Study Observes Damage to Thyroid Gland in Fatal Burn Patients

A histopathologic study of the thyroid gland in patients who suffered fatal burns demonstrated the morphological changes in the thyroid as a result of a burn-induced hypermetabolic state, pointing to a strong likelihood of hypothyroidism among severe burn patients.

Researchers at Nilratan Sircar Medical College and Hospital, West Bengal, India, sought to understand how the hypermetabolic state induced by severe burns affects the thyroid gland and its function. They noted existing evidence of decreasing triiodothyronine (T3) serum concentrations in burn patients over the first few days post injury and aimed to examine the morphological changes of the thyroid that accompany these functional changes. The study’s author noted that though histological lesions on the thyroid glands of animals in experimental burn studies have been observed, no such studies have previously examined this pathophysiological aspect of severe burns in humans.

The study included a sample of 64 patients who suffered fatal burn wounds, excluding those who suffered chemical, electrical, or radiation burns; cases of post-mortem burns or charred bodies; and those with a known history of thyroid dysfunction. Samples from each patient’s thyroid glands were collected for medicolegal autopsy, preserved in a 10% buffered formalin solution, embedded in paraffin, and stained with hematoxylin and eosin (H&E) for examination under light microscopy.

Researchers observed distinct histopathological changes in the majority of the thyroid samples, including mononuclear cell infiltration (65.62%), distortion of the thyroid follicular architecture (59.37%), clumping of thyroglobulin (21.87%), and exhaustion of the thyroid follicles (17.18%). They also noted that mononuclear cell infiltration and distortion of the thyroid follicular architecture increased with longer periods of survival, and mononuclear cell infiltration increased with greater total body surface area of burns (over 50%). 

Histopathological changes in the thyroid gland following severe burns are a result of metabolic damage to the thyroid, primarily presenting as distortion of thyroid follicular architecture and mononuclear cell infiltration, the latter of which may be attributed to the inflammatory response following the burn. The increase in these results observed with longer survival times post burn and greater total body surface area of burns suggests “an acute and persistently evolving inflammatory manifestation.” According to the study’s authors, “Burn injury produces comprehensive changes to the entire immune system. Regardless of infection, pro-inflammatory immune responses are produced in the peripheral blood and affected tissue gradually leading to the systemic inflammatory response syndrome (SIRS), hypermetabolic state, and damage to nearby tissues and distant organs as well.”

The authors add, “it can also be inferred that the hypothalamic-pituitary-thyroid axis has a minimal role in combating post-burn stress as the disrupted follicles won’t respond to the feedback mechanism,” noting the potential need for hormone therapy in surviving burn patients to manage thyroid function as a part of the healing process.

—Kirra Fedyszyn, Associate Digital Editor

Reference:
Chattopadhyay S, Roy AK, Saha D. Assessment of histopathological changes in the thyroid gland of fatal burn patients: A cross-sectional study. Burns Open. 2022;6(4):164-167. https://doi.org/10.1016/j.burnso.2022.08.001