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==Differentiating Euthyroid sick syndrome from other Diseases==
==Differentiating Euthyroid sick syndrome from other Diseases==
Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:<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><ref name="pmid11836274">{{cite journal |vauthors=Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE |title=Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=489–99 |year=2002 |pmid=11836274 |doi=10.1210/jcem.87.2.8182 |url=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref>
Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:<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><ref name="pmid11836274">{{cite journal |vauthors=Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE |title=Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=489–99 |year=2002 |pmid=11836274 |doi=10.1210/jcem.87.2.8182 |url=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref>
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="3" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
|-
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Goiter
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb
|-
| rowspan="3" style="background:#DCDCDC;" |Primary hypothyroidism
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
Diffuse
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* May be accompanied by other [[autoimmune diseases]]
|-
| align="center" style="background:#DCDCDC;" |[[Thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*[[Thyroiditis|Infectious thyroiditis]] associated with neck pain
|-
| align="center" style="background:#DCDCDC;" |Others
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* History of [[hyperthyroidism]]
* Drug history
|-
| colspan="2" style="background:#DCDCDC;" |Transient hypothyroidism
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* May present primarily with [[hyperthyroidism]]
|-
| colspan="2" style="background:#DCDCDC;" |Subclinical hypothyroidism
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Asymptomatic
|-
| rowspan="2" align="center" style="background:#DCDCDC;" |Central Hypothyroidism
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Pituitary
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↓'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
|-
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Hypothalamus
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
|-
| colspan="2" style="background:#DCDCDC;" |Resistance to TSH/TRH
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Rare
|}


==References==
==References==

Revision as of 17:48, 7 August 2017

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

Overview

Fasting, starvation, sepsis, trauma, cardiopulmonary bypass, malignancy, heart failure, hypothermia, myocardial infarction, chronic renal failure, cirrhosis, and diabetic ketoacidosis.



  • [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
  • [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating Euthyroid sick syndrome from other Diseases

Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:[1][2][3]

Disease History and symptoms Laboratory findings Additional findings
Fever Goiter Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb
Primary hypothyroidism Autoimmune + +/-

Diffuse

- ↑ ↓ N/↓ Normal N/↑ Normal ↑
Thyroiditis + +/- + ↑ ↓ Normal Normal N/↑ Normal Normal
Others - +/- - ↑ ↓ Normal Normal N/↑ Normal Normal
Transient hypothyroidism +/- - +/- ↑ ↑ Normal Normal ↑ Normal Normal
Subclinical hypothyroidism - - - ↑ Normal Normal Normal ↑ Normal N/↑
  • Asymptomatic
Central Hypothyroidism Pituitary + - - N/↓ N/↓ N/↓ ↓ Normal Normal Normal
Hypothalamus + - - ↑ Normal ↓ Normal
Resistance to TSH/TRH - - - ↑ N/↓ N/↓ Normal Normal ↑/↓ Normal
  • Rare

References

  1. ↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  2. ↑ Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE (2002). "Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)". J. Clin. Endocrinol. Metab. 87 (2): 489–99. doi:10.1210/jcem.87.2.8182. PMID 11836274.
  3. ↑ Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)". Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.

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