Euthyroid sick syndrome: Difference between revisions

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{{Euthyroid sick syndrome}}
{{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]]==


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


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


==Pathophysiology==
==[[Euthyroid sick syndrome pathophysiology|Pathophysiology]]==


==Causes==
==[[Euthyroid sick syndrome causes|Causes]]==
Drugs leading to decreased 5'monodeiodinase are propranolol (high doses), amiodarone, and glucocorticoid therapy.


==Differentiating {{PAGENAME}} from Other Diseases==
==[[Differentiating Euthyroid sick syndrome from other diseases|Differentiating Euthyroid sick syndrome  from other Diseases]]==


==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 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: <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>
 
{| class="wikitable"
! align="center" style="background: #4479BA; color: #FFFFFF; " |Symptoms
! align="center" style="background: #4479BA; color: #FFFFFF; " |Constituitional
! align="center" style="background: #4479BA; color: #FFFFFF; " | HEENT
! align="center" style="background: #4479BA; color: #FFFFFF; " |Neuromuscular
! align="center" style="background: #4479BA; color: #FFFFFF; " |Other findings
|-
| align="center" style="background: #DCDCDC; " |More common
|
* [[Fatigue]]
* Cold intolerance
* Decreased [[sweating]]
* [[Hypothermia]]
* Coarse skin
* [[Weight gain]]
|
* [[Hoarseness]]
* [[Goiter]]
* Fullness in the throat and neck
|
* [[Depression]]
* [[Emotional lability]]
* [[Attention deficit]]
|
* [[Macroglossia]]
* [[Obstructive sleep apnea]]
* [[Paresthesia]]
* Nerve entrapment syndromes ([[carpal tunnel syndrome]])
* [[Blurred vision]] (central hypothyroidism)
|-
| align="center" style="background: #DCDCDC; " |Less common
|
* Puffiness
* [[Hair loss]]
* [[Constipation]]
* [[Fever]]  
** If accompanied by [[thyroiditis]]
|
* [[Sore throat]]
* [[Periorbital edema]]
|
* Slowed speech and movements
|
* Pituitary hyperplasia followed by [[hyperprolactinemia]]
* [[Ataxia]]
* [[Myxedema coma]] (with [[Edema|non-pitting edema]])
* [[Cardiomegaly]]
* [[Pericardial effusion]]
* [[Ascites]]
* [[Hyperlipidemia]]
* [[Galactorrhea]]
* [[Infertility]]
|}
 
===Physical Examination===
 
===Laboratory Findings===
Laboratory findings consistent with the diagnosis of euthyroid sick syndrome include
{| class="wikitable"
!Euthyroid sick syndrome
!Laboratory test
|-
|Mild euthyroid sick syndrome
|
* Low [[Triiodothyronine|T3]]
* Normal [[T4]]
* Normal [[fT4]]
* Normal [[Thyroid-stimulating hormone|TSH]]
* Elevated [[reverse T3]]
|-
|Moderate euthyroid sick syndrome
|
* Low [[T3]]
* Normal [[T4]]
* Normal to elevated [[fT4]]
* Normal to elevated [[TSH]]           
* Elevated [[reverse T3]]
|-
|Severe euthyroid sick syndrome
|
* Low [[T3]]  
* Low [[T4]]
* Low [[Thyroid-stimulating hormone|TSH]]
* Normal to low [[fT4]]
* Elevated [[reverse T3]]   
|}
 
===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==
==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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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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MRI

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Medical Therapy

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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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