along with the parallel decrease in T4 deiodination, indicates that reduced deiodination might be related to the transient decrease in serum Se.
Similar content being viewed by others
References
Köhrle J (1994) Thyroid hormone deiodination in target tissues—a regulatory role for the trace element selenium? Exp Clin Endocrinol 102:63–89
Meinhold H, Campos-Barros A, Behne D (1992) Effects of selenium and iodine deficiency on iodothyronine deiodinases in brain, thyroid and peripheral tissue. AMA 19:8–12
Becket G, Beddows S, Morice P, Nicol F, Arthur J (1987) Inhibition of hepatic deiodination of thyroxine is caused by selenium deficiency in rats. Biochem J 248:443–447
Smallridge R (1992) Metabolic and anatomic thyroid emergencies: a review. Crit Care Med 20:276–291
Wartofsky L, Burman K (1982) Alterations in thyroid function in patients with systemic illness: the “euthyroid sick syndrome”. Endoc Rev 3:164–216
Woolf P, Lee L, Hamill R, McDonald J (1988) Thyroid test abnormalities in traumatic brain injury: correlation with neurologic impairment and sympathetic nervous system activation. Am J Med 84:201–208
Chioléro R, Lemarchand-Béraud T, Schütz Y, de Tribolet N, Bayer-Berger M, Freeman J (1988) Thyroid function in severely traumatized patients with or without head injury. Acta Endocrinol 117:80–86
McLarty D, Ratcliffe W, McColl K, Stone D, Ratcliffe J (1975) Thyroid hormone levels and prognosis in patients with serious non-thyroidal illness. Lancet II:275–276
Slag M, Morley J, Elson M, Crowson T, Nuttall F, Shafer R (1981) Hypothyroxinemia in critically ill patients as predictor of high mortality. JAMA 245: 43–45
Ikeda Y, Long D (1990) The molecular basis of brain injury and brain edema: the role of oxygen free radicals. Neurosurgery 27:1–11
Yu M, McCowan J, Phebus L, Towner R, Ho P, Keith P, Luttman C, Saunders R, Ruterbories K, Lindstrom T, Wikel J, Morgan E, Hahn R (1993) Benzylamine antioxidants-relationship between structure, peroxyl radical scavenging, lipid peroxidation inhibition, and cytoprotection. J Med Chem 36: 1262–1271
Evans P (1993) Free radicals in brain metabolism and pathology. Br. Med Bull 49:577–587
Hawker F, Stewart P, Snitch P (1990) Effects of acute illness on selenium homeostasis. Crit Care Med 18:442–446
Copes W, Champion H, Sacco W, Lawnick M, Keast S, Bain L (1988) The injury severity score revisited. J Trauma 28:69–77
Jennet B, Teasdale G, Braakman R, Minderhood J, Heiden J, Kurze T (1979) Prognosis of patients with severe head injury. Neurosurgery 4:283–289
Knaus W, Draper E, Wagner D, Zimmerman J (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Shenkin A (1994) Adult micronutrient requirements. In: Payne-James W, Grimble G, Silk D (eds) Artificial nutrition support in clinical practice. Arnold, London, pp 151–166
Hoffman I, Westerby R, Hidiroglou M (1968) Precise fluorimetric microdetermination of selenium in agricultural materials. J Assoc Off Anal Chem 51:1039–1042
Berger M, Cavadini C (1994) Apports cachés d'oligo-éléments chez les grands brûlés et les polytraumatisés. Ann Fr Anesth Réanim 13:289–296
Berger M, Cavadini C, Bart A, Blondel A, Bartholdi I, Vandervale A, Krupp S, Chioléro R, Freeman J, Dirren H (1992) Selenium losses in 10 burned patients. Clin Nutr 11:75–82
Chopra I, Chopra U, Smith S, Reza M, Solomon D (1975) Reciprocal changes in serum concentrations of 3,3′,5′-triiodothyronine (reverse T3) and 3,3′,5-triiodothyronine (T3) in systemic illness. J Clin Endocrinol Metab 41:1043–1049
Huang T, Boado R, Chopra I, Solomon D, Chua Teco G (1987) The effect of free radicals on hepatic 5′-monodeiodination of thyroxine and 3,3′,5′-triiodothyronine. Endocrinology 121:498–503
