Most Common Diseases of 50 Plus: Thyroid Disease : Euthyroid sick syndrome as a result of Sepsis - Treatments in conventional medicine perspective

Kyle J. Norton(Scholar and Master of Nutrients, all right reserved)
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                         Thyroid disease


Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones.


             Euthyroid sick syndrome as a result of Sepsis

Sepsis is defined as a condition caused by chemicals released into the bloodstream to fight the infection trigger inflammation throughout the body as a result of severe infection(a)(b). according to the study by the University of Utah, sepsis is the commonest cause of admission to medical ICUs across the world. Mortality from sepsis continues to be high. Besides shock and multi-organ dysfunction occurring following the intense inflammatory reaction to sepsis, complications arising from sepsis-related immunoparalysis contribute to the morbidity and mortality from sepsis(c).

                                              The  Treatments 

Treatments in conventional medicine perspective
1. Antibiotics
Most case of sepsis are treated with combination of two or three antibiotics given at the same time.
High doses of vancomycin were administered in order to rescue patients from septic shock. Plasma drug concentration dropped while clinical condition of patients worsened. Conversely, drug levels increased spontaneously once the infection was reverted. The theoretical model provided greater insight into pharmacokinetic features related with the use of vancomycin in septic patients(58). Other study indicated that patients with sepsis do not seem to have the same level of impairment of tissue distribution as described for patients with septic shock. A 25% lower dose of piperacillin administered by continuous infusion seems to maintain higher trough concentrations compared with standard bolus dosing. It is likely that the clinical advantages of continuous infusion are most likely to be evident when treating pathogens with high minimum inhibitory concentration, although without therapeutic drug monitoring and subsequent dose adjustment, infusions may never achieve target concentrations of organisms with very high minimum inhibitory concentrations in a small number of patients(59).

2. IV Fluids
In the study to determine the clinical and pharmacokinetic differences between continuous and intermittent dosing in patients with severe sepsis, found that continuous administration of beta-lactam antibiotics achieved higher plasma antibiotic concentrations than intermittent administration with improvement in clinical cure. This study provides a strong rationale for further multicenter trials with sufficient power to identify differences in patient-centered endpoints(60). Other study suggested that routine use of prolonged infusion of time-dependentantibiotics for the empiric treatment of gram-negative bacterial infections offers no advantage over intermittent infusion antibiotic therapy with regard to treatment success, mortality, or hospital length of stay. These results were confirmed after controlling for potential confounders in a multivariate analysis(61).

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/9086580
(b)http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/thyroid_disorders/euthyroid_sick_syndrome.html
(c) http://en.wikipedia.org/wiki/Euthyroid_sick_syndrome
(d) http://www.ncbi.nlm.nih.gov/pubmed/8028742
(1) http://clinicalcases.org/2004/05/sick-euthyroid-syndrome-in-patient-with.html
(58) http://www.ncbi.nlm.nih.gov/pubmed/18397685.
(59) http://www.ncbi.nlm.nih.gov/pubmed/19237898
(60) http://www.ncbi.nlm.nih.gov/pubmed/23074313
(61) http://www.ncbi.nlm.nih.gov/pubmed/23341160