| Background and Objective:Systemic inflammatory reaction syndrome (SIRS) is defined as activation of host defense system by various causes, infectious or non-infectious. Inflammatory cells secret large quantities of inflammatory mediators, and if unchecked, uncontrolled activation of inflammatory mediators results in multiple organ dysfunction syndrome (MODS). Cytokines play a major role in the pathogenesis of SIRS. In recent years, emphasis has been placed on the effect of cytokines on the endocrine system. It appears that cytokines may alter the hypothalamic- pituitary- thyroid axis an.1 induce abnormal thyroid hormone levels.Many non-thyroidal systemic diseases involve altered thyroid hormone levels, mainly low triiodothyronine (T3), with thyroxine(T4) normal, reduced or elevated. The thyrotropin (TSH) level is typically normal or reduced. The term euthyroid sick syndrome (ESS) has been used to describe this pattern of thyroid hormone alternations during non-thyroidal illness. The mechanisms involved in the pathogenesis of ESS are not clear yet. Much current attention is centered on the of cytokines in ESS developing.We studied the pattern of thyroid hormone alternations in SIRS patients, to give evidence for the effect of cytokines on thyroid axis, and to further discuss the pathogenesis of ESS.Patients and Design:50 SIRS patients admitted to intensive care unit of our hospital were enrolled. Excluded were patients with a medical history of thyroid diseases and those taking thyroid-replacement therapy or drugs known to influence thyroid hormone levels. Patients were divided into two groups as to whether they got MODS or not. The diagnosis of MODS was based on the Fly criteria in the year of 1991.Patients' blood was sampled in the morning, for thyroid hormone measurements, including total T3 (TT3), total T4 (TT4), free T3 (FT3), free T4 (FT4) and TSH. The acute physiology and chronic health evaluation II (APACHE II) score of every patient was calculated according to clinical data. Patients were followed up until death or being discharged from ICU. Outcome (recovery or deterioration) of every patient was recorded, as well as the length of time from the onset of SIRS to the day when thyroid hormones were measured (the duration of SIRS).Results:1. Euthyroid sick syndrome was presented in 45(90%) cases. No difference of thyroid hormone levels was observed between the males and females (p>0.05).2. All patients were divided into three groups according to APACHE II scores: <15 in group A, 15-17 in group B and >17 in group C. TT3 was significantly lower in the group B and C than in the group A (p<0.05, p<0.01, respectively). TT4 was significantly lower in the group C than in the group A and B (p<0.05, p<0.01, respectively). TT3/TT4 value was significantly lower in the group B than in the group A (p<0.01), but was tended to be higher in the group C (p>0.05) . Between these groups, there were no significant differences of age or the duration of SIRS (p>0.05).3. TT3 level and TT3/TT4 value were negatively correlated with the duration of SIRS (p<0.05). No correlations were obtained between the duration of SIRS and TT4, FT3, FT4, and TSH (p>0.05).4. All patients were divided into two groups as to whether they had low TSH levels or not. Comparing to the normal TSH group, those patients with low TSH had lower T3 and T4, higher APACHE II scores, higher proportion of MODS, and higher proportion of recovery, but no differences (p>0.05).5. 45 patients with low TT3 or FT3 were further divided into two groups as to whether they had low TT4 or FT4 or not. There was no significant difference of the duration of SIRS between the two groups (p>0.05). Those patients with low TT4 or FT4 had significantly lower TT3 level (p<0.01).6. TT3, TT4 and FT3 levels in the MODS patients were significantly lower than in the patients without MODS (p<0.05). MODS patients got low TT4 or FT4 levels more frequently than the patients without MODS (p<0.05).Conclusions:1. Systemic inflammatory reaction syndro...
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