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Heart ArrestThyro-CPRNCT04392258

Observational and Diagnostical Study on Transient Allostatic Responses of Thyroid Function After Cardiopulmonary Resuscitation

An observational study of Heart Arrest and Ventricular Fibrillation, run by Ruhr University of Bochum at 1 site in Germany.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Time-limited adaptive responses of thyroid function are common in the critically ill. About 70% of all patients treated on intensive care units develop a so-called non-thyroidal illness syndrome (NTIS) or TACITUS (thyroid allostasis in critical illness, tumours, uraemia and starvation), which is marked by low serum… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
TSH determination, FT4 determination and FT3 determination
How many people
200 participants
Where
1 siteGermany
Study dates
1 May 2021to 31 Dec 2022
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: De-identified datasets (protocol A) or patients (protocol B) admitted to an intensive care unit after cardiopulmonary resuscitation (CPR)

Who may be able to join

  • Admission after cardiopulmonary resuscitation
  • Minimum age of 18 years
  • Results of TSH and peripheral thyroid hormone concentrations already available or possibility to reorder these investigations in a post-hoc manner if consent has been obtained (i. e. time interval after venipuncture within the storage period of the central laboratory)
  • Inclusion after own consent of the patient after reawakening, via custodian or independent consultant.

Who cannot join

  • Missing data on thyroid homeostasis in the first blood specimen (obtained before 3 hours after admission)
  • Traumatic brain injury
  • Persistent hints for thyroid dysfunction, not explained by non-thyroidal illness syndrome (NTIS) / euthyroid sick syndrome (ESS) / thyroid allostasis in critical illness, tumors, uremia and starvation (TACITUS) in consecutive investigations over several days after resuscitation
  • Functionally relevant thyroid or pituitary disorder, as documented in international classification of diseases (ICD) codes.
  • Exposure to radiocontrast agents less than 3 months ago
  • Therapy with amiodarone (currently or during the previous 3 years)
Show all 10Show fewer
  • Pregnancy
  • Known thyroid disease
  • Consent not obtained within the routine storage period of the central laboratory
  • Post-hoc-exclusion if evidence for true dysfunction the the pituitary or the thyroid became available during the study period.

Trial locations and contacts

1 site in 1 country.

Germany1 site, 1 recruiting
  • Medizinische Klinik I, Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum

    Bochum, North Rhine-Westphalia, D-44789

    Johannes W Dietrich, M.D., +49-234-302 ext. 6400, johannes.w.dietrich@bergmannsheil.de

    Harald H Klein, M.D., +49-234-302 ext. 6400, harald.klein@ruhr-uni-bochum.de

    Recruiting

Other trials in Germany

About this study

Time-limited adaptive responses of thyroid function are common in the critically ill. About 70% of all patients treated on intensive care units develop a so-called non-thyroidal illness syndrome (NTIS) or TACITUS (thyroid allostasis in critical illness, tumours, uraemia and starvation), which is marked by low serum concentrations of the thyroid hormone T3 and other adaptive reactions of thyroid homeostasis. Occasionally, temporarily elevated concentrations of thyrotropin (TSH) and peripheral thyroid hormones are to be observed, especially after cardiopulmonary resuscitation (CPR). However, the available evidence is limited, although abnormal concentrations of thyroid hormones after CPR have occasionally been reported.

Aim of the planned study is to investigate the thyrotropic (i.e. thyroid-controlling) partial function of the anterior pituitary lobe immediately after CPR. It is intended to evaluate statistical measures of TSH concentration and peripheral thyroid hormones in de-identified datasets (protocol A). Additionally, a prospective sub-study (protocol B) aims at a more precise description of pituitary and thyroid responses by means of serial investigations in routine serum samples, both immediately after CPR and during the course of ongoing treatment. This includes the evaluation of additional possible predictors, too.

Read more

Primary endpoint of the study is changed TSH concentration immediately after CPR compared to the TSH value 24 hours later. Secondary endpoint is the relation between thyroid-controlling pituitary function and mortality.

A high proportion of patients undergoing CPR will eventually receive iodinated radiocontrast media (e.g. for computed tomography or coronary angiography). This is one of the reasons why early identifying subjects at high risk for possible iodine-induced thyrotoxicosis is important. Increased oxygen consumption of the heart in hyperthyroidism is one of the reasons for high mortality in thyrotoxicosis. Therefore, accurate diagnosis of alterations in the hypothalamus-pituitary-thyroid (HPT) axis is of paramount importance.

Read the detailed description

Transient allostatic responses of thyroid function are common in the critically ill. About 70% of all patients treated on intensive care units develop a so-called non-thyroidal illness syndrome (NTIS) or TACITUS (thyroid allostasis in critical illness, tumours, uraemia and starvation), which is marked by low serum concentrations of the thyroid hormone T3 and other adaptive reactions of thyroid homeostasis. Occasionally, temporarily elevated concentrations of thyrotropin (TSH) and peripheral thyroid hormones are to be observed, especially after cardio-pulmonary resuscitation (CPR). However, the available evidence is limited, although abnormal concentrations of thyroid hormones after CPR have been reported.

Aim of the planned study is to investigate the thyrotropic partial function of the anterior pituitary lobe immediately after CPR. It is intended to evaluate statistical moments of TSH concentration and peripheral thyroid hormones in de-identified datasets (protocol A). Additionally, a prospective substudy (protocol B) aims at a more precise description of pituitary and thyroid responses by means of serial investigations in routine serum samples, both immediately after CPR and during the course of ongoing in-patient treatment. This also includes the evaluation of additional possible predictors.

Primary endpoint of the study are changed TSH concentrations immediately after CPR compared to the value 24 hours later. Secondary endpoint is the relation between thyrotropic pituitary function and mortality.

