Euthyroid sick syndrome (patient information)
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Euthyroid sick syndrome |
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Euthyroid sick syndrome On the Web |
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Risk calculators and risk factors for Euthyroid sick syndrome |
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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 is a condition which is seen in severe illness such as burns, malignancy, sepsis, myocardial infarction, pneumonia and cirrhosis. The thyroid gland itself is normal. In these conditions the body goes into a state of hypermetabolism leading to increased muscle and calorie loss. It is speculated, that the body in order to contain this hypermetabolism induces some degree of hypothyroidism by inhibiting conversion of thyroxine (T4) to triiodothyronine (T3). Initially euthyroid sick syndrome presents with low serum T3 (triiodothyronine). 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(thyroxine) are more with more severe illnesses. Usual symptoms include fatigue and weakness, weight gain, puffy face, cold intolerance, constipation and bradycardia. It may result in infertility in adults. Blood tests of thyroid-stimulating hormone (TSH) level and T4 (thyroxine) level are very important for the diagnosis of euthyroid sick syndrome. Treatment includes rapid correction of the underlying illness.
What are the symptoms of (Euthyroid sick syndrome)?
Signs and symptoms of hypothyroidism associated with euthyroid sick syndrome varies from person to person. In addition, there will be symptoms of the underlying disease. Usual symptoms associated with decreased level of thyroid hormone include:
- Fatigue and weakness
- Weight gain
- Puffy face
- Cold intolerance
- Joint and muscle pain
- Constipation
- Bradycardia
- Depression
- Irregular menstrual periods in women
- Infertility
What causes (Euthyroid sick syndrome)?
Euthyroid sick syndrome can be caused by any serious illness. The most common causes include:
- Sepsis
- Malignancy
- Trauma
- Surgery
- Burns
- Bone marrow transplantation
- Metabolic disorders
- Other Inflammatory conditions
- Any major condition of
Who is at highest risk?
Euthyroid sick syndrome is seen in 40% of patients presenting with any major illness. In intensive care unit (ICU) patient's the rate is as high as 70-75%. Other conditions which puts the patients at increased risk include:
- Congenital hypothyroidism
- Surgical removal of part or all of the thyroid gland
- Radiation therapy of the thyroid
- Some medications, such as amiodarone, propylthiouracil, methimazole and Lithium.
- Age over 50 years
- Female
Diagnosis
The diagnosis of euthyroid sick syndrome is based on clinical presentation and thyroid function tests.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. The diagnosis of euthyroid sick syndrome is made when there is a clear severe underlying illness, normal appearing thyroid gland and low T3 with elevated reverse T3. The other thyroid hormones T4, TSH, and TRH all depend upon the severity of the illness. These hormones are affected in variable degrees based on the severity and duration of the underlying illness.
When to seek urgent medical care?
Call your health care provider if symptoms of hypothyroidism appear. If you experience either of the following symptoms, seeking urgent medical care as soon as possible.
Treatment options
In euthyroid sick syndrome emphasis is on rapid correction of underlying disease. Many seriously ill patients have low levels of thyroid hormones but are not clinically hypothyroid and do not require thyroid hormone supplementation.
Where to find medical care for (Euthyroid sick syndrome)?
Directions to Hospitals Treating hypothyroidism
Prevention
The prevention for euthyroid sick syndrome is unknown.
What to expect (Outlook/Prognosis)?
Prognosis of hypothyroidism depends on:
- Whether the patient is treated or not. In most cases, if underlying condition is rapidly treated, thyroid hormone levels returns to normal levels.
- If the underlying condition is not treated and T4 level falls below 3 mcg/dL, euthyroid sick syndrome can be fatal.
Possible complications
The complications of euthyroid sick syndrome depends upon other organ systems involved and underlying disease(s). The general complications of hypothyroidism as seen in euthyroid sick syndrome include hypothermia, bradycardia, heart failure, dyspnea, confusion, apathy and psychosis.
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm