Diabetologie und Stoffwechsel 2007; 2 - A55
DOI: 10.1055/s-2007-984801

The relation of thyroid hormone levels and reduced insulin sensitivity to survival of patients with septic shock

PG Halvatsiotis 1, S Stefanopoulou 1, A Kotanidou 2, S Orfanos 2, C Martinos 2, C Roussos 2, T Economopoulos 1, SA Raptis 1, 3
  • 12nd Dept of Int. Med. Propaedeutic, Athens University Medical School
  • 21st Dept. of Critical Care, Athens University Medical School
  • 3Hellenic National Diabetes Center

Muscular weakness frequently develops in the intensive care unit patients and it is associated with higher mortality rate. Oxidative phosphorylation produces energy and hypothyroidism produces a hypometabolic state. Studies have showed reductions of thyroid hormone levels in critical illness. We aimed to measure thyroid hormone levels in septic patients and investigate the relationship of these hormones with survival and inhibition of mitochondrial respiration. We determined representative mitochondrial enzyme gene transcript levels in vastus lateralis needle biopsy samples, using a real-time QPCR technique for citrate synthase (SC), Cytochrome C oxidase I & III, NADH, and UCPs 2 & 3. We measured the TSH, FT3, FT4 hormones levels with biochemical methods. We studied 7 critically ill patients under irreversible septic shock (52±7 y) who died within 30 days (SS) and 8 age and gender matched septic patients (46±7 y) (p=0,51) who survived (SSV). All patients were non diabetic and SS group demonstrated lower insulin sensitivity than SSV using the HOMA test (11,56±3,5 vs. 48,59±11,4) (p=0,011). There was no difference in the enzyme activity of all mitochondrial enzymes between the 2 groups. The gene transcript of CS was significantly higher in SSV than SS (2,62±0,3 vs. 1,29±0,6 AU) (p=0,011) while there was no difference in the transcripts of the other mitochondrial enzymes. There was no difference in TSH levels between the 2 groups. The levels of FT3 hormone were significantly higher in SSV than SS (1,481±0,07 vs. 1,123±0,06 pg/ml) (p=0,002) and FT4 were also significantly higher in SSV than SS (1,07±0,1 vs. 0,77±0,06ng/dl) (p=0,032). In conclusion, in septic patients, we found an association of the severity of sepsis with the development of insulin resistance and mitochondrial dysfunction while lack of thyroid hormones, major ubiquitous regulators of mitochondrial activity, may contribute to the muscular energy production abnormalities.