Euthyroid sick syndrome natural history, complications and prognosis
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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]
Overview
If left untreated, patients with euthyroid sick syndrome may progress to develop hypothyroidism or resolve spontaneously with correction of underlying condition. If underlying condition is not corrected, the thyroid hormone levels starts to drop after 2-3 weeks of initial illness. The symptoms of hypothyroidism may take some additional weeks before they start to appear. The complications of euthyroid sick syndrome depends upon other organ systems involved and underlying disease. The general complications of hypothyroidism as seen in euthyroid sick syndrome include hypothermia, bradycardia, heart failure, dyspnea, myopathy, confusion, apathy and psychosis. Laboratory findings will show increased levels of cholesterol and triglycerides. In addition, patients will have features of organs system involvement. The prognosis varies and depends upon extent of the underlying disease at the time of diagnosis. Patients with low T3 (< 2.3 pg/ml) levels may have a longer hospital stay. Mortality rate is as high as 80% when serum T4 value is <3 mcg/dL.
Natural History, Complications, and Prognosis
Natural History
If left untreated, patients with euthyroid sick syndrome may either progress to:[1]
- Hypothyroidism: If the underlying condition is not corrected, thyroid hormone levels starts to drop after 2-3 weeks of initial illness. The symptoms of hypothyroidism may take some additional weeks before they start to appear. The common symptoms of hypothyroidism include fatigue, cold intolerance, decreased sweating, hypothermia, coarse skin, and weight gain
If the patient is treated of the underlying condition, thyroid hormones gradually return to normal level and symptoms of hypothyroidism subside.
Complications
The complications of euthyroid sick syndrome depends upon the other organ systems involved and underlying disease. The general complications of hypothyroidism as seen in euthyroid sick syndrome include:[2][3]
- Hypothermia
- Bradycardia
- Heart failure
- Dyspnea
- Confusion
- Apathy
- Psychosis
- Increased serum cholestrol & triglycerides
Prognosis
Depending on the extent of the underlying disease at the time of diagnosis, the prognosis may vary. Patients with low free T3 (< 2.3 pg/ml) levels may have a longer hospital stay and higher rates of intensive care unit admission. Mortality rate is as high as 80% when serum T3 is extremely low and/or T4 value is <3 mcg/dL.[4][5][6][7][8]
References
- ↑ Fliers, Eric; Bianco, Antonio C; Langouche, Lies; Boelen, Anita (2015). "Thyroid function in critically ill patients". The Lancet Diabetes & Endocrinology. 3 (10): 816–825. doi:10.1016/S2213-8587(15)00225-9. ISSN 2213-8587.
- ↑ Docter R, Krenning EP, de Jong M, Hennemann G (1993). "The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism". Clin. Endocrinol. (Oxf). 39 (5): 499–518. PMID 8252737.
- ↑ Shanoudy H, Soliman A, Moe S, Hadian D, Veldhuis JD, Iranmanesh A, Russell DC (2001). "Early manifestations of "sick euthyroid" syndrome in patients with compensated chronic heart failure". J. Card. Fail. 7 (2): 146–52. doi:10.1054/jcaf.2001.24665. PMID 11420766.
- ↑ Liu J, Wu X, Lu F, Zhao L, Shi L, Xu F (2016). "Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia". Sci Rep. 6: 22271. doi:10.1038/srep22271. PMC 4772089. PMID 26928863.
- ↑ Slag MF, Morley JE, Elson MK, Crowson TW, Nuttall FQ, Shafer RB (1981). "Hypothyroxinemia in critically ill patients as a predictor of high mortality". JAMA. 245 (1): 43–5. PMID 7431627.
- ↑ Özcan KS, Osmonov D, Toprak E, Güngör B, Tatlısu A, Ekmekçi A, Kaya A, Tayyareci G, Erdinler İ (2014). "Sick euthyroid syndrome is associated with poor prognosis in patients with ST segment elevation myocardial infarction undergoing primary percutaneous intervention". Cardiol J. 21 (3): 238–44. doi:10.5603/CJ.a2013.0108. PMID 23990180.
- ↑ Muñoz-Ramirez Mdel R, Ortega-Valdez CA, Murillo-Heredia E (2016). "[Euthyroid sick syndrome as a risk factor for mortality in critically ill patients]". Med Clin (Barc) (in Spanish; Castilian). 146 (9): 414–5. doi:10.1016/j.medcli.2015.09.002. PMID 26520613.
- ↑ Rothberger GD, Gadhvi S, Michelakis N, Kumar A, Calixte R, Shapiro LE (2017). "Usefulness of Serum Triiodothyronine (T3) to Predict Outcomes in Patients Hospitalized With Acute Heart Failure". Am. J. Cardiol. 119 (4): 599–603. doi:10.1016/j.amjcard.2016.10.045. PMID 28017303.