Euthyroid sick syndrome diagnostic criteria

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


The diagnosis of euthyroid sick syndrome is based on clinical presentation and thyroid function tests. An important part in diagnosing euthyroid sick syndrome is to be able to differentiate between other causes of hypothyroidism and euthyroid sick syndrome. Although the diagnosis of hypothyroidism is mainly a laboratory diagnosis, the coexisting conditions and wide variation in clinical presentation may make the diagnosis difficult. The best initial test is TSH, which in euthyroid sick syndrome can be low, normal, or elevated but not as high as it would be in hypothyroidism. Serum reverse T3 is elevated from inhibition of 5' monodeiodinase(type I). Patient having severe underlying illness, as in euthyroid sick syndrome have elevated levels of serum cortisol from underlying stress whereas patients of hypothyroidism have low serum cortisol from associated hypothalmic/pituitary abnormality. [1][2][3]

Diagnostic Criteria

There is no specific diagnostic criteria for euthyroid sick syndrome. However, diagnosis of euthyroid sick syndrome is made when there is a severe underlying illness, normal appearing thyroid gland and low T3 with elevated reverse T3. The other thyroid hormones T4, TSH, and TRH all depend upon the severity of the illness. These hormones are affected in variable degrees based on the severity and duration of the underlying illness.

Euthyroid sick syndrome T3

(80-180 ng/dl)


(4.6-12 ug/dl)


(0.7-1.9 ng/dl)


(0.4 to 4.0mIU/L)

Reverse T3

(90 to 350pg/mL)

Mild euthyroid sick syndrome N N N
Moderate euthyroid sick syndrome N N/↓ N/↓
Severe euthyroid sick syndrome N/↓
Recovery N/↓ N N N N/


  1. O'Brien T, Dinneen SF, O'Brien PC, Palumbo PJ (1993). "Hyperlipidemia in patients with primary and secondary hypothyroidism". Mayo Clin. Proc. 68 (9): 860–6. PMID 8371604.
  2. Diekman T, Lansberg PJ, Kastelein JJ, Wiersinga WM (1995). "Prevalence and correction of hypothyroidism in a large cohort of patients referred for dyslipidemia". Arch. Intern. Med. 155 (14): 1490–5. PMID 7605150.
  3. Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.

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