From the Guidelines
Thyroid hormone administration is not effective in treating septic shock and should not be used as a routine treatment. The most recent and highest quality study, published in 2020 in the journal Intensive Care Medicine 1, suggests against the routine use of levothyroxine in children with septic shock and other sepsis-associated organ dysfunction in a sick euthyroid state, with a weak recommendation and low quality of evidence.
Key Points to Consider
- The concept of treating "sick euthyroid syndrome" with thyroid hormone has been explored, but results from clinical studies have been mixed, with some showing hemodynamic improvements while others demonstrate no mortality benefit 1.
- Potential risks of thyroid hormone supplementation include tachyarrhythmias, increased oxygen consumption, and worsened catabolism.
- Currently, thyroid hormone supplementation is not recommended as routine therapy for septic shock by major critical care guidelines, and should only be considered in research settings or in cases of confirmed hypothyroidism.
Clinical Implications
- In real-life clinical practice, the focus should be on established treatments for septic shock, such as fluid resuscitation, vasopressor support, and broad-spectrum antibiotics, rather than experimental therapies like thyroid hormone administration.
- Clinicians should prioritize evidence-based treatments that have been shown to improve morbidity, mortality, and quality of life outcomes in patients with septic shock.
- The use of thyroid hormone supplementation should be approached with caution and only considered in specific cases where the benefits may outweigh the risks, such as in patients with confirmed hypothyroidism 1.
From the Research
Thyroid Hormone Administration in Septic Shock
- The effectiveness of thyroid hormone administration in treating septic shock is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that thyroid hormone disorders are common in patients with sepsis or septic shock, and decreased thyroid hormone levels may be associated with worse outcomes 2, 4, 5.
- One study found that lower serum free T3 and free T4 levels were significantly associated with higher sequential organ failure assessment scores and increased 28-day mortality in patients with septic shock 5.
- Another study found that decreased thyroid function at baseline might be associated with a worse outcome of patients with sepsis or septic shock, although the findings were not consistent 4.
- The use of corticosteroids, such as hydrocortisone, is recommended in patients with refractory septic shock, but the role of thyroid hormone administration is not mentioned 3, 6.
Current Management of Sepsis and Septic Shock
- The current management of sepsis and septic shock involves rapid diagnosis, antimicrobial administration, and resuscitation targets such as mean arterial pressure, mental status, capillary refill time, lactate, and urine output 6.
- Intravenous fluid resuscitation and early vasopressors are also recommended, with norepinephrine as the first-line vasopressor 6.
- Steroids such as hydrocortisone and fludrocortisone may be considered in patients with refractory septic shock, but thyroid hormone administration is not mentioned as a treatment option 6.