1. [Cerebral low T3 syndrome].
- Author
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Tenedieva ND, Tenedieva VD, Eliava ShSh, Krymskiĭ VA, Shakhnovich AR, Amcheslavskiĭ VG, Toma GI, Dausheva AA, Mikrikova LV, and Voronov VG
- Subjects
- Adult, Female, Humans, Intracranial Aneurysm mortality, Intracranial Aneurysm surgery, Male, Middle Aged, Postoperative Period, Predictive Value of Tests, Subarachnoid Hemorrhage mortality, Subarachnoid Hemorrhage surgery, Survival Rate, Syndrome, Thyrotropin blood, Thyrotropin cerebrospinal fluid, Thyroxine blood, Thyroxine cerebrospinal fluid, Thyroxine metabolism, Thyroxine-Binding Proteins cerebrospinal fluid, Thyroxine-Binding Proteins metabolism, Triiodothyronine blood, Triiodothyronine cerebrospinal fluid, Tumor Necrosis Factor-alpha analysis, Brain metabolism, Intracranial Aneurysm metabolism, Subarachnoid Hemorrhage metabolism, Triiodothyronine metabolism
- Abstract
The authors studied the time course of changes in the parameters of the cerebral thyronergic system (total and free triiodthyronine (T3) and thyroxin (T4), thyroxine-binding globulin (TBG), thyroid-stimulating hormone (TSH) by radioimmunoassay (Immunotech, Czechia; CIS, France), proinflammatory cytokine of TNF-alpha by enzyme immunoassay (Innogenetic, Belgium) in the blood and cerebrospinal fluid (CSF) in 59 patients (37 males and 22 females whose age ranged from 21 to 64 years) in acute subarachnoidal hemorrhage due to arterial aneurysmal rupture. On admission, the condition of 47 (79.7%) was rated as grades III-VI according to the Hunt-Hess scale, which was responsible for high mortality rates (33.89% in the assessment of outcomes according to the Glasgow outcome scale). The causes of death were ischemic and hemorrhagic insults, edema of the brain, cerebral stem wedging. Laboratory findings were analyzed in relation to the clinical condition of patients, outcomes, and the degree of secondary vasospasm assessed by Doppler transcranial study by the average blood flow velocity in the middle cerebral artery. They revealed a significant depression of thyroidal metabolism with developed the total low T3 syndrome just before surgical treatment in patients with deterioration in the early postoperative period. The significant correlations found by the authors between the decreased blood T3 and TSH levels and 1) the severity of neurological disorders; 2) the degree of vasospasm, and 3) the outcome of disease, as well as negative correlations of elevated TNF-alpha levels not only in the blood, but also in CSF with the content of CT3, CT4 and with the severity of neurological symptomatology are indicative of the development of isolated syndrome in the brain, which is characterized by specific thyroidal metabolic disorders, which the author propose to call the cerebral low T3 syndrome (by taking into account the presence of the autonomic systems of thyroidal homeostatic provision).
- Published
- 2002