Physiologie du mourir : hypothyroïdie en soins palliatifs

Patients in their last months or weeks of life demonstrate an hypothyroid syndrome. This is due to a low secretion of TRH and TSH (central inhibition of thyroid function) as well as to a reduced transformation of T4 into T3 by desiodination in the liver and other peripheral tissues. These changes have a profound influence on the metabolism and contribute to the clinical picture observed. This is thought to be a normal adaptative phenomenon. It is believed that it protects the patients against the proteolytic effect of T3, sparing the muscle mass. Others show that the low T3 syndrome shortens the survival time in certain diseases. Our analysis suggests that thyroid replacement could be safely reduced in the end-of-life period in patients using exogenous replacement of T4.