Observational and Diagnostical Study on Transient Allostatic Responses of Thyroid Function After Cardiopulmonary Resuscitation

Summary

Time-limited adaptive responses of thyroid function are common in the critically ill. About 70% of all patients treated on intensive care units develop a so-called non-thyroidal illness syndrome (NTIS) or TACITUS (thyroid allostasis in critical illness, tumours, uraemia and starvation), which is marked by low serum concentrations of the thyroid hormone T3 and other adaptive reactions of thyroid homeostasis. Occasionally, temporarily elevated concentrations of thyrotropin (TSH) and peripheral thyroid hormones are to be observed, especially after cardiopulmonary resuscitation (CPR). However, the available evidence is limited, although abnormal concentrations of thyroid hormones after CPR have occasionally been reported.

Aim of the planned study is to investigate the thyrotropic (i.e. thyroid-controlling) partial function of the anterior pituitary lobe immediately after CPR. It is intended to evaluate statistical measures of TSH concentration and peripheral thyroid hormones in de-identified datasets (protocol A). Additionally, a prospective sub-study (protocol B) aims at a more precise description of pituitary and thyroid responses by means of serial investigations in routine serum samples, both immediately after CPR and during the course of ongoing treatment. This includes the evaluation of additional possible predictors, too.

Primary endpoint of the study is changed TSH concentration immediately after CPR compared to the TSH value 24 hours later. Secondary endpoint is the relation between thyroid-controlling pituitary function and mortality.

A high proportion of patients undergoing CPR will eventually receive iodinated radiocontrast media (e.g. for computed tomography or coronary angiography). This is one of the reasons why early identifying subjects at high risk for possible iodine-induced thyrotoxicosis is important. Increased oxygen consumption of the heart in hyperthyroidism is one of the reasons for high mortality in thyrotoxicosis. Therefore, accurate diagnosis of alterations in the hypothalamus-pituitary-thyroid (HPT) axis is of paramount importance.

Conditions

• Heart Arrest
• Ventricular Fibrillation
• Ventricular Flutter
• Ventricular Tachycardia

Interventions

DIAGNOSTIC_TEST

TSH determination

Determination of serum concentration of thyrotropin (TSH)

DIAGNOSTIC_TEST

FT4 determination

Determination of serum free thyroxine (FT4) concentration

DIAGNOSTIC_TEST

FT3 determination

Determination of serum free triiodothyronine (FT3) concentration

DIAGNOSTIC_TEST

SPINA-GT

Calculation of thyroid's secretory capacity (SPINA-GT)

DIAGNOSTIC_TEST

SPINA-GD

Calculation of total deiodinase activity (SPINA-GD)

Sponsors & Collaborators

• Ruhr University of Bochum

  lead OTHER

Principal Investigators

• Johannes W Dietrich, M.D. · Bergmannsheil University Hospitals

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-05-01

Primary Completion

2022-06-01

Completion

2022-12-31

Countries

• Germany

Study Locations