Purpose

That thyroid hormones exert pleiotropic effects and have a contributory role in triggering seizures in patients with traumatic brain injury (TBI) can be hypothesized. We aimed at investigating thyroid function tests as prognostic factors of the development of seizures and of functional outcome in TBI.

Methods

This retrospective study enrolled 243 adult patients with a diagnosis of mild-to-severe TBI, consecutively admitted to our rehabilitation unit for a 6-month neurorehabilitation program. Data on occurrence of seizures, brain imaging, injury characteristics, associated neurosurgical procedures, neurologic and functional assessments, and death during hospitalization were collected at baseline, during the workup and on discharge. Thyroid function tests (serum TSH, fT4, and fT3 levels) were performed upon admission to neurorehabilitation.

Results

Serum fT3 levels were positively associated with an increased risk of late post-traumatic seizures (LPTS) in post-TBI patients independent of age, sex and TBI severity (OR = 1.85, CI 95% 1.22–2.61, p < 0.01). Measured at admission, fT3 values higher than 2.76 pg/mL discriminated patients with late post-traumatic seizures from those without, with a sensitivity of 74.2% and a specificity of 60.9%. Independently from the presence of post-traumatic epilepsy and TBI severity, increasing TSH levels and decreasing fT3 levels were associated with worse neurological and functional outcome, as well as with higher risk of mortality within 6 months from the TBI event.

Conclusions

Serum fT3 levels assessed in the subacute phase post-TBI are associated with neurological and functional outcome as well as with the risk of seizure occurrence. Further studies are needed to investigate the mechanisms underlying these associations.

中文翻译：

---

创伤性脑损伤亚急性期的甲状腺功能：创伤后神经和功能结果的潜在预测因子

目的

可以假设甲状腺激素发挥多效性作用，并在引发创伤性脑损伤 (TBI) 患者的癫痫发作中发挥作用。我们旨在调查甲状腺功能测试作为 TBI 癫痫发作发展和功能结果的预后因素。

方法

这项回顾性研究招募了 243 名被诊断为轻度至重度 TBI 的成年患者，这些患者连续入住我们的康复部门，进行为期 6 个月的神经康复计划。在基线、检查期间和出院时收集关于癫痫发作、脑成像、损伤特征、相关神经外科手术、神经和功能评估以及住院期间死亡的数据。在接受神经康复治疗时进行甲状腺功能测试（血清 TSH、fT4 和 fT3 水平）。

结果

血清 fT3 水平与 TBI 后患者的晚期创伤后癫痫发作 (LPTS) 风险增加呈正相关，与年龄、性别和 TBI 严重程度无关（OR = 1.85，CI 95% 1.22-2.61，p  < 0.01）。入院时测量，高于 2.76 pg/mL 的 fT3 值可区分患有晚期创伤后癫痫发作的患者和未发生创伤后癫痫发作的患者，敏感性为 74.2%，特异性为 60.9%。独立于创伤后癫痫和 TBI 严重程度的存在，增加 TSH 水平和降低 fT3 水平与更差的神经和功能结果相关，以及在 TBI 事件后 6 个月内更高的死亡风险。

结论

在 TBI 后亚急性期评估的血清 fT3 水平与神经和功能结果以及癫痫发作的风险相关。需要进一步的研究来调查这些关联背后的机制。