Sick Euthyroid Syndrome in Patients with Uncompensated Heart Failure: Prevalence, Clinical Profile and Prognosis

pp. 434-442

Abstract

AIM To evaluate clinical findings, prevalence and prognosis of euthyroid sick syndrome with low triiodothyronine (ESS) in patients with congestive heart failure. Methods Between 10-97 and 07-99, seventy nine patients with uncompensated heart failure, non related to acute coronary syndrome, were prospectively admitted. Total triiodothyronine (T3);total tiroxine (T4)and thyroid stimulating hormone(TSH) were measured in samples obtained within the first 24 hours after admission. SES was diagnosed in association with a T3 value of less than 80 ng/ml and a normal serum TSH concentration. Results Euthyroid sick syndrome was found in 18 patients(23%).They were older than the non-sick euthyroid syndrome (non ESS) group (67±11.9vs. 63±13.5years old, p=ns) and a male predominance was observed (89% vs. 46% p = 0.001). Etiology was found to be coronary heart disease in 42%,hypertension in24%and valve disease in 18%,with no differences between SES and non ESS groups. There were no significant differences between both groups in relation to history, clinical findings and functional class. Patients in SES group were treated more frequently with dobutamine (36% vs. 13% p = 0.005) as well as IV nitroprussiate (50% vs. 25% p = 0.03). The incidence of refractory heart failure was 22.2% vs. 4.9%in SES and non ESS groups, and two-years cumulative survival was 48.9% vs. 91.2%, respectively (log rank test p=0.016). Conclusions SES was diagnosed in one out of four patients with uncompensated heart failure. There were not clinical differences between ESS and non ESS group, except for male predominance. However, SES group showed worse in-hospital course and a higher long-term mortality, therefore its role in this setting should be evaluated.