Euthyroid sick syndrome

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Euthyroid sick syndrome Microchapters

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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

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

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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:

Synonyms and keywords: sick euthyroid syndrome; non-thyroidal illness syndrome; low T3 low T4 syndrome

Euthyroid sick syndrome
ICD-10 E07.8
ICD-9 790.94
MeSH D005067

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Drugs leading to decreased 5'monodeiodinase are propranolol (high doses), amiodarone, and glucocorticoid therapy.

Differentiating Euthyroid sick syndrome from Other Diseases

Fasting, starvation, sepsis, trauma, cardiopulmonary bypass, malignancy, heart failure, hypothermia, myocardial infarction, chronic renal failure, cirrhosis, and diabetic ketoacidosis.


Epidemiology and Demographics

Euthyroid sick syndrome is seen in 40-100% patients of nonthyroidal illness.

Age

Euthyroid sick syndrome is more commonly seen in elderly population. People over 65 have more chronic illnesses and have a greater probability of developing euthyroid sick syndrome.

Race

Euthyroid sick syndrome has no racial predilection.

Sex

Euthyroid sick syndrome affects men and women equally.

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and symptom

The common symptoms and signs of clinical hypothyroidism are listed in the table below. The appearance of symptoms depends on the degree of hypothyroidism severity: [1][2][3][4]

Symptoms Constituitional HEENT Neuromuscular Other findings
More common
Less common
  • Slowed speech and movements

Physical Examination

Laboratory Findings

Laboratory findings consistent with the diagnosis of euthyroid sick syndrome include

Euthyroid sick syndrome Laboratory test
Mild euthyroid sick syndrome
Moderate euthyroid sick syndrome
Severe euthyroid sick syndrome

Imaging Findings

Other Diagnostic Studies

In euthyroid sick syndrome the thyroid gland appears normal. Therefore, there is no role of thyroid uptake scan in euthyroid sick syndrome.

Treatment

Medical Therapy

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

External links

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

References

  1. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P (2014). "Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study". Eur. J. Endocrinol. 171 (5): 593–602. doi:10.1530/EJE-14-0481. PMID 25305308.
  2. Diaz A, Lipman Diaz EG (2014). "Hypothyroidism". Pediatr Rev. 35 (8): 336–47, quiz 348–9. doi:10.1542/pir.35-8-336. PMID 25086165.
  3. Samuels MH (2014). "Psychiatric and cognitive manifestations of hypothyroidism". Curr Opin Endocrinol Diabetes Obes. 21 (5): 377–83. doi:10.1097/MED.0000000000000089. PMC 4264616. PMID 25122491.
  4. McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.


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