Euthyroid sick syndrome history and symptoms: Difference between revisions

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Revision as of 14:22, 4 August 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

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	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)
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 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

Euthyroid sick syndrome	Laboratory test
Mild euthyroid sick syndrome	Low T3 Normal T4 Normal fT4 Normal 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 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.

History and Symptoms

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History

Patients with [disease name]] may have a positive history of:

[history finding 1]
[history finding 2]
[history finding 3]

Common Symptoms

Common symptoms of [disease] include:

[symptom 1]
[symptom 2]
[symptom 3]

Less Common Symptoms

Less common symptoms of [disease name] include

[symptom 1]
[symptom 2]
[symptom 3]

References

↑ 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.

Template:WH Template:WS

[pmid25305308-1] 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.

[pmid25086165-2] 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.

[pmid25122491-3] 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.

[pmid19949140-4] McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.

[1]

[2]

[3]

[4]

@@ Line 4: / Line 4: @@
 {{CMG}}; {{AE}}
 ==Overview==
-The majority of patients with [disease name] are asymptomatic.
+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>
-OR
-The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
+{| 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.
 ==History and Symptoms==
 *The majority of patients with [disease name] are asymptomatic.