Euthyroid sick syndrome causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Euthyroid sick syndrome can be caused by any serious illness which leads to increased level of cytokines, decreased level of leptin, hyper-metabolism, decreased protein synthesis and decreased level of thyroid-binding globulin. The conditions include sepsis, malignancy, trauma, surgery, burns, bone marrow transplantation, metabolic disorders, and other inflammatory conditions.

Causes

Common Causes

Euthyroid sick syndrome can be caused by any serious illness which leads to increased level of cytokines, decreased level of leptin, hyper-metabolism, iodine containing contrast medium, decreased protein synthesis and decreased level of thyroid-binding globulin. The conditions include:[1][2][3]

Less Common Causes

  • The following table summarize the effect of various drugs on thyroid hormones level:
↓ Hormone secretion ↓ T4 ↓ TSH ↓ 5' monodeiodinase ↑ Breakdown of

thyroid hormones

Thyroid binding globulin
Increased Decreased
  • Lithium
  • Amiodarone
  • Aluminum hydroxide
  • Ferrous sulphate
  • Sucralfate
  • Dopamine
  • Octreotide
  • Glucocorticoids
  • Propylthiouracil
  • Amiodarone
  • Propranolol (high dose)
  • Phenobarbital
  • Rifampin
  • Phenytoin
  • Carbamazepine
  • Estrogens
  • Tamoxifen
  • Fluorouracil
  • Methadone
  • Heroin
  • Androgens
  • Anabolic steroids
  • Glucocorticoids
  • Furosemide
  • Mefenamic acid
  • Salicylates

References

  1. Silva MH, Araujo MC, Diniz EM, Ceccon ME, Carvalho WB (2015). "Nonthyroidal illnesses syndrome in full-term newborns with sepsis". Arch Endocrinol Metab. 59 (6): 528–34. doi:10.1590/2359-3997000000111. PMID 26677087.
  2. Frączek MM, Gackowski A, Przybylik-Mazurek E, Nessler J (2016). "[The relation between the low T3 syndrome in the clinical course of myocardial infarction and heart failure]". Pol. Merkur. Lekarski (in Polish). 40 (240): 380–3. PMID 27403906.
  3. Girvent M, Maestro S, Hernández R, Carajol I, Monné J, Sancho JJ, Gubern JM, Sitges-Serra A (1998). "Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation". Surgery. 123 (5): 560–7. doi:10.1067/msy.1998.87238. PMID 9591009.

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