THYROID STATUS IN CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA

Abstract

Nowadays, community – acquired pneumonia (CAP ) is a common pediatric infection. Even with appropriate understanding of pneumonia pathogenesis, this disease remains a major cause of illness death in children. The number of cases with severe pneumonia is increased, that requires the prolong hospital admission and considerable financial expenses. However, the derivation of such information requires advanced clinical expertise to correctly assess observational clinical signs. Moreover, this article was shown that severity CAP in children can be determined through addition of conventional biomarkers (thyroid hormones).

The aim of the study – to learn the changes of the thyroid functional state depending on the inflammatory process during CAP in children of school age.

Materials and Methods. There were investigated 50 children in age 6–14 years with CAP . A clinical manifestation, laboratory and instrumental examination were obtained to all children according to the diagnostical criteria of pneumonia and estimation. The condition of thyroid gland was investigated by ultrasound. Functional activity of the thyroid system was estimated by means of determination in blood of levels of free thyroxine (fT4), free triiodo-thyronine (fT3) and thyroid stimulating hormone (TSH ).

Results and Discussion. The article presents the data on the laboratory indexes of the thyroid status in children with moderate and severe CAP . The evaluation and comparison of the results were done at admission and after 21 days from the onset of the disease. Moreover, all data were compared with the results of children of control group. It has been established that severe pneumonia in children is characterized by a transient low level of fT3 and increase a level of TSH in the absence of structural changes the thyroid gland during severe pneumonia. Non-thyroid illness syndrome was developed, that can be as a marker of severity of pneumonia. In a dynamics there was a tendency to the height initially low levels of fT3, that on 21 days from the onset of disease got around the middle level of patients with moderate pneumonia and to the mean population values. The general condition and clinical symptoms of the patients was improving after treatment of pneumonia and thyroid status was normalized. Finally, we demonstrated that level of fT3 in serum less than 3.41pmol/lcan be determined using as a newly proposed biomarker of severity and unfavorable course of CAP in children.

Conclusions. Nonthyroid illness syndrome (type 1, type 5) developed for patients with severe community-acquired pneumonia; hormones of thyroid are one of perspective markers of heavy flow of community-acquired pneumonia; severe CAP can lead to hormonal disbalance of the thyroid system, but without the structural changes of the gland itself.