Utiger R (1980) Decreased extrathyroidal trioodothyronine production in nonthyroidal illness: benefit or harm? Am J Med 69:807–810
American Society for Parenteral and Enteral Nutrition (1993) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN 17:1SA-51SA
Hill K, Burk RF (1994) Selenoprotein P—An extracellular protein containing multiple selenocysteines. In: Burk RF (ed) Selenium in biology and human health. Springer, New York, pp 117–132
Singh A, Smoak B, Patterson K, LeMay L, Veillon C, Deuster P (1991) Biochemical indices of selected trace mineral in men: effect of stress. Am J Clin Nutr 53:126–131
Chan P (1992) Antioxidant-dependent amelioration of brain injury: role of CuZn-superoxide dismutase. J Neurotrauma 9:S417-S423
Orlowski M, Karkowsky A (1976) Glutathione metabolism and some possible functions of glutathione in the nervous system. Int Rev Neurobiol 19: 75–121
Vanderpas J, Contempré B, Duale N, Goossens W, Bebe N, Thorpe R, Ntambue K, Dumont J, Thilly C, Diplock A (1990) Iodine and selenium deficiency associated with cretinism in northern Zaire. Am J Clin Nutr 52:1087–1093
Arthur J, Nicol F, Hutchinson A, Beckett G (1990) The effects of selenium depletion on the metabolism of thyroid hormones in the rat. J Inorg Biochem 39:101–108
Chanoine J, Safran M, Farwell A, Dubord S, Alex S, Stone S, Arthur J, Braverman L, Leonard J (1992) Effects of selenium deficiency on thyroid economy in rats. Endocrinology 131: 1787–1792
Oertel M, Gross M, Rokos H, Köhrle J (1993) Selenium-dependent regulation of type I 5′-deiodinase expression. Am J Clin Nutr 57:313S-314S.
Contempré B, Dumont J, Bebe N, Thilly C, Diplock A, Vanderpas J (1991) Effect of selenium supplementation in hypothyroid subjects of an iodine and selenium deficient area: the possible danger on indiscriminate supplementation of iodine-deficient subjects with selenium. J Clin Endocrinol Metab 73: 213–215
Roti E, Minelli R, Gardini E, Bianconi L, Ronchi A, Gatti A, Minoia C (1993) Selenium administration does not cause thyroid insufficiency in subjects with mild iodine deficiency and sufficient selenium intake. J Endocrinol Invest 16: 481–484
Van Lente F, Daher R (1992) Plasma selenium concentrations in patients with euthyroid sick syndrome. Clin Chem 38:1885–1888
Behne D, Kyriakopoulos A, Gessner H, Walzog B, Meinhold H (1992) Type I iodothyronine activity after high selenium intake, and relations between selenium and iodine metabolism in rats. J Nutr 7:1542–1546
Brent G, Hershman J (1986) Thyroxine therapy in patients with severe nonthyroidal illness and low serum thyroxine concentration. J Clin Endocrinol Metab 63:1–8
Dyke C, Yeh R, Lehman J, Abd-Elfattah A, Ding M, Wechsler A, Salter D (1991) Triiodothyronine-enhanced left ventricular function after ischemic injury. Ann Thorac Surg 52:14–19
Novitzky D (1992) Heart transplantation, euthyroid sick syndrome, and triiodothyronine replacement. J Heart Lung Transplant 11:S196-S198
Mariot J, Jacob F, Voltz C, Perrier J, Strub P (1991) Intérêt de l'hormonothérapie associant triiodothyronine et cortisone chez le patient en état de mort cérébrale. Ann Fr Anesth Réan 10: 321–328
Little J (1985) Effect of thyroid hormone supplementation on survival after bacterial infection. Endocrinology 117: 1431–1435
Author information
Authors and Affiliations
Additional information
The analytical work was supported by NESTEC SA, CH-1000 Lausanne 26, Switzerland
Rights and permissions
About this article
Cite this article
Berger, M.M., Lemarchand-Béraud, T., Cavadini, C. et al. Relations between the selenium status and the low T3 syndrome after major trauma. Intensive Care Med 22, 575–581 (1996). https://doi.org/10.1007/BF01708099
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01708099