|
|
| (33 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Euthyroid sick syndrome}} |
| {{CMG}}; {{AE}} | | {{CMG}}; {{AE}}{{Akshun}} |
|
| |
|
| {{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]]. [[Euthyroid]] sick [[syndrome]] is seen in conditions of [[starvation]] and [[critical illness]] such as [[sepsis]], [[surgery]], [[Physical trauma|severe trauma]], [[burns]], [[metabolic disorders]], [[bone marrow transplantation]], and [[malignancy]]. During these [[Stress (medicine)|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 [[Triiodothyronine|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 (medicine)|stress]] inducing condition, the thyroid-stimulating hormone([[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 (triiodothyronine) is the biologically active form of thyroid hormone. Normally most of the T3(triiodothyronine) is produced by peripheral deiodination of circulating T4 (thyroxine) 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. 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. The drop in levels of T3 and T4 are more with more severe illnesses. Mortality rate is high when there is a marked decrease in serum T3 and T4.
| |
|
| |
|
| <ref name="GRASBERGERGOLCHER2002">{{cite journal|last1=GRASBERGER|first1=Helmut|last2=GOLCHER|first2=Henriette M.B.|last3=FINGERHUT|first3=Anja|last4=JANSSEN|first4=Onno E.|title=Loop variants of the serpin thyroxine-binding globulin: implications for hormone release upon limited proteolysis|journal=Biochemical Journal|volume=365|issue=1|year=2002|pages=311–316|issn=0264-6021|doi=10.1042/bj20020014}}</ref><ref name="pmid10554534">{{cite journal |vauthors=Schilling JU, Zimmermann T, Albrecht S, Zwipp H, Saeger HD |title=[Low T3 syndrome in multiple trauma patients--a phenomenon or important pathogenetic factor?] |language=German |journal=Med. Klin. (Munich) |volume=94 Suppl 3 |issue= |pages=66–9 |year=1999 |pmid=10554534 |doi= |url=}}</ref>
| | ==[[Euthyroid sick syndrome causes|Causes]]== |
|
| |
|
| ==References== | | ==[[Differentiating Euthyroid sick syndrome from other diseases|Differentiating Euthyroid sick syndrome from other Diseases]]== |
| {{reflist|2}}
| |
|
| |
|
| [[Category:Needs content]] | | ==[[Euthyroid sick syndrome epidemiology and demographics|Epidemiology and Demographics]]== |
| [[Category:Emergency medicine]]
| |
| [[Category:Endocrinology]]
| |
| [[Category:Neurology]]
| |
| [[Category:Obstetrics]]
| |
| [[Category:Disease]]
| |
|
| |
|
| {{WH}}
| | ==[[Euthyroid sick syndrome risk factors|Risk Factors]]== |
| {{WS}}
| |
|
| |
|
| ==Causes== | | ==[[Euthyroid sick syndrome screening|Screening]]== |
|
| |
|
| ==Differentiating {{PAGENAME}} from Other Diseases== | | ==[[Euthyroid sick syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| [[Fasting]], [[starvation]], [[sepsis]], [[Physical trauma|trauma]], [[cardiopulmonary bypass]], [[malignancy]], [[heart failure]], [[hypothermia]], [[myocardial infarction]], [[chronic renal failure]], [[cirrhosis]], and [[diabetic ketoacidosis]]. | |
| | |
| __NOTOC__
| |
| ==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== | | ==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== |