Euthyroid sick syndrome history and symptoms: Difference between revisions
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{{Euthyroid sick syndrome}} | {{Euthyroid sick syndrome}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{Akshun}} | ||
==Overview== | ==Overview== | ||
Patients of euthyroid sick syndrome present with serious [[illness]] and are [[febrile]] with [[hypermetabolism]]. In euthyroid sick syndrome the symptoms of the underlying condition may overlap with features of [[hypothyroidism]]. Generally it takes atleast 2-3 weeks for [[thyroid hormone]] levels to decline and symptoms of [[hypothyroidism]] takes even longer period for [[expression]]. | Obtaining a [[History and Physical examination|history]] gives important information in making a [[diagnosis]] of euthyroid sick syndrome. Complete history should be obtained regarding past and any newly diagnosed medical condition, previous history of thyroid disease and current medications. Patients of euthyroid sick syndrome present with serious [[illness]] and are [[febrile]] with [[hypermetabolism]]. In euthyroid sick syndrome the symptoms of the underlying condition may overlap with features of [[hypothyroidism]]. Generally it takes atleast 2-3 weeks for [[thyroid hormone]] levels to decline and symptoms of [[hypothyroidism]] takes even longer period for [[expression]]. The common symptoms of hypothyroidism are [[fatigue]], cold intolerance, decreased [[sweating]], [[hypothermia]], coarse skin, [[weight gain]], [[depression]], [[emotional lability]], and [[attention deficit]]. | ||
==History== | |||
Obtaining a [[History and Physical examination|history]] gives important information in making a [[diagnosis]] of euthyroid sick syndrome. It provides insight into the cause, precipitating factors, and associated [[comorbid]] conditions. A complete [[History and Physical examination|history]] will help determine the correct [[therapy]] and helps in determining the [[prognosis]]. In severe cases of euthyroid sick syndrome patients may be [[Disorientation|disoriented]], therefore, the [[patient]] interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be:<ref name="pmid8371604">{{cite journal |vauthors=O'Brien T, Dinneen SF, O'Brien PC, Palumbo PJ |title=Hyperlipidemia in patients with primary and secondary hypothyroidism |journal=Mayo Clin. Proc. |volume=68 |issue=9 |pages=860–6 |year=1993 |pmid=8371604 |doi= |url=}}</ref><ref name="pmid7605150">{{cite journal |vauthors=Diekman T, Lansberg PJ, Kastelein JJ, Wiersinga WM |title=Prevalence and correction of hypothyroidism in a large cohort of patients referred for dyslipidemia |journal=Arch. Intern. Med. |volume=155 |issue=14 |pages=1490–5 |year=1995 |pmid=7605150 |doi= |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid26071885">{{cite journal |vauthors=Fliers E, Bianco AC, Langouche L, Boelen A |title=Thyroid function in critically ill patients |journal=Lancet Diabetes Endocrinol |volume=3 |issue=10 |pages=816–25 |year=2015 |pmid=26071885 |pmc=4979220 |doi=10.1016/S2213-8587(15)00225-9 |url=}}</ref> | |||
*Any newly diagnosed [[medical condition]] such as cirrhosis, pneumonia and renal failure. | |||
*Previous history of [[thyroid disease]] | |||
*Current [[medications]] | |||
==Symptoms== | |||
===Common Symptoms=== | |||
The common symptoms of hypothyroidism are:<ref name="pmid25305308">{{cite journal |vauthors=Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P |title=Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study |journal=Eur. J. Endocrinol. |volume=171 |issue=5 |pages=593–602 |year=2014 |pmid=25305308 |doi=10.1530/EJE-14-0481 |url=}}</ref><ref name="pmid25086165">{{cite journal |vauthors=Diaz A, Lipman Diaz EG |title=Hypothyroidism |journal=Pediatr Rev |volume=35 |issue=8 |pages=336–47; quiz 348–9 |year=2014 |pmid=25086165 |doi=10.1542/pir.35-8-336 |url=}}</ref><ref name="pmid25122491">{{cite journal |vauthors=Samuels MH |title=Psychiatric and cognitive manifestations of hypothyroidism |journal=Curr Opin Endocrinol Diabetes Obes |volume=21 |issue=5 |pages=377–83 |year=2014 |pmid=25122491 |pmc=4264616 |doi=10.1097/MED.0000000000000089 |url=}}</ref><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> | |||
