Euthyroid sick syndrome: Difference between revisions

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{{SI}}
{{Euthyroid sick syndrome}}
{{CMG}}; {{AE}}
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{{SK}} sick euthyroid syndrome; non-thyroidal illness syndrome; low T3 low T4 syndrome
{{SK}} sick euthyroid syndrome; non-thyroidal illness syndrome (NTIS); low T3 low T4 syndrome; thyroid allostasis in critical illness, tumours, uraemia and starvation (TACITUS)


{{Infobox_Disease |
'''For patient information, click [[Xyz (patient information)|here]]'''
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|E|07|8|e|00}} |
ICD9 = {{ICD9|790.94}} |
ICDO = |
OMIM = |
MedlinePlus = |
MeshID = D005067 |
}}


==Overview==
==[[Euthyroid sick syndrome overview|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 and the [[thyroid gland]] does not appear to be dysfunctional. Euthyroid sick syndrome is seen in conditions of starvation and critical illness such as sepsis, surgery, and bone marrow transplantation. 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 5'deiodinase. 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.<ref name="pmid9712558">{{cite journal |vauthors=Plank LD, Connolly AB, Hill GL |title=Sequential changes in the metabolic response in severely septic patients during the first 23 days after the onset of peritonitis |journal=Ann. Surg. |volume=228 |issue=2 |pages=146–58 |year=1998 |pmid=9712558 |pmc=1191454 |doi= |url=}}</ref><ref name="pmid21724536">{{cite journal |vauthors=Economidou F, Douka E, Tzanela M, Nanas S, Kotanidou A |title=Thyroid function during critical illness |journal=Hormones (Athens) |volume=10 |issue=2 |pages=117–24 |year=2011 |pmid=21724536 |doi= |url=}}</ref><ref name="pmid30020">{{cite journal |vauthors=Harris AR, Fang SL, Vagenakis AG, Braverman LE |title=Effect of starvation, nutriment replacement, and hypothyroidism on in vitro hepatic T4 to T3 conversion in the rat |journal=Metab. Clin. Exp. |volume=27 |issue=11 |pages=1680–90 |year=1978 |pmid=30020 |doi= |url=}}</ref>


==Historical Perspective==
==[[Euthyroid sick syndrome historical perspective|Historical Perspective]]==


==Classification==
==[[Euthyroid sick syndrome classification|Classification]]==


==Pathophysiology==
==[[Euthyroid sick syndrome pathophysiology|Pathophysiology]]==
T3 is the biologically active form of thyroid hormone. Normally most of the T3 is produced by peripheral deiodination of circulating T4 by the enzyme 5’-monodeiodinase. In euthyroid sick syndrome there occurs inhibition of the enzyme 5΄-deiodinase and it leads to decrease conversion of T4 to T3.


==Causes==
==[[Euthyroid sick syndrome causes|Causes]]==


==Differentiating {{PAGENAME}} from Other Diseases==
==[[Differentiating Euthyroid sick syndrome from other diseases|Differentiating Euthyroid sick syndrome  from other Diseases]]==
[[Fasting]], [[starvation]], [[sepsis]], [[Physical trauma|trauma]], [[cardiopulmonary bypass]], [[malignancy]], [[heart failure]], [[hypothermia]], [[myocardial infarction]], [[chronic renal failure]], [[cirrhosis]], and [[diabetic ketoacidosis]].


==Epidemiology and Demographics==
==[[Euthyroid sick syndrome epidemiology and demographics|Epidemiology and Demographics]]==


==Risk Factors==
==[[Euthyroid sick syndrome risk factors|Risk Factors]]==


==Screening==
==[[Euthyroid sick syndrome screening|Screening]]==


==Natural History, Complications, and Prognosis==
==[[Euthyroid sick syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
===Natural History===
 
===Complications===
 
===Prognosis===


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
[[Euthyroid sick syndrome history and symptoms|History and Symptoms]] | [[Euthyroid sick syndrome physical examination|Physical Examination]] | [[Euthyroid sick syndrome laboratory findings|Laboratory Findings]] | [[Euthyroid sick syndrome X-ray|X-Ray Findings]] | [[Euthyroid sick syndrome CT scan|CT-Scan Findings]] | [[Euthyroid sick syndrome MRI|MRI Findings]] | [[Euthyroid sick syndrome other diagnostic studies|Other Diagnostic Studies]] | [[Euthyroid sick syndrome other imaging findings|Other Imaging Findings]]
 
===History and Symptoms===
 
===Physical Examination===
 
===Laboratory Findings===
 
===Imaging Findings===
 
===Other Diagnostic Studies===


==Treatment==
==Treatment==
===Medical Therapy===
[[Euthyroid sick syndrome medical therapy|Medical Therapy]] | [[Euthyroid sick syndrome surgery|Surgery]] | [[Euthyroid sick syndrome primary prevention|Primary Prevention]] | [[Euthyroid sick syndrome secondary prevention|Secondary Prevention]] | [[Euthyroid sick syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Euthyroid sick syndrome future or investigational therapies|Future or Investigational Therapies]]
Ill patients may have normal to low TSH depending on the spectrum of illness. Total T4 and T3 levels may be altered by [[binding protein]] abnormalities, and medications. [[Reverse T3]] are generally increased signifying inhibition of normal Type 1 enzyme or reduced clearance of reverse T3. Measurement of free T4 and/or free T3 levels will be normal.
 
===Surgery===


===Prevention===
==Case Studies==
[[Euthyroid sick syndrome case study one|Case #1]]


==External links==
==External links==

Latest revision as of 20:59, 4 September 2017

Euthyroid sick syndrome Microchapters

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Overview

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Pathophysiology

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Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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MRI

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Case #1

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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]

Synonyms and keywords: sick euthyroid syndrome; non-thyroidal illness syndrome (NTIS); low T3 low T4 syndrome; thyroid allostasis in critical illness, tumours, uraemia and starvation (TACITUS)

For patient information, click here

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Euthyroid sick syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X-Ray Findings | CT-Scan Findings | MRI Findings | Other Diagnostic Studies | Other Imaging Findings

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

External links

  • McIver B, Gorman C (1997). "Euthyroid sick syndrome: an overview". Thyroid. 7 (1): 125–32. PMID 9086580.

References


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