Association Between Thyroid Dysfunction and Intensive Care Unit Acquired Weaknesss
Association Between Thyroid Dysfunction and Intensive Care Unit Acquired Weaknesss
Intensive care unit-acquired weakness (ICU-AW) is the most common neuromuscular impairment in
 critically ill patients. It affects more than 50 % of patients in the intensive care and is
 related to many problems as difficult weaning from mechanical ventilation, prolonged hospital
 stay and increased mortality.Thyroid disorders are also associated with neuromuscular
 abnormalities and may decrease the threshold for the development of any type of myopathy.
 However, no previous study investigated the direct relationship between thyroid dysfunction
 and ICUAW.This study aims at evaluation of the association between thyroid dysfunction and
 intensive care unit acquired weakness.
Intensive care unit acquired weakness refers to muscle weakness encountered in the intensive
 care unit as a consequence of critical illness. It affects more than 50 % of patients in the
 intensive care and is related to many problems as difficult weaning from mechanical
 ventilation, prolonged hospital stay and increased mortality.

 There are three distinct entities for ICUAW that can only be differentiated by
 neurophysiological studies. These are critical illness myopathy (CIM), critical illness
 polyneuropathy (CIP) and critical illness neuromyopathy (CINM).

 Identification of risk factors responsible for the development of ICUAW is the first step in
 the prevention and management of this disorder. Till time septic shock, hyperglycemia, high
 dose steroid therapy, prolonged mechanical ventilation and the use of neuromuscular blocking
 agents are the main accused.

 Thyroid disorders are also associated with neuromuscular abnormalities. Unfortunately, the
 prevalence of thyroid dysfunction in the intensive care is high reaching 90%. Moreover,
 patients with severe critical illness, who are typically prone to the development of ICUAW,
 show changes in their thyroid biochemistry namely low T3 levels (with or without low T4
 levels) in the presence of normal TSH levels. These changes are collectively known as
 Non-Thyroidal illness syndrome (previously low T3 syndrome and Euthyroid sick syndrome) which
 is the most common form of thyroid dysfunction in the intensive care unit.
Inclusion Criteria:

 -  Patients of both sexes admitted to the general ICU of Ain Shams University Hospitals
 with critical illness for more than 7 days * Diagnosis of ICU acquired weakness will
 be made based on clinical criteria for ICUAW and confirmed by nerve conduction
 studies.

 Exclusion Criteria:

 -  Patients with cerebrovascular accidents, neuromuscular disorders, spine abnormalities,
 spinal cord or head injuries, CNS tumors, secondary thyroid disorders and electrolyte
 disturbances were excluded from the study. Patients receiving thyroid replacement or
 anti-thyroid drugs for the treatment of any throid disorder will be also excluded from
 the study as these drugs may alter their thyroid biochemistry