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Considerations for the Future

Considerations for the Future

Almost every physician remembers seeing a patient in a medical intensive care unit and/or surgical intensive care unit who appeared edematous, obtunded, with periorbital edema, and a swollen tongue. Such patients are often seen to have fluid compartment abnormalities and metabolic disturbances (almost to the point of metabolic collapse). In the context of Wilson’s Temperature Syndrome are these abnormalities very difficult to understand? In November of 1988 Dr. Howard Silverman and his associates at the University of Southern California and the Los Angeles County – USC Medical Center reported a study in which the thyroid function tests were observed in 73 patients within 48 hours of admission to an intensive care unit. When the thyroid indices were stratified to see which tests, if any, were predictive in terms of outcome, the mortality rate was found to be significantly increased among those patients having low T4 or T3; or high T3 uptake or RT3 values exceeding 100 nanograms per deciliter. It is significant to me in these findings that low T3 and elevated RT3 were more likely to be found in patients who subsequently died.

Another study in the Japanese medical journal titled Nippon Geka Gaika Zashi, Dec. 1988, showed that dogs in cardiogenic shock were more likely to survive than the controls when administered T3 therapy and were less likely to survive than the controls when administered RT3. These studies suggest that peripheral thyroid hormone system function can sometimes mean the difference between life and death.

Is it any wonder that the critically ill trauma patient or a patient recovering from major surgery might experience a clinically significant T4 to T3 conversion impairment? Such an impairment might not be inappropriate but it may very well be maladaptive. Some might consider T3 therapy to be a less than natural influence in such a circumstance, but it is no less natural than IV fluids, gastric suctioning, respirators, electrolyte replacement, antibiotics, cardiac medications, blood transfusions, and most every other “unnatural” modality used in the care and treatment of the critically ill. I look forward to the time that body temperature abnormalities are among the first things considered in the care and treatment of illness rather than the last.

There will come a time in the near future (the technology is already available) when a specially programmed pump will infuse just the right amount of T3, 24 hours a day in order to provide for optimal body temperature patterns for optimal clinical functioning and healing (especially in the critically ill). Body temperature patterns can be monitored via probe 24 hours a day and stored in a data base. The specially programmed pump can then use this information to calculate the proper infusion rate (almost like an artificial thermostat). And when this modality is implemented I imagine that it will make all the difference in the world in the survival and recovery and quality of life of many patients who are critically ill and severely injured and perhaps even those battling cancer and AIDS.