Inge Grondman1, Aline H de Nooijer1, Nikolaos Antonakos2, Nico A F Janssen1, Maria Mouktaroudi2, Konstantinos Leventogiannis2, Marco Medici3,4, Jan W A Smit3, Antonius E van Herwaarden5, Leo A B Joosten1, Frank L van de Veerdonk1, Peter Pickkers6, Matthijs Kox6, Martin Jaeger1, Mihai G Netea1,7, Evangelos J Giamarellos-Bourboulis2, Romana T Netea-Maier3. 1. Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands. 2. 4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece. 3. Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen, 6525 GA, Nijmegen, the Netherlands. 4. Academic Center for Thyroid Diseases and Departments of Internal Medicine and Epidemiology, Erasmus Medical Centre, 3015 GE, Rotterdam, the Netherlands. 5. Department of Laboratory Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands. 6. Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525GA, Nijmegen, the Netherlands. 7. Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany.
Abstract
CONTEXT: Lymphopenia is a key feature of immune dysfunction in patients with bacterial sepsis and coronavirus disease 2019 (COVID-19) and is associated with poor clinical outcomes, but the cause is largely unknown. Severely ill patients may present with thyroid function abnormalities, so-called nonthyroidal illness syndrome, and several studies have linked thyrotropin (thyroid stimulating hormone, TSH) and the thyroid hormones thyroxine (T4) and 3,5,3'-triiodothyronine (T3) to homeostatic regulation and function of lymphocyte populations. OBJECTIVE: This work aimed to test the hypothesis that abnormal thyroid function correlates with lymphopenia in patients with severe infections. METHODS: A retrospective analysis of absolute lymphocyte counts, circulating TSH, T4, free T4 (FT4), T3, albumin, and inflammatory biomarkers was performed in 2 independent hospitalized study populations: bacterial sepsis (n = 224) and COVID-19 patients (n = 161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts. RESULTS: Only T3 significantly correlated (ρ = 0.252) with lymphocyte counts in patients with bacterial sepsis, and lower concentrations were found in severe lymphopenic compared to nonlymphopenic patients (n = 56 per group). Severe lymphopenic COVID-19 patients (n = 17) showed significantly lower plasma concentrations of TSH, T4, FT4, and T3 compared to patients without lymphopenia (n = 18), and demonstrated significantly increased values of the inflammatory markers interleukin-6, C-reactive protein, and ferritin. Remarkably, after 1 week of follow-up, the majority (12 of 15) of COVID-19 patients showed quantitative recovery of their lymphocyte numbers, whereas TSH and thyroid hormones remained mainly disturbed. CONCLUSION: Abnormal thyroid function correlates with lymphopenia in patients with severe infections, like bacterial sepsis and COVID-19, but future studies need to establish whether a causal relationship is involved.
CONTEXT: Lymphopenia is a key feature of immune dysfunction in patients with bacterial sepsis and coronavirus disease 2019 (COVID-19) and is associated with poor clinical outcomes, but the cause is largely unknown. Severely ill patients may present with thyroid function abnormalities, so-called nonthyroidal illness syndrome, and several studies have linked thyrotropin (thyroid stimulating hormone, TSH) and the thyroid hormones thyroxine (T4) and 3,5,3'-triiodothyronine (T3) to homeostatic regulation and function of lymphocyte populations. OBJECTIVE: This work aimed to test the hypothesis that abnormal thyroid function correlates with lymphopenia in patients with severe infections. METHODS: A retrospective analysis of absolute lymphocyte counts, circulating TSH, T4, free T4 (FT4), T3, albumin, and inflammatory biomarkers was performed in 2 independent hospitalized study populations: bacterial sepsis (n = 224) and COVID-19patients (n = 161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts. RESULTS: Only T3 significantly correlated (ρ = 0.252) with lymphocyte counts in patients with bacterial sepsis, and lower concentrations were found in severe lymphopenic compared to nonlymphopenic patients (n = 56 per group). Severe lymphopenic COVID-19patients (n = 17) showed significantly lower plasma concentrations of TSH, T4, FT4, and T3 compared to patients without lymphopenia (n = 18), and demonstrated significantly increased values of the inflammatory markers interleukin-6, C-reactive protein, and ferritin. Remarkably, after 1 week of follow-up, the majority (12 of 15) of COVID-19patients showed quantitative recovery of their lymphocyte numbers, whereas TSH and thyroid hormones remained mainly disturbed. CONCLUSION:Abnormal thyroid function correlates with lymphopenia in patients with severe infections, like bacterial sepsis and COVID-19, but future studies need to establish whether a causal relationship is involved.
Authors: David Tak Wai Lui; Chi Ho Lee; Wing Sun Chow; Alan Chun Hong Lee; Anthony Raymond Tam; Polly Pang; Tip Yin Ho; Chloe Yu Yan Cheung; Carol Ho Yi Fong; Chun Yiu Law; Kelvin Kai Wang To; Ching Wan Lam; Kathryn Choon Beng Tan; Yu Cho Woo; Ivan Fan Ngai Hung; Karen Siu Ling Lam Journal: Front Endocrinol (Lausanne) Date: 2022-01-13 Impact factor: 5.555
Authors: D T W Lui; C H Lee; W S Chow; A C H Lee; A R Tam; C Y Y Cheung; C H Y Fong; S T M Kwok; C Y Law; K K W To; C W Lam; K C B Tan; Y C Woo; I F N Hung; K S L Lam Journal: J Endocrinol Invest Date: 2022-07-13 Impact factor: 5.467