====Constituitional==== | |||
|- | |||
| | |||
* [[Fatigue]] | * [[Fatigue]] | ||
* Cold intolerance | * Cold intolerance | ||
| Line 23: | Line 23: | ||
* Coarse skin | * Coarse skin | ||
* [[Weight gain]] | * [[Weight gain]] | ||
====HEENT==== | |||
* [[Hoarseness]] | * [[Hoarseness]] | ||
* Fullness in the throat and neck | * Fullness in the throat and neck | ||
====Neuromuscular==== | |||
* [[Depression]] | * [[Depression]] | ||
* [[Emotional lability]] | * [[Emotional lability]] | ||
* [[Attention deficit]] | * [[Attention deficit]] | ||
====Other findings==== | |||
* [[Macroglossia]] | * [[Macroglossia]] | ||
* [[Obstructive sleep apnea]] | * [[Obstructive sleep apnea]] | ||
* [[Paresthesia]] | * [[Paresthesia]] | ||
* Nerve entrapment syndromes ([[carpal tunnel syndrome]]) | * Nerve entrapment syndromes ([[carpal tunnel syndrome]]) | ||
* [[Blurred vision]] | * [[Blurred vision]] | ||
===Less common symptoms=== | |||
====Constituitional==== | |||
* Puffiness | * Puffiness | ||
* [[Hair loss]] | * [[Hair loss]] | ||
* [[Constipation]] | * [[Constipation]] | ||
* [[Fever]] | * [[Fever]] (If accompanied by [[thyroiditis]]) | ||
====HEENT==== | |||
* [[Sore throat]] | * [[Sore throat]] | ||
* [[Periorbital edema]] | * [[Periorbital edema]] | ||
====Neuromuscular==== | |||
* Slowed speech and movements | * Slowed speech and movements | ||
====Other findings==== | |||
* [[Ataxia]] | * [[Ataxia]] | ||
* [[Myxedema coma]] (with [[Edema|non-pitting edema]]) | * [[Myxedema coma]] (with [[Edema|non-pitting edema]]) | ||
* [[Infertility]] | * [[Infertility]] | ||
==References== | ==References== | ||
Latest revision as of 16:09, 3 November 2017
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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
Obtaining a history gives important information in making a diagnosis of euthyroid sick syndrome. Complete history should be obtained regarding past and any newly diagnosed medical condition, previous history of thyroid disease and current medications. Patients of euthyroid sick syndrome present with serious illness and are febrile with hypermetabolism. In euthyroid sick syndrome the symptoms of the underlying condition may overlap with features of hypothyroidism. Generally it takes atleast 2-3 weeks for thyroid hormone levels to decline and symptoms of hypothyroidism takes even longer period for expression. The common symptoms of hypothyroidism are fatigue, cold intolerance, decreased sweating, hypothermia, coarse skin, weight gain, depression, emotional lability, and attention deficit.
History
Obtaining a history gives important information in making a diagnosis of euthyroid sick syndrome. It provides insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. In severe cases of euthyroid sick syndrome patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be:[1][2][3][4]
- Any newly diagnosed medical condition such as cirrhosis, pneumonia and renal failure.
- Previous history of thyroid disease
- Current medications
Symptoms
Common Symptoms
The common symptoms of hypothyroidism are:[5][6][7][8]
Constituitional
- Fatigue
- Cold intolerance
- Decreased sweating
- Hypothermia
- Coarse skin
- Weight gain
HEENT
- Hoarseness
- Fullness in the throat and neck
Neuromuscular
Other findings
- Macroglossia
- Obstructive sleep apnea
- Paresthesia
- Nerve entrapment syndromes (carpal tunnel syndrome)
- Blurred vision
Less common symptoms
Constituitional
- Puffiness
- Hair loss
- Constipation
- Fever (If accompanied by thyroiditis)
HEENT
Neuromuscular
- Slowed speech and movements
Other findings
References
- ↑ 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.
- ↑ 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.
- ↑ Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
- ↑ Fliers E, Bianco AC, Langouche L, Boelen A (2015). "Thyroid function in critically ill patients". Lancet Diabetes Endocrinol. 3 (10): 816–25. doi:10.1016/S2213-8587(15)00225-9. PMC 4979220. PMID 26071885.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.