الفهرس 
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Abstract
This prospective observational cross-sectional randomized study was conducted in emergency ICU of anesthesia and intensive care department, Minia University Hospital on patients suffering from isolated moderate to severe traumatic brain injury GCS (12-3) in one year from August 2022 to September 2023.
It was done after obtaining approval from ethical committee of Faculty of Medicine, Minia University in 12 ̸ 2020 ID 695:12 ̸ 2020
Fifty patients were investigated for the incidence and effect Euthyroid sick syndrome (which defined as a syndrome occurs in patients with systemic illness who were previously euthyroid but develop low serum thyroid hormone levels especially FT3 below normal reference ranges) on morbidity and mortality in traumatic brain injury patients. And if there is any relation to the level of GFAP (a biomarker of traumatic brain injury).
After taking personal information like
1. Personal data: age and sex.
2. Past history of previous interventions.
3. History of medical diseases
4. Past history of drug allergy or previous operation.
N.B Histories were obtained from relatives of 1st degree if the patient condition did not permit.
Patients were followed up for 1 week and the following parameters were assessed:
1. Glasgow coma scale (GCS)
2. APACHE II score
3. SOFA score
4. Thyroid functions on the (1st, 3rd, 5th, 7th) days on admission.
5. Glial fibrillary acidic protein (GFAP) 1st, 3rd, 5th, 7th) days on admission.
6. Need for mechanical ventilation.
7. Length of ICU Stay.
8. Outcomes (survive or died).
The study revealed:
The incidence of ESS among studied patients was presented as 50%. Although the number of patients suffered from ESS was higher is severe traumatic brain injury than the moderate but the difference was not statistically significant.
There was no significant difference in age and sex distribution between patients with and without ESS. Glasgow coma scores (GCS) tended to be lower in patients with ESS, although the difference was not statistically significant.
Patients with ESS had significantly lower levels of T3compared to patients without ESS; this suggests a clear association between ESS and alterations in T3 level.
GFAP levels did not show significant differences between patients with and without ESS across multiple measuring days in spite higher readings recorded in the ESS group.
No significant difference was found in Apache II score between patients with and without ESS.
However, Sofa scores were consistently higher in patients with ESS, but became significant from the 3rd day onward, indicating a higher severity of organ dysfunction in these patients.
Regression analysis reflected the validity of Sofa score as a prognostic indicator of developing ESS.
Patients with ESS had significantly higher mortality rates, increased need for mechanical ventilation (MV), and higher requirement for vasopressors compared to those without ESS.
Also, ESS was found to be a significant predictor of mortality, need for MV, and need for vasopressors.
Lastly, ESS group showed significant correlations between GCS and various clinical parameters such as, Sofa score, thyroid hormone levels (T3, T4), and GFAP levels. These correlations indicate the potential impact of ESS on patient outcomes and physiological parameters.