Euthyroid sick syndrome overview: Difference between revisions

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==Differentiating Euthyroid sick syndrome from Other Diseases==
==Differentiating Euthyroid sick syndrome from Other Diseases==
[[Euthyroid]] sick syndrome must be differentiated from other causes of [[hypothyroidism]] on the basis of clinical features and laboratory findings. In [[euthyroid]] sick syndrome, serum [[T3]] is decreased more than [[T4]], the T3RU (T3 resin uptake) is high, and [[Thyroid-stimulating hormone|TSH]] is normal or mildly decreased. In [[primary hypothyroidism]], serum [[T4]] is decreased more than [[T3]], the T3RU (T3 resin uptake) is low, and [[TSH]] is increased. Other causes of [[hypothyroidism]] include transient hypothyroidism, sub-clinical hypothyroidism, central hypothyroidism ([[pituitary]] or [[Hypothalamic|hypothaalmic]]) and peripheral [[resistance]] to [[Thyroid-stimulating hormone|TSH]]/[[Thyrotropin-releasing hormone|TRH]].<ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="pmid11836274">{{cite journal |vauthors=Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE |title=Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=489–99 |year=2002 |pmid=11836274 |doi=10.1210/jcem.87.2.8182 |url=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref>
[[Euthyroid]] sick syndrome must be differentiated from other causes of [[hypothyroidism]] on the basis of clinical features and laboratory findings. In [[euthyroid]] sick syndrome, serum [[T3]] is decreased more than [[T4]], the T3RU (T3 resin uptake) is high, and [[Thyroid-stimulating hormone|TSH]] is normal or mildly decreased. In [[primary hypothyroidism]], serum [[T4]] is decreased more than [[T3]], the T3RU (T3 resin uptake) is low, and [[TSH]] is increased.


==Epidemiology and Demographics==
==Epidemiology and Demographics==

Revision as of 16:43, 8 August 2017

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

Overview

Euthyroid sick syndrome is a thyroid hormone disorder where the levels of T3 (triiodothyronine) and/or T4 (thyroxine) are at unusual levels, in the setting of a nonthyroidal illness. Thyroid hormones play a major role in the metabolism, growth and maturation of the human body. Euthyroid sick syndrome is seen in conditions of starvation and critical illness such as sepsis, surgery, severe trauma, burns, metabolic disorders, bone marrow transplantation, and malignancy. During these stress conditions, there occurs hypermetabolism, increased energy expenditure, hyperglycemia, and muscle loss. It is speculated, that the body in order to contain this hypermetabolism induces some degree of hypothyroidism by inhibiting deiodination of T4 to T3 by the enzyme 5’-monodeiodinase. This is an adaptive process by which the body prevents further muscle and calorie loss. Euthyroid sick syndrome presents with low serum T3. 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.[1][2][3]

Historical Perspective

Classification

Pathophysiology

Euthyroid sick syndrome is not a primary thyroid disorder but instead results from changes induced by the nonthyroidal illness. The cause of euthyroid sick syndrome is multifactorial. It is thought that euthyroid sick syndrome is the result of severe illness and inflammation. During these stress conditions, there occurs hypermetabolism, increased energy expenditure, hyperglycemia, and muscle loss. It is speculated, that the body in order to contain this hypermetabolism induces some degree of hypothyroidism by inhibiting deiodination of T4 to T3 by the enzyme 5’-monodeiodinase. This is an adaptive process by which the body prevents further muscle and calorie loss. Inflammation leads to increased production of cytokines that severely affect genes involved in the production and release of T4 and T3. There is also downregulation of TRH and TSH release from the hypothalamus and pituitary gland respectively. It may be signalled by a decrease in leptin caused by malnutrition. On gross pathology, euthyroid sick syndrome does not appear to be dysfunctional. On microscopic histopathological analysis, euthyroid sick syndrome presents with normal thyroid histology.

Causes

Differentiating Euthyroid sick syndrome from Other Diseases

Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of clinical features and laboratory findings. In euthyroid sick syndrome, serum T3 is decreased more than T4, the T3RU (T3 resin uptake) is high, and TSH is normal or mildly decreased. In primary hypothyroidism, serum T4 is decreased more than T3, the T3RU (T3 resin uptake) is low, and TSH is increased.

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT scan

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

References

  1. Plank LD, Connolly AB, Hill GL (1998). "Sequential changes in the metabolic response in severely septic patients during the first 23 days after the onset of peritonitis". Ann. Surg. 228 (2): 146–58. PMC 1191454. PMID 9712558.
  2. Economidou F, Douka E, Tzanela M, Nanas S, Kotanidou A (2011). "Thyroid function during critical illness". Hormones (Athens). 10 (2): 117–24. PMID 21724536.
  3. Harris AR, Fang SL, Vagenakis AG, Braverman LE (1978). "Effect of starvation, nutriment replacement, and hypothyroidism on in vitro hepatic T4 to T3 conversion in the rat". Metab. Clin. Exp. 27 (11): 1680–90. PMID 30020.


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