A high proportion of patients undergoing CPR will eventually receive iodinated radiocontrast media (e.g. for computed tomography or coronary angiography). This is one of the reasons why early identifying subjects at high risk for possible iodine-induced thyrotoxicosis is important. Increases oxygen consumption of myocardial tissue in hyperthyroidism is one of the reasons for high mortality in thyrotoxicosis. Therefore, accurate diagnosis of alterations in the hypothalamus-pituitary-thyroid (HPT) axis is of paramount importance.

Being tested
TSH determination, FT4 determination, FT3 determination, SPINA-GT, SPINA-GD
Keywords
thyroid, homeostasis, allostasis, resuscitation, allostatic load, critical illness, TACITUS, NTIS, Circulatory arrest
Medical subject headings
Heart Arrest, Ventricular Fibrillation, Ventricular Flutter, Tachycardia, Ventricular, Thyroid Diseases, Critical Illness

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TSH determinationDiagnostic test

    Also called serum thyrotropin determination

    Determination of serum concentration of thyrotropin (TSH)

  • FT4 determinationDiagnostic test

    Also called serum free T4 determination

    Determination of serum free thyroxine (FT4) concentration

  • FT3 determinationDiagnostic test

    Also called serum free T3 determination

    Determination of serum free triiodothyronine (FT3) concentration

  • SPINA-GTDiagnostic test

    Also called GT, Thyroid's secretory capacity, LOINC 82368-2, thyroid's incretory capacity

    Calculation of thyroid's secretory capacity (SPINA-GT)

  • SPINA-GDDiagnostic test

    Also called GD, Sum activity of peripheral deiodinases, LOINC 82367-4, deiodination capacity

    Calculation of total deiodinase activity (SPINA-GD)

Study groups in NCT04392258
Study groupRoleWhat they receive
Status post resuscitationPatients or dataset that underwent resuscitation
Receives: Diagnostic Test: TSH determination; Diagnostic Test: FT4 determination; Diagnostic Test: FT3 determination; Diagnostic Test: SPINA-GT; Diagnostic Test: SPINA-GD

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. TSH response

    Changes in TSH concentration after CPR compared to the value after 24 hours

    Measured: three hours

Secondary outcomes (1)
  1. Prognosis

    Mortality dependent on pituitary thyrotropic partial function

    Measured: Through study completion, an average of 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 May 2020
  2. Study start1 May 2021
  3. Primary completion1 Jun 2022 (estimated)
  4. Study completion31 Dec 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case only
Time perspective
Prospective
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04392258
Sponsor's protocol ID
19-6678-BR
Other IDs
U1111-1251-7468, DRKS00021695
Acronym
Thyro-CPR
Status last verified
Aug 2021
First submitted
7 May 2020
Last updated
19 Aug 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Sharing may be considered upon reasonable request.

Publications

  • Dietrich JW, Stachon A, Antic B, Klein HH, Hering S. The AQUA-FONTIS study: protocol of a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardized diagnostics and classification of non-thyroidal illness syndrome. BMC Endocr Disord. 2008 Oct 13;8:13. doi: 10.1186/1472-6823-8-13.

    PubMed 18851740
  • Dietrich JW, Landgrafe G, Fotiadou EH. TSH and Thyrotropic Agonists: Key Actors in Thyroid Homeostasis. J Thyroid Res. 2012;2012:351864. doi: 10.1155/2012/351864. Epub 2012 Dec 30.

    PubMed 23365787
  • Dietrich JW, Muller P, Schiedat F, Schlomicher M, Strauch J, Chatzitomaris A, Klein HH, Mugge A, Kohrle J, Rijntjes E, Lehmphul I. Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling. Eur Thyroid J. 2015 Jun;4(2):129-37. doi: 10.1159/000381543. Epub 2015 May 23.

    PubMed 26279999
  • Dietrich JW, Landgrafe-Mende G, Wiora E, Chatzitomaris A, Klein HH, Midgley JE, Hoermann R. Calculated Parameters of Thyroid Homeostasis: Emerging Tools for Differential Diagnosis and Clinical Research. Front Endocrinol (Lausanne). 2016 Jun 9;7:57. doi: 10.3389/fendo.2016.00057. eCollection 2016.

    PubMed 27375554
  • Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front Endocrinol (Lausanne). 2017 Jul 20;8:163. doi: 10.3389/fendo.2017.00163. eCollection 2017.

    PubMed 28775711
  • Muller P, Dietrich JW, Lin T, Bejinariu A, Binnebossel S, Bergen F, Schmidt J, Muller SK, Chatzitomaris A, Kurt M, Gerguri S, Clasen L, Klein HH, Kelm M, Makimoto H. Usefulness of Serum Free Thyroxine Concentration to Predict Ventricular Arrhythmia Risk in Euthyroid Patients With Structural Heart Disease. Am J Cardiol. 2020 Apr 15;125(8):1162-1169. doi: 10.1016/j.amjcard.2020.01.019. Epub 2020 Jan 29.

    PubMed 32087999
  • Aweimer A, El-Battrawy I, Akin I, Borggrefe M, Mugge A, Patsalis PC, Urban A, Kummer M, Vasileva S, Stachon A, Hering S, Dietrich JW. Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study. J Intern Med. 2021 May;289(5):675-687. doi: 10.1111/joim.13189. Epub 2020 Nov 12.

    PubMed 33179374

Questions about this trial

What is this clinical trial studying?

An observational study of Heart Arrest and Ventricular Fibrillation, run by Ruhr University of Bochum at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 19 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Johannes W Dietrich, M.D. (+49-234-302 ext. 6400, johannes.dietrich@ruhr-uni-bochum.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

TSH response (time frame: three hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04392258, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Aug 2021.

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