Euthyroid sick syndrome history and symptoms
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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
Obtaining a history gives important information in making a diagnosis of euthyroid sick syndrome. Complete history should be obtained regarding past and any newly diagnosed medical condition, previous history of thyroid disease and current medications. Patients of euthyroid sick syndrome present with serious illness and are febrile with hypermetabolism. In euthyroid sick syndrome the symptoms of the underlying condition may overlap with features of hypothyroidism. Generally it takes atleast 2-3 weeks for thyroid hormone levels to decline and symptoms of hypothyroidism takes even longer period for expression. The common symptoms of hypothyroidism are fatigue, cold intolerance, decreased sweating, hypothermia, coarse skin, weight gain, depression, emotional lability, and attention deficit.[1][2][3][4][5][6][7][8]
History
Obtaining a history gives important information in making a diagnosis of euthyroid sick syndrome. It provides insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. In severe cases of euthyroid sick syndrome patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be:
- Any newly diagnosed medical condition such as cirrhosis, pneumonia and renal failure.
- Previous history of thyroid disease
- Current medications
Symptoms
Common Symptoms
The common symptoms of hypothyroidism are:
Constituitional
- Fatigue
- Cold intolerance
- Decreased sweating
- Hypothermia
- Coarse skin
- Weight gain
HEENT
- Hoarseness
- Goiter
- Fullness in the throat and neck
Neuromuscular
Other findings
- Macroglossia
- Obstructive sleep apnea
- Paresthesia
- Nerve entrapment syndromes (carpal tunnel syndrome)
- Blurred vision (central hypothyroidism)
Less common symptoms
Constituitional
- Puffiness
- Hair loss
- Constipation
- Fever (If accompanied by thyroiditis)
HEENT
Neuromuscular
- Slowed speech and movements
Other findings
- Pituitary hyperplasia followed by hyperprolactinemia
- Ataxia
- Myxedema coma (with non-pitting edema)
- Cardiomegaly
- Pericardial effusion
- Ascites
- Hyperlipidemia
- Galactorrhea
- Infertility
References
- ↑ O'Brien T, Dinneen SF, O'Brien PC, Palumbo PJ (1993). "Hyperlipidemia in patients with primary and secondary hypothyroidism". Mayo Clin. Proc. 68 (9): 860–6. PMID 8371604.
- ↑ Diekman T, Lansberg PJ, Kastelein JJ, Wiersinga WM (1995). "Prevalence and correction of hypothyroidism in a large cohort of patients referred for dyslipidemia". Arch. Intern. Med. 155 (14): 1490–5. PMID 7605150.
- ↑ Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
- ↑ Fliers E, Bianco AC, Langouche L, Boelen A (2015). "Thyroid function in critically ill patients". Lancet Diabetes Endocrinol. 3 (10): 816–25. doi:10.1016/S2213-8587(15)00225-9. PMC 4979220. PMID 26071885.
- ↑ Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P (2014). "Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study". Eur. J. Endocrinol. 171 (5): 593–602. doi:10.1530/EJE-14-0481. PMID 25305308.
- ↑ Diaz A, Lipman Diaz EG (2014). "Hypothyroidism". Pediatr Rev. 35 (8): 336–47, quiz 348–9. doi:10.1542/pir.35-8-336. PMID 25086165.
- ↑ Samuels MH (2014). "Psychiatric and cognitive manifestations of hypothyroidism". Curr Opin Endocrinol Diabetes Obes. 21 (5): 377–83. doi:10.1097/MED.0000000000000089. PMC 4264616. PMID 25122491.
- ↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.