Euthyroid sick syndrome classification

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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]


Euthyroid sick syndrome may be classified according to the level of thyroid hormones and the severity of the underlying disease into mild, moderate, severe, and recovery phase.


Source: Courtesy of Chatzitomaris A et al Endocrinol. 8:163. doi: 10.3389/fendo.2017.00163 (2017)made freely available under a Creative Commons Attribution License (CC BY)

Euthyroid sick syndrome may be classified according to the level of thyroid hormones and the severity of the underlying disease. Depending upon the severity and duration of the stress inducing condition, the thyroid-stimulating hormone (TSH), thyroxine (T4), and free T4 (FT4) are affected in variable proportions. The drop in levels of T3 and T4 is associated with more severe illnesses. On the basis of thyroid hormone levels euthyroid sick syndrome can be categorized into:[1][2][3][4][5][6][7]

Additionally, two phenotypes of euthyroid sick syndrome use to be distinguished, depending on the question if it occurs over short time in acute illness or if it represents a chronic condition (referred to as wasting syndrome)[3]. In the latter case, concentrations of T3 are even more reduced, and 3,5-T2 concentrations are increased[6].

Euthyroid Sick Syndrome
Mild euthyroid sick syndrome
Moderate euthyroid sick syndrome
Severe euthyroid sick syndrome
Recovery phase
•Decreased T3
•Normal T4, FT4 and TSH
•Increased reverse T3
• Decreased T3
• Normal/decreased FT4 and TSH
• Increased reverse T3
• Decreased T3, T4 and TSH
• Normal/decreased FT4
• Increased reverse T3
• Normal/decreased T3
• Normal/increased T4, FT4 and TSH
• Normal/increased reverse T3


  1. Golombek SG (2008). "Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients". Semin. Perinatol. 32 (6): 413–8. doi:10.1053/j.semperi.2008.09.010. PMID 19007679.
  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. 3.0 3.1 Van den Berghe G (2014). "Non-thyroidal illness in the ICU: a syndrome with different faces". Thyroid. 24 (10): 1456–65. doi:10.1089/thy.2014.0201. PMC 4195234. PMID 24845024.
  4. Murakami M (2012). "[Nonthyroidal illness (NTI)]". Nippon Rinsho (in Japanese). 70 (11): 2005–10. PMID 23214076.
  5. Lee S, Farwell AP (2016). "Euthyroid Sick Syndrome". Compr Physiol. 6 (2): 1071–80. doi:10.1002/cphy.c150017. PMID 27065175.
  6. 6.0 6.1 Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front Endocrinol (Lausanne). 2017 Jul 20;8:163. doi:10.3389/fendo.2017.00163. PMID 28775711; PMCID PMC5517413
  7. Dietrich JW, Landgrafe G, Fotiadou EH. TSH and Thyrotropic Agonists: Key Actors in Thyroid Homeostasis. J Thyroid Res. 2012;2012:351864. doi:10.1155/2012/351864. PMID 23365787; PMCID PMC3544290.

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