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High prevalence of non-thyroidal illness syndrome in patients at long-term care facilities

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Abstract

Purpose

Patients in acute care hospitals are often transferred to long-term care (LTC) when there is an expectation for a lengthy recovery. Prolonged non-thyroidal illness syndrome (NTIS) creates a state of hypothyroidism. We aimed to investigate the prevalence of NTIS in patients at LTC facilities.

Methods

A cross-sectional study at University Hospitals and Rehabilitation and Skilled Nursing facility was performed. Four groups: control (n:33), intensive care unit (ICU) (n:34), long-term care hospital (LTCH) (n:50), and long-term care on chronic ventilatory support (LTCVS) (n:30). Serum levels of TSH, free T4 (FT4), free T3 (FT3), and interleukin 6 (IL6) measured at admission day in controls, within 48 h of admission in the intensive care group, between days 31 and 120 in the LTC hospital group and days 31 and 6 years in the LTC on chronic ventilatory support group.

Results

Serum FT3 levels were lower in groups intensive care unit ICU, LTCH, and LTCVS than control. Low serum FT3 levels were observed in 80% ICU, 54% LTCH, 37% LTCVS, and 6% control patients. Low serum FT4 levels were observed in 32% ICU, 16% LTCH, and 20% LTCVS patients. Both low serum FT4 and FT3 levels were observed in 32% ICU, 16% LTCH, and 13% LTCVS patients. Serum IL6 and FT3 levels showed a negative correlation.

Conclusions

NTIS is highly prevalent in patients in LTC, creating a state of persistent hypothyroidism. The effects of thyroid hormone replacement in patients at LTC with non-thyroidal illness deserve further investigation.

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Acknowledgements

Leah Arp, LVN, CWCA, assisted the research personnel at Southern Specialty Rehabilitation and Skilled Nursing, Lubbock, Texas. Prof. Dr Arturo Gonzalez-Quintela, MD, PhD, helped with the IRB approval process at Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Galicia, Spain.

Funding

This work was supported by the Consellería de Industria, Xunta de Galicia, Spain (grant number ED341b 2017/19) and by The Vernon C Farthing Endowment, TTUHSC-SOM and University Medical Center, Lubbock, Texas, USA.

Author contributions

J.L.A. designed the study, obtained research funds, coordinated the study group, and wrote the paper. C.D. designed the study and was the site coordinator at Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). G.B. designed the study, participated in the collection of samples at the Texas site, and wrote the paper. K.I. participated in sampling collection at the Texas site. D.A.V. participated in the study design, participated in the collection of samples at the Complexo Hospitalario Universitario de Santiago de Compostela, and obtained research funds. N.L.F. and S.L. performed the biochemical and hormonal measurements. M.W. designed and performed the statistical analysis. A.R.P. obtained the written consent and serum samples in the ICU at the Complexo Hospitalario Universitario de Santiago de Compostela. A.M.R. designed the study, coordinated the study group, obtained written consent and samples at the Texas sites, and wrote the paper.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Truman Medical Centers and University of Missouri Kansas City, Kansas City, MO, USA

    Joaquin Lado-Abeal

  2. Division of Endocrinology and Nutrition, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain

    Carmen Diaz & David Araujo-Vilar

  3. Department of Internal Medicine, Division of Pulmonary Disease and Critical Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Gilbert Berdine

  4. Department of Internal Medicine, Division of General Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Kenneth Iwuji

  5. Thyroid and Metabolic Diseases Unit (UETeM), Department of Psychiatry, Radiology, Public Health, Nursing and Medicine (Medicine Area), Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS)-IDIS, University of Santiago de Compostela School of Medicine, Santiago de Compostela, Spain

    David Araujo-Vilar

  6. Division of Clinical Analysis, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain

    Natalia Lampon-Fernandez & Santiago Lojo

  7. Department of Management Science and Statistics, The University of Texas at San Antonio, San Antonio, TX, USA

    Min Wang

  8. Division of Anaesthesia and Reanimation, Complexo Hospitalario Universitario de Santiago (CHUS), SERGAS, Santiago de Compostela, Spain

    Alfonso Rodriguez-Perez

  9. Department of Internal Medicine, Division of Endocrinology, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Ana Marcella Rivas

Authors
  1. Joaquin Lado-Abeal
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  2. Carmen Diaz
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  3. Gilbert Berdine
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  4. Kenneth Iwuji
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  7. Min Wang
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  8. Santiago Lojo
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  9. Alfonso Rodriguez-Perez
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Correspondence to Joaquin Lado-Abeal.

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If any of the sections are not relevant to your paper, please include the heading and write for that section. The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

Ethics approval

The study was conducted in accordance with the World Medical Association Declaration of Helsinki. The study was approved by the Institutional Reviews Board of Texas Tech University Health Sciences Center and Southern Specialty Rehabilitation and Skilled Nursing (IRB number L17–151) and Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) (IRB number 2017/346).

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Lado-Abeal, J., Diaz, C., Berdine, G. et al. High prevalence of non-thyroidal illness syndrome in patients at long-term care facilities. Endocrine 70, 348–355 (2020). https://doi.org/10.1007/s12020-020-02321-5

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