{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T04:07:58Z","timestamp":1777003678457,"version":"3.51.4"},"reference-count":71,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2021,3,13]],"date-time":"2021-03-13T00:00:00Z","timestamp":1615593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"ERC Advanced","award":["833247"],"award-info":[{"award-number":["833247"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Lymphopenia is a key feature of immune dysfunction in patients with bacterial sepsis and coronavirus disease 2019 (COVID-19) and is associated with poor clinical outcomes, but the cause is largely unknown. Severely ill patients may present with thyroid function abnormalities, so-called nonthyroidal illness syndrome, and several studies have linked thyrotropin (thyroid stimulating hormone, TSH) and the thyroid hormones thyroxine (T4) and 3,5,3\u2032-triiodothyronine (T3) to homeostatic regulation and function of lymphocyte populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This work aimed to test the hypothesis that abnormal thyroid function correlates with lymphopenia in patients with severe infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of absolute lymphocyte counts, circulating TSH, T4, free T4 (FT4), T3, albumin, and inflammatory biomarkers was performed in 2 independent hospitalized study populations: bacterial sepsis (n\u2005=\u2005224) and COVID-19 patients (n\u2005=\u2005161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Only T3 significantly correlated (\u03c1\u2005=\u20050.252) with lymphocyte counts in patients with bacterial sepsis, and lower concentrations were found in severe lymphopenic compared to nonlymphopenic patients (n\u2005=\u200556 per group). Severe lymphopenic COVID-19 patients (n\u2005=\u200517) showed significantly lower plasma concentrations of TSH, T4, FT4, and T3 compared to patients without lymphopenia (n\u2005=\u200518), and demonstrated significantly increased values of the inflammatory markers interleukin-6, C-reactive protein, and ferritin. Remarkably, after 1 week of follow-up, the majority (12 of 15) of COVID-19 patients showed quantitative recovery of their lymphocyte numbers, whereas TSH and thyroid hormones remained mainly disturbed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Abnormal thyroid function correlates with lymphopenia in patients with severe infections, like bacterial sepsis and COVID-19, but future studies need to establish whether a causal relationship is involved.<\/jats:p><\/jats:sec>","DOI":"10.1210\/clinem\/dgab148","type":"journal-article","created":{"date-parts":[[2021,3,13]],"date-time":"2021-03-13T20:09:25Z","timestamp":1615666165000},"page":"1994-2009","source":"Crossref","is-referenced-by-count":25,"title":["The Association of TSH and Thyroid Hormones With Lymphopenia in Bacterial Sepsis and COVID-19"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4687-9845","authenticated-orcid":false,"given":"Inge","family":"Grondman","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline H","family":"de Nooijer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Antonakos","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9629-8627","authenticated-orcid":false,"given":"Nico A F","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Mouktaroudi","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Leventogiannis","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Medici","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen, 6525 GA, Nijmegen, the Netherlands"},{"name":"Academic Center for Thyroid Diseases and Departments of Internal Medicine and Epidemiology, Erasmus Medical Centre, 3015 GE, Rotterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan W A","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen, 6525 GA, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonius E","family":"van Herwaarden","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6166-9830","authenticated-orcid":false,"given":"Leo A B","family":"Joosten","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank L","family":"van de Veerdonk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Pickkers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525GA, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthijs","family":"Kox","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525GA, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Jaeger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai G","family":"Netea","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands"},{"name":"Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, 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