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Non-thyroidal illness syndrome in patients with Diabetes mellitus: laboratory pattern and correlation with glycemic control, complications and inflammatory activity

Grant number: 10/08854-0
Support type:Regular Research Grants
Duration: December 01, 2010 - July 31, 2012
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal researcher:Denise Engelbrecht Zantut Wittmann
Grantee:Denise Engelbrecht Zantut Wittmann
Home Institution: Faculdade de Ciências Médicas (FCM). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil
Assoc. researchers:Arnaldo Moura Neto ; Marcos Antonio Tambascia ; Sarah Monte Alegre


The non-thyroidal illness syndrome is characterized by a fall of serum triiodothyronine levels, both total and free fraction (T3 and FT3) and a rise of its reverse form (rT3), with thyrotropin (TSH) remaining between normal range. With greater severity of the underlining disease, fall of serum thyroxin levels (T4) can occur. It is present in patients with severe, acute diseases, especially among those admitted in intensive care units. The pathophysiology includes a decline in the conversion of T4 to T3 due to inhibited type 1 deiodinase activity and increased inactivation of T3 to rT3 by type 3 deiodinase, with consequent rise in serum rT3 levels and drop in T3 levels. The activation of type 2 deiodinase in the central nervous system is responsible for keeping the hypothalamus in a physiologically euthyroid state, thus avoiding the otherwise expected rise in TSH levels. Much has been studied about this syndrome in patients suffering from severe diseases, and not only the ones of acute nature. A correlation between worse prognosis and low serum T4 levels has been established. More recently, this syndrome has been reported in those with chronic diseases in an outpatient basis, including Diabetes Mellitus (DM), particularly if under inadequate glycemic control. However, there is a lack of prospective studies linking metabolic control of DM, and its complications, with severity and evolution of the non-thyroidal illness syndrome, as well as its thyroid hormone pattern. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
NETO, ARNALDO MOURA; RIBEIRO PARISI, MARIA CANDIDA; ALEGRE, SARAH MONTE; PAVIN, ELIZABETH JOAO; TAMBASCIA, MARCOS ANTONIO; ZANTUT-WITTMANN, DENISE ENGELBRECHT. Relation of thyroid hormone abnormalities with subclinical inflammatory activity in patients with type 1 and type 2 diabetes mellitus. ENDOCRINE, v. 51, n. 1, p. 63-71, JAN 2016. Web of Science Citations: 9.
MOURA NETO, A.; PARISI, M. C. R.; TAMBASCIA, M. A.; PAVIN, E. J.; ALEGRE, S. M.; ZANTUT-WITTMANN, D. E. Relationship of thyroid hormone levels and cardiovascular events in patients with type 2 diabetes. ENDOCRINE, v. 45, n. 1, p. 84-91, FEB 2014. Web of Science Citations: 10.
MOURA NETO, ARNALDO; RIBEIRO PARISI, MARIA CANDIDA; TAMBASCIA, MARCOS ANTONIO; ALEGRE, SARAH MONTE; PAVIN, ELIZABETH JOAO; ZANTUT-WITTMANN, DENISE ENGELBRECHT. The influence of body mass index and low-grade systemic inflammation on thyroid hormone abnormalities in patients with type 2 diabetes. ENDOCRINE JOURNAL, v. 60, n. 7, p. 877-884, JUL 2013. Web of Science Citations: 9.

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