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==Classification==
==Classification==
[[Euthyroid]] sick syndrome may be classified according to the level of [[thyroid hormones]] and the severity of the underlying [[disease]]. Depending upon the severity and duration of the [[Stress (medicine)|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. On the basis of [[thyroid hormone]] levels [[euthyroid]] sick syndrome can be categorized into:<ref name="pmid19007679">{{cite journal |vauthors=Golombek SG |title=Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients |journal=Semin. Perinatol. |volume=32 |issue=6 |pages=413–8 |year=2008 |pmid=19007679 |doi=10.1053/j.semperi.2008.09.010 |url=}}</ref><ref name="pmid27403906">{{cite journal |vauthors=Frączek MM, Gackowski A, Przybylik-Mazurek E, Nessler J |title=[The relation between the low T3 syndrome in the clinical course of myocardial infarction and heart failure] |language=Polish |journal=Pol. Merkur. Lekarski |volume=40 |issue=240 |pages=380–3 |year=2016 |pmid=27403906 |doi= |url=}}</ref><ref name="pmid24845024">{{cite journal |vauthors=Van den Berghe G |title=Non-thyroidal illness in the ICU: a syndrome with different faces |journal=Thyroid |volume=24 |issue=10 |pages=1456–65 |year=2014 |pmid=24845024 |pmc=4195234 |doi=10.1089/thy.2014.0201 |url=}}</ref><ref name="pmid23214076">{{cite journal |vauthors=Murakami M |title=[Nonthyroidal illness (NTI)] |language=Japanese |journal=Nippon Rinsho |volume=70 |issue=11 |pages=2005–10 |year=2012 |pmid=23214076 |doi= |url=}}</ref><ref name="pmid27065175">{{cite journal |vauthors=Lee S, Farwell AP |title=Euthyroid Sick Syndrome |journal=Compr Physiol |volume=6 |issue=2 |pages=1071–80 |year=2016 |pmid=27065175 |doi=10.1002/cphy.c150017 |url=}}</ref>
[[Euthyroid]] sick syndrome may be classified according to the level of [[thyroid hormones]] and the severity of the underlying [[disease]]. Depending upon the severity and duration of the [[Stress (medicine)|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. On the basis of [[thyroid hormone]] levels [[euthyroid]] sick syndrome can be categorized into:<ref name="pmid19007679">{{cite journal |vauthors=Golombek SG |title=Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients |journal=Semin. Perinatol. |volume=32 |issue=6 |pages=413–8 |year=2008 |pmid=19007679 |doi=10.1053/j.semperi.2008.09.010 |url=}}</ref><ref name="pmid27403906">{{cite journal |vauthors=Frączek MM, Gackowski A, Przybylik-Mazurek E, Nessler J |title=[The relation between the low T3 syndrome in the clinical course of myocardial infarction and heart failure] |language=Polish |journal=Pol. Merkur. Lekarski |volume=40 |issue=240 |pages=380–3 |year=2016 |pmid=27403906 |doi= |url=}}</ref><ref name="pmid24845024">{{cite journal |vauthors=Van den Berghe G |title=Non-thyroidal illness in the ICU: a syndrome with different faces |journal=Thyroid |volume=24 |issue=10 |pages=1456–65 |year=2014 |pmid=24845024 |pmc=4195234 |doi=10.1089/thy.2014.0201 |url=}}</ref><ref name="pmid23214076">{{cite journal |vauthors=Murakami M |title=[Nonthyroidal illness (NTI)] |language=Japanese |journal=Nippon Rinsho |volume=70 |issue=11 |pages=2005–10 |year=2012 |pmid=23214076 |doi= |url=}}</ref><ref name="pmid27065175">{{cite journal |vauthors=Lee S, Farwell AP |title=Euthyroid Sick Syndrome |journal=Compr Physiol |volume=6 |issue=2 |pages=1071–80 |year=2016 |pmid=27065175 |doi=10.1002/cphy.c150017 |url=}}</ref>
*Mild
*Mild euthyroid sick syndrome:
*Moderate
** Decreased T3
*Severe
** Normal T4, FT4 and TSH
*Recovery
** Increased T3
{| class="wikitable"
*Moderate euthyroid sick syndrome:
!Euthyroid sick syndrome
** Decreased T3
!T3
** Normal/decreased FT4 and TSH
(80-180 ng/dl)
** Increased reverse T3
!T4
*Severe euthyroid sick syndrome:
(4.6-12 ug/dl)
** Decreased T3, T4 and TSH
!FT4
** Normal/decreased FT4
(0.7-1.9 ng/dl)
** Increased reverse T3
!TSH
*Recovery phase
(0.4 to 4.0mIU/L)
** Normal/decreased T3 and reverse T3
!Reverse T3
** Normal T4, FT4 and TSH
'''(90 to 350'''pg/mL)
|-
|Mild euthyroid sick syndrome
|↓
|N
|N
|N
|'''↑'''
|-
|Moderate euthyroid sick syndrome
|↓
|N
|N/↓
|N/↓
|'''↑'''
|-
|Severe euthyroid sick syndrome
|↓
|↓
|N/↓
|↓
|'''↑'''
|-
|Recovery
|N/↓
|N
|N
|N
|N/'''↑'''
|}


==References==
==References==

Revision as of 14:27, 16 August 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

Euthyroid sick syndrome may be classified according to the level of thyroid hormones and the severity of the underlying disease into mild, moderate, severe, and recovery phase.

Classification

Euthyroid sick syndrome may be classified according to the level of thyroid hormones and the severity of the underlying disease. 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. On the basis of thyroid hormone levels euthyroid sick syndrome can be categorized into:[1][2][3][4][5]

  • Mild euthyroid sick syndrome:
    • Decreased T3
    • Normal T4, FT4 and TSH
    • Increased T3
  • Moderate euthyroid sick syndrome:
    • Decreased T3
    • Normal/decreased FT4 and TSH
    • Increased reverse T3
  • Severe euthyroid sick syndrome:
    • Decreased T3, T4 and TSH
    • Normal/decreased FT4
    • Increased reverse T3
  • Recovery phase
    • Normal/decreased T3 and reverse T3
    • Normal T4, FT4 and TSH

References

  1. ↑ Golombek SG (2008). "Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients". Semin. Perinatol. 32 (6): 413–8. doi:10.1053/j.semperi.2008.09.010. PMID 19007679.
  2. ↑ Frączek MM, Gackowski A, Przybylik-Mazurek E, Nessler J (2016). "[The relation between the low T3 syndrome in the clinical course of myocardial infarction and heart failure]". Pol. Merkur. Lekarski (in Polish). 40 (240): 380–3. PMID 27403906.
  3. ↑ Van den Berghe G (2014). "Non-thyroidal illness in the ICU: a syndrome with different faces". Thyroid. 24 (10): 1456–65. doi:10.1089/thy.2014.0201. PMC 4195234. PMID 24845024.
  4. ↑ Murakami M (2012). "[Nonthyroidal illness (NTI)]". Nippon Rinsho (in Japanese). 70 (11): 2005–10. PMID 23214076.
  5. ↑ Lee S, Farwell AP (2016). "Euthyroid Sick Syndrome". Compr Physiol. 6 (2): 1071–80. doi:10.1002/cphy.c150017. PMID 27065175.

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