Thyroid hormones as a marker to diagnose the severity of fungal sepsis in neonates


  • Vatti Rajeswari Department of Paediatrics, Sree Balaji Medical college, Chrompet, Tamil Nadu, India
  • Selvendran C. Department of Paediatrics, Sree Balaji Medical college, Chrompet, Tamil Nadu, India



Fungal sepsis, Marker of sepsis, Thyroid insufficiency


Background: Sepsis due to fungi in the neonatal period occurs in infants admitted to the ICU for long periods of time, especially affecting infants with a birth weight <1500 g. In this case series thyroid insufficiencies have been used as a marker to diagnose the severity of fungal sepsis and outcome of those babies. Objectives of this study was to describe thyroid hormone variations in new-borns with fungal sepsis and to find the correlation between thyroid hormone deficiency and severity of fungal sepsis

Methods: It is a prospective observational study of 100 infants done in Sree Balaji Medical College, chrompet. Thyroid profile was done to all patients. Patients with Low T3 syndrome and Low T3, T4 syndrome were divided into group A and B and statistical analysis was done to find the correlation between thyroid insufficiency and severity of the fungal sepsis.

Results: Significant correlation was noted between low T3, low T4 levels and fungal sepsis.

Conclusions: Thyroid insufficiency, with the variables described, could be a marker of disease severity with the possible need for hormone supplementation to decrease the mortality.


Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonneli M, Ferrer R, et al. Campanha de sobrevivência à sepse: Diretrizes internacionais para tratamento de sepse grave e choque séptico: 2016. Crib Care Med. 2013;41(2):580-637.

Chopra IJ. Euthyroid sick syndrome: is it a misnomer? J Clini Endocrinol Metab. 1997 Feb 1;82(2):329-34.

De Groot LJ. Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab. 1999;84(1):151-64.

Papanicolaou DA. Euthyroid sick syndrome and the role of cytokines. Rev Endocr Metab Disord. 2000;1(1-2):43-8.

Economies F, Douka E, Tzanela M, Nanas S, Kotanidou A. Thyroid function during critical illness. Hormones (Athens). 2011;10(2):117-24.

Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol (Lausanne). 2014;5(102):1-11.

Peeters RP, Wouters PJ, Kaptein E, Van Toor H, Visser J, Van den Berghe GV. Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients. J Clin Endocrinol Metab. 2003;88(7):3202-11.

Peeters RP, Wouters PJ, Toor HV, Kaptein E, Visser TJ, Van den Berghe G. Serum 3,3’,5’-triiodothyronine (rT3) and 3,5,3’ –triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. J Clinical Endocrinol Metab. 2005;90(8):4559-65.

Marks SD. Nonthyroidal illness syndrome in children. Endocrine. 2009;36(3):355-67.

Golombek SG. Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients. Semin Perinatol. 2008;32(6):413-8.

Colombo AL, Guimarães T. Epidemiologia das infecções hematogênicas por Candida ssp. Rev Soc Bras Med Trop. 2003;36(5):599-607.

Borges RM, Soares LR, Brito CS, Brito DV, Abdallah VO, Gontijo Filho PP. Fatores de risco associados à colonização por Candida spp em neonatos internados em uma Unidade de Terapia Intensiva Neonatal brasileira. Rev Soc Bras Med Trop. 2009 Aug;42(4):431-5.

Steinbach WJ, Roilides E, Berman D, Hoffman JA, Groll AH, Bin-Hussain I, et al. Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates. Pediatr Infects Dis J. 2012 Dec 1;31(12):1252-7.

Nucci M, Queiroz-Telles F, Alvarado-Matute T, Tiraboschi IN, Cortes J, Zurita J, et al. Epidemiology of candidemia in Latin America: a laboratory-based survey. PloS One. 2013 Mar 19;8(3):e59373.

Roilides E, Farmaki F, Evdoridou J, Doris J, Hatziionnids F, Tsivitanidou M, et al. Neonatal candidiasis: analysis of epidemiology; drug susceptibility, and molecular typing of causative isolates. Eur J Clin Microbiol Infect Dis. 2004; 23(10):745-50.

Colombo AL, Nucci M, Park BJ, Nouér SA, Arthington-Skaggs B, Matta DA, et al.; Brazilian Network Candidemia Study. Epidemiology of candidemia in Brazil: nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol. 2006;44(8):2816-23.

Fisher DA. Euthyroid low thyroxine (T4) and triiodothyronine (T3) states in premature and sick neonates. Pediatr Clin North Am. 1990;37(6):1297-312.

De Zegher F, Vanhole C, Van den Berghe G, Devlieger H, Eggermont E, Veldhuis JD. Properties of thyroid-stimulating hormone and cortisol secretion by the human newborn on the day of birth. J Clini Endocrinol Metab. 1994 Aug 1;79(2):576-81.

Das BK, Agarwal P, Agarwal JK, Mishra OP. Serum cortisol and thyroid hormone levels in neonates with sepsis. Indian J Pediatr. 2002;69(8):663-5.

Moura EG, Moura CC. Regulação da síntese e secreção de tireotrofina. Ar Bras Endocrinol Metab. 2004;48(1):40-52.

Kaptein EM, Spencer CA, Kamiel MB, Nicoloff JT. Prolonged Dopamine Administration and Thyroid Hormone Economy in Normal and Critically 111 Subject. J Clini Endocrinol Metab. 1980 Aug 1;51(2):387-93.

Van Den Berghe G, de Zegher, Lauwers P. Dopamine suppresses pituitary function in infants and children. Critic Care Med. 1994;22(11):1747-53.

Langton JE, Brent GA. Nonthyroidal illness syndrome: evaluation of thyroid function in sick patients. Endocrinol Metab Clini North Am. 2002 Mar;31(1):159-72.

Goldsmit GS, Valdes M, Herzovich V, Rodriguez S, Chaler E, Golombek SG, et al. Evaluation and clinical application of changes in thyroid hormone and TSH levels in critically ill full-term new-borns. J Perinatal Med. 2011 Jan 1;39(1):59-64.

Yildizdaş D, Önenli-Mungan N, Yapicioğlu H, Topaloğlu AK, Stoudemire Y, Yüksel B. Thyroid hormone levels and their relationship to survival in children with bacterial sepsis and septic shock. J Pediatr Endocrinol Metab. 2004;17(10):1435-42.






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