Thyroid Function in Critical Illness and Burn Injury,
ARMY INST OF SURGICAL RESEARCH FORT SAMHOUSTON TX
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The marked and protracted hypermetabolic and catabolic response in major burn and other severe traumatic injury has been appreciated for most of this century. This response includes elevated body temperature, high cardiac output, and decreased peripheral resistance, and resolves in survivors as the wounds heal over weeks to months. During this time before wound closure, a condition resembling thyrotoxicosis is thus present. Because of this and the long-standing speculation that stress is the etiology of hyperthyroidism, Oliver Cope et al recognized the importance of determining whether the post-burn hypermetabolic condition is a function of transient hyperthyroidism. They found that thyroidal radioactive iodine uptake RAIU and serum protein bound iodine measurements were normal in burn patients and concluded that hyperthyroidism was not present and was not the mediator of the hypermetabolism. Later, others found a widely varying thyroidal RAIU in burn patients. However, in their patients with the most severe burns, a low RAIU clearly predominated during the 3 months after injury and ultimately resolved in survivors. RAIU measurements could have been influenced by a number of variables such as changing fluid and circulatory status, and thyroidal and renal iodide delivery, or iodine exposure or deprivation before or during the hospital course.
- Medicine and Medical Research