Euthyroid sick syndrome diagnostic criteria

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

Overview

The diagnosis of euthyroid sick syndrome is based on clinical presentation and thyroid function tests. An important part in diagnosing euthyroid sick syndrome is to be able to differentiate between other causes of hypothyroidism and euthyroid sick syndrome. Although the diagnosis of hypothyroidism is mainly a laboratory diagnosis, the coexisting conditions and wide variation in clinical presentation may make the diagnosis difficult. The best initial test is TSH, which in euthyroid sick syndrome can be low, normal, or elevated but not as high as it would be in hypothyroidism. Serum reverse T3 is elevated from inhibition of 5' monodeiodinase(type I). Patient having severe underlying illness, as in euthyroid sick syndrome have elevated levels of serum cortisol from underlying stress whereas patients of hypothyroidism have low serum cortisol from associated hypothalmic/pituitary abnormality. Recent evidence has shown that subclinical hypothyroidism may have various consequences, such as hyperlipidemia, increased risk of cardiovascular disease (even heart failure), somatic and neuromuscular symptoms, infertility, and other complications.

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]
• The diagnosis of [disease name] is based on the [criteria name] criteria, which include
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
• The diagnosis of [disease name] is based on the [definition name] definition, which includes
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]

OR

• There are no established criteria for the diagnosis of [disease name].