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Non-thyroidal illness syndrome (NTIS), also referred to as euthyroid sick syndrome (ESS) or thyroid allostasis in critical illness, tumours, uraemia and starvation (TACITUS) is a complex endocrine condition that may occur in critically ill patients. It is associated with significantly increased morbidity and mortality.

NTIS is characterised by three components that may occur single or in combination:

1. central hypothyroidism (transient thyrotropic insufficiency)
2. impaired protein binding of thyroid hormones and
3. reduced formation of T3 and increased conversion to rT3 (low-T3-syndrome).

Despite of long lasting research to some of its details, NTIS is still poorly characterized in an integrative view. Additionally, it lacks a clinically usable classification.

Given the fact that patients with TACITUS are faced with poor prognosis, several studies have been conducted in the past evaluating the question of possible treatment. However, they didn't yield unambiguous results, maybe due to the fact that these studies did not differentiate among the distinct components of NTIS.

Therefore, this study is intended to develop a clear-cut definition and classification of NTIS in order to set a foundation for future therapeutic studies.

This study recruits critically ill patients treated in medical and surgical intensive care units of the Bergmannsheil University hospitals for evaluation of integrative thyrotropic control and follow-up. From these data the correlation of individual prognosis with laboratory-defined components of TACITUS will be determined.

This project is intended to:

1. deliver a prognostical aid by providing a differentiated classification,
2. to contribute to a standardised, rational and inexpensive diagnostical procedure and
3. to lay the foundation for future therapeutic trials by identifying subgroups that may benefit from therapy.


The AQUA FONTIS study is registered in the database of NIH (number NCT00591032).




                    Bochum (RUB)


Current news:

November 12th 2020: Paper on thyroid allostasis in takotsubo syndrome published.

September 19th 2019: Research paper on NTIS / TACITUS syndrome in trauma published.

January 28th, 2011: The AQUA FONTIS G study receives the abstract award of the North Rhine-Westphalian Society for Endocrinology and Diabetology.

December 1st, 2009: Recruitment phase of AQUA FONTIS I study finalised.

March 18th, 2008: The first patient is included in the AQUA FONTIS II study.

May 11th, 2007: Start of the operative phase of the AQUA FONTIS I study.

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