J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-89664 | DOI: 10.4274/jcrpe.galenos.2024.2023-12-7

Non-thyroidal Illness in Children with Congestive Heart Failure

Biswajit Sahoo¹, Aashima Dabas¹, Binita Goswami², Anurag Agarwal¹, Sumod Kurian^3
1Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi
²Department of Biochemistry, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi
³Department of Cardiology, G.B.Pant Institute of Post-graduate Medical Education and Research, New Delhi

INTRODUCTION: To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure(CHF).
METHODS: This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity using Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24hours of hospitalization and evaluated for fT3, fT4, TSH, NT pro-Brain natriuretic peptide (NT pro-BNP) and reverseT3.
RESULTS: A total of 80 (64 acyanotic CHD) children of median (IQR) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%)- 27 with low fT3 levels. The proportion of NTI was maximum in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41); p=0.018. Ten (27%) patients with NTI expired as compared to 2 (4.7%) without NTI with unadjusted odds ratio (95% CI) 7.593(1.54, 37.38); p-value=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR 1.41, 95% CI 1.03, 1.92; p=0.032).Linear regression for fT3 showed significant relation with log NT-BNP [beta -3.541, (95% CI -1.387, -0.388)] and with TSH [beta 2.652 (95%CI 0.054, 0.383)]. The cutoff (AUC, 95%CI) that predicted mortality were fT4 <14.5 pmol/L (0.737, 0.60, 0.88), fT3/rT3 index <1.86 pg/ng (0.284, 0.129, 0.438) and NT pro-BNP >3725 pg/mL (0.702; 0.53, 0.88).
DISCUSSION AND CONCLUSION: NTI was seen in a significant proportion of children with CHD and CHF. Free T3 level was significantly affected with NTBNP levels (severity of CHF).

Keywords: Non-thyroidal illness, free T3, reverse T3, NT pro-BNP and Pediatric early warning score

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