Thyrotropin-releasing hormone in critical illness: from a dopamine-dependent test to a strategy for increasing low serum triiodothyronine, prolactin, and growth hormone concentrations
Van den Berghe, G.; de Zegher, F.; Vlasselaers, D.; Schetz, M.; Verwaest, C.; Ferdinande, P.; Lauwers, P.
Critical Care Medicine 24(4): 590-595
1996
ISSN/ISBN: 0090-3493 PMID: 8612408 Document Number: 461421
Objective: The aim of this study was to examine the effect of dopamine infusion on the thyrotropin (TSH), thyroid hormone, prolactin, and growth hormone responses to thyrotropin-releasing hormone (TRH) in critically ill patients. Design: Prospective, randomized, controlled, open-labeled clinical study. Setting: The intensive care unit, University Hospital Gasthuisberg, Leuven, over a 1-month period. Patients and Interventions: In 15 critically ill patients receiving dopamine treatment (5 mu-g/kg/min) for a mean of 43.3 +- 1.2 (SEM) hrs after trauma or cardiac surgery, we studied the TSH, thyroid hormone, prolactin, and growth hormone responses to the administration of two consecutive intravenous TRH boluses of 200 mu-g, with a 6-hr interval. The dopamine infusion was continued in the control group and discontinued in the study group. Serum concentrations of TSH, prolactin, and growth hormone were measured before and 20, 40, 60, and 120 mins after TRH administration. Serum concentrations of thyroxine (T-4), triiodothyronine (T-3), reverse T-3, and thyroid hormone binding globulin were determined before and 120 mins after each TRH injection. Measurements and Main Results: There was a gt 100-fold interindividual variation in the baseline TSH concentration and in the TSH peak value after TRH administration. Two consecutive doses of TRH evoked a mean 16% increase in serum T-4 concentration (p = .003) and a mean 47% increase in T-3 (p = .001), whereas serum reverse T-3 and thyroid hormone binding globulin values remained unaltered. Each of the TRH boluses increased serum growth hormone concentrations in the continued dopamine and discontinued dopamine groups, by a median of 60% (p =.001) and 68% (p = .001), respectively. Three hours after dopamine withdrawal, there was a three-fold increase of the peak TSH response (p = .001), a higher T-3 response (p = .01), and a ten-fold increase of the peak prolactin value (p =.001) in response to TRH administration. Conclusions: The TSH response to TRH administration in critical illness presents a striking interindividual variation and is dopamine dependent. Repeated TRH administration results in a repetitive increase of TSH, prolactin, growth hormone, T-4, and T-3, without increasing reverse T-3. These observations point toward a potential for TRH as a strategy for reversing the euthyroid sick syndrome, growth hormone deficiency, and immune dysfunction associated with critical illness.