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The significance of high thyroxine in hospitalized patients with low thyroid-stimulating hormone

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Abstract

Purpose

There is scarce data about the interpretation of high thyroid hormone levels in hospitalized patients. We wished to investigate the significance of high thyroxine (T4) in hospitalized patients with low TSH.

Methods

We conducted a retrospective study of data from patients in nonsurgical departments. Three groups of random patients with low TSH were defined and compared: 123 patients with only high FT4 levels (T4 group), 82 with high FT3 levels with or without high FT4 level (T3 group), and 119 with low FT3 and FT4 level in the lower half of the norm and below (NTIS group).

Results

The primary cause of admission in the T4 and NTIS groups was infectious disease, 20.3% and 40.3%, respectively; while in the T3 group it was cardiovascular disease (31.7%). The T4 group but not T3 group had epidemiological and clinical characteristics similar to the NTIS group. The T4 group had a significant correlation between increased CRP levels and decreased FT3 (r = 0.366, p < 0.001) similar to the NTIS group. The T3 group had a borderline correlation between increased FT3 and FT4 levels (r = 0.208, p = 0.061) but the T4 group did not.

Conclusions

The combination of low TSH and high FT4 levels in hospitalized patient is usually caused by nonthyroidal illness combined with drug effects. This thyroid function disturbance is common in hospitalized patients and if the FT3 level is below the middle of the norm, treatment is probably unnecessary.

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Abbreviations

T3:

triiodothyroxine

T4:

thyroxine

NTIS:

nonthyroidal illness syndrome

CRP:

C reactive protein

TSH:

thyroid stimulating hormone

FT3:

free T3

FT4:

free T4

CVD:

cardiovascular disease

COPD:

chronic obstructive pulmonary disease

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Acknowledgements

The authors wish to thank Ms. Tobie Kuritsky and Mrs. Anita Glick for editorial assistance.

Author information

Authors and Affiliations

  1. Endocrinology Unit, Galilee Medical Center, Nahariya, Israel

    Amir Bashkin

  2. Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

    Amir Bashkin, Lea Even & Ohad Ronen

  3. Department of Internal Medicine E, Galilee Medical Center, Nahariya, Israel

    Jalaa Abu Ali

  4. Department of Biochemistry and Endocrinology Laboratory, Galilee Medical Center, Nahariya, Israel

    Mona Shehadeh

  5. Department of Pediatrics, Galilee Medical Center, Nahariya, Israel

    Lea Even

  6. Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel

    Ohad Ronen

Authors
  1. Amir Bashkin
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  2. Jalaa Abu Ali
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  3. Mona Shehadeh
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  4. Lea Even
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Correspondence to Amir Bashkin.

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The study was approved by the Institutional Review Board.

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Bashkin, A., Abu Ali, J., Shehadeh, M. et al. The significance of high thyroxine in hospitalized patients with low thyroid-stimulating hormone. Endocrine 72, 445–451 (2021). https://doi.org/10.1007/s12020-020-02463-6

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  • DOI: https://doi.org/10.1007/s12020-020-02463-6

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