Brain natriuretic peptide (BNP) in euthyroid sick syndrome

INTRODUCTION: Thyroid hormones (TH) play a significant role in cardiovascular (CV) homeostasis. When the effect of TH on the CV system has been examined, especially in recent years, "euthyroid sick syndrome (ESS)" has attracted attention. In this study, we aimed to investigate the correlation between ESS, which is frequently observed in hospitalized patients with have systemic disease, and the brain natriuretic peptide (BNP) level.
METHODS: In this cross-sectional study, 78 ESS patients who were hospitalized for various systemic diseases and a control group of 67 euthyroid patients were included. Patients who have heart failure (HF) with clinical and/or laboratory findings, renal failure, chronic liver disease, renal parenchymal disease, known hyperthyroidism or hypothyroidism, taking a thyroid hormone, using steroids, using antithyroid drugs, known to affect the BNP level Patients using medication were excluded from the study. The serum brain natriuretic peptide (BNP) levels, biochemical examinations, acute phase reactants, and echocardiography findings were analyzed.
RESULTS: Serum BNP was significantly higher in ESS patients compared to the control group. Serum free thyroxine (fT4) level was positively correlated, and serum free triiodothyronine (fT3) and thyroid stimulating hormone (TSH) levels were negatively correlated with BNP. Furthermore, it was determined that serum BNP level was positively correlated with positive acute-phase reactants (high-sensitivity C-reactive protein, ferritin) and negatively correlated with albumin, which is a negative acute-phase reactant.
DISCUSSION AND CONCLUSION: ESS is associated with an increase in serum BNP. In critically ill patients without CV disease, a low level of fT3 may contribute to the development of cardiac dysfunction. We consider that the patient's age, admission diagnosis, acute-phase reactants, and inflammatory cytokines should be considered in addition to thyroid hormones while evaluating BNP levels in ESS.

Ötiroid hasta sendromunda beyin natirüretik peptid (BNP)

GÝRÝÞ ve AMAÇ: Kardiyovasküler (KV) homeostazda tiroid hormonarý (TH) önemli role sahiptir. Özellikle son yýllarda KV sistem üzerine TH’larýnýn etkisi incelendiðinde “Ötiroid hasta sendromu (ÖHS)” dikkat çekmektedir. Bu çalýþmada hastanede yatarak tedavi alan ve sistemik hastalýðý bulunan hastalarda sýklýkla gözlenen ÖHS ile Beyin natirüretik peptid (BNP) düzeyi iliþkisini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kesitsel olarak dizayn edilen çalýþmada; kalp yetersizliði (KY) klinik ve/veya laboratuar bulgusu olan, renal yetmezliði olan, kronik karaciðer hastalýðý olan, renal parankim hastalýðý olan, bilinen hipertiroidi ya da hipotiroidisi olan, tiroid hormon replasmaný alan, steroid kullanan, antitiroid ilaç kullanan, BNP düzeyini etkilediði bilinen ilaç kullanýmý olan hastalar çalýþma dýþý býrakýldý. Çeþitli sistemik hastalýklar nedeni ile yatarak tedavi alan 78 ÖHS’lu hasta vaka, 67 ötiroid hasta kontrol grubuna alýnarak serum BNP düzeyleri, biyokimyasal tetkikleri, akut faz reaktanlarý ve ekokardiyografi bulgularý analiz edildi.
BULGULAR: ÖHS grubunda serum BNP düzeyinin kontrol gruba göre anlamlý olarak yüksek olduðu görülmüþtür. Serum BNP düzeyi ile; serum serbest tiroksin (sT4) düzeyinin pozitif, serum serbest triiodotironin (sT3) ve tiroid uyarýcý hormon (TSH) düzeyleri ise negatif korele bulunmuþtur. Ayrýca serum BNP düzeyinin pozitif akut faz reaktanlarý (yüksek duyarlýklý C reaktif protein, ferritin) ile pozitif, negatif akut faz reaktaný olan albüminle ise negatif korele olduðu saptanmýþtýr.
TARTIÞMA ve SONUÇ: ÖHS serum BNP artýþý ile iliþkilidir. KV hastalýðý olmayan kritik durumdaki hastalarda düþük sT3 düzeyi kardiyak disfonksiyon geliþimine katkýda bulunabilir. ÖHS’da BNP düzeyleri deðerlendirilirken, tiroid hormonlarýna ek olarak, hasta yaþýnýn, yatýþ tanýsýnýn, akut faz reaktanlarýnýn ve inflamatuar sitokinlerin göz önünde bulundurulmasý gerektiðini düþünmekteyiz.