Thyroid Function in the Sick Thyroid Syndrome in Khartoum and El Shaab Teaching Hospitals, Khartoum- Sudan

Abstract

This is prospective, case control, hospital based study was conducted at Khartoum Teaching Hospital and El Shaab Teaching Hospital in the period October 2004 to January 2005. In this study, serum thyroid hormone levels (TSH, TT4, TT3,FFT4 and FT3) were measured using a sensitive chemiluminescence immunoassay automated system and kits (immulite®) in 60 hospitalized patients suffering from acute orchronic systemic non-thyroidal illness and 21 apparently healthy individuals as controls. Selection criteria were satisfied by hospitalized patients who had no past history or family history of thyroid disease nor evidence of clinical and/or laboratory abnormalities suggestive of primary thyroid or pituitary dysfunction. The objective of this study was to determine the pattern of alteration in thyroid hormone economy in various non-thyroidal illnesses in Khartoum Sudan and also to correlate these alterations with the severity of illness and therapeutic drugs used. The results were compared with both reference ranges provided by the Immulite ® manufacturer with its kits and results obtained on control subjects. The study concluded that there was a statistically significant reduction in total triiodothyronine levels and free triiodthyronine levels in 38 (63.33%) and 32 (52.33%) respectively and elevated thyroxine levels in 12 (20%) of patients. In spite of these alterations TSH levels were normal in 55 (91.67%) of studied patients. The study also categorized patients into groups: Those who had low T3 only; those had elevated T4 only; a group who had low T3 and T4 and a group who had low T3,T4 and TSH. It was also found that the degree of alteration of thyroid hormone levels appears to be correlated with the severity of the disease and the administration of some drug which affect thyroid hormone economy. Finally this study recommends that large prospective, carefully controlled studies should be done to monitor thyroid function test findings during and after recovery from NTI. The study also recommends that thyroid function tests should not be requested during illness unless there is strong evidence of coexistence of thyroid disease, and should be repeated when non-thyroidal illness is resolved and that the request form should contain all relevant clinical information, and that close contact between clinicians and pathologists be maintained to facilitate good interpretation of test results and also that every lab should establish its own reference range.