Preoperative low tri-iodothyronine concentration is associated with worse health status and shorter five year survival of primary brain tumor patients

// Adomas Bunevicius 1, 2 , Vytenis Pranas Deltuva 1, 2 , Sarunas Tamasauskas 1 , Timothy Smith 3 , Edward R. Laws 3 , Robertas Bunevicius 4, * , Giorgio Iervasi 5 , Arimantas Tamasauskas 1 1 Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania 2 Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania 3 Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA 4 Behavioural medicine institute, Lithuanian University of Health Sciences, Palanga, Lithuania 5 CNR Institute of Clinical Physiology, Pisa, Italy * Dr. R Bunevicius died before the work presented here reached completion. This manuscript is dedicated to his memory and to the many contributions he made to psychoneuroendocrinology. Correspondence to: Adomas Bunevicius, email: a.bunevicius@yahoo.com Keywords: tri-iodothyronine, thyroid, glioma, meningioma, survival Received: October 04, 2016     Accepted: December 01, 2016     Published: December 30, 2016 ABSTRACT Background : Low tri-iodothyronine syndrome is associated with worse prognosis of severely ill patients. We investigated the association of thyroid hormone levels with discharge outcomes and 5-year mortality in primary brain tumor patients. Methods: From January, 2010 until September, 2011, 230 patients (70% women) before brain tumor surgery were evaluated for cognitive (Mini mental State Examination; MMSE) and functional (Barthel index; BI) status, and thyroid function profile. The Low triiodothyronine syndrome was defined as triiodothyronine concentration below the reference range. Unfavorable discharge outcomes were Glasgow outcome scale score of ≤3. Follow-up continued until November, 2015. Results: Seventy-four percent of patients had Low triiodothyronine syndrome. Lower total tri-iodothyronine concentrations were associated with lower MMSE (p=.013) and BI (p=.023) scores independent of age, gender and histological diagnosis. Preoperative Low tri-iodothyronine syndrome increased risk for unfavorable discharge outcomes adjusting for age, gender and histological diagnosis (OR=2.944, 95%CI [1.314-6.597], p=.009). In all patients, lower tri-iodothyronine concentrations were associated with greater mortality risk (p≤.038) adjusting for age, gender, extent of resection, adjuvant treatment and histological diagnosis. The Low tri-iodothyronine syndrome was associated with greater 5-year mortality for glioma patients (HR=2.197; 95%CI [1.160-4.163], p=.016) and with shorter survival (249 [260] vs. 352 [399] days; p=.029) of high grade glioma patients independent of age, gender, extent of resection and adjuvant treatment. Conclusions: The Low tri-iodothyronine syndrome is common in brain tumor patients and is associated with poor functional and cognitive status, and with worse discharge outcomes. The Low tri-iodothyronine syndrome is associated with shorter survival of glioma patients.