Euthyroid sick syndrome

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

Synonyms and keywords: sick euthyroid syndrome; non-thyroidal illness syndrome; low T3 low T4 syndrome

Euthyroid sick syndrome
ICD-10	E07.8
ICD-9	790.94
MeSH	D005067

Causes

Drugs leading to decreased 5'monodeiodinase are propranolol (high doses), amiodarone, and glucocorticoid therapy.

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:

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

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

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

Medical Therapy

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.

External links

• McIver B, Gorman C (1997). "Euthyroid sick syndrome: an overview". Thyroid. 7 (1): 125–32. PMID 9086580.

References

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