Euthyroid Sick Syndrome Clinical Presentation

  • Author: Serhat Aytug, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Sep 26, 2011
 

History

History is specific to each NTI.

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Physical

On physical examination, there are no typical findings for patients with NTI. The examination findings in each patient reflect the characteristics of her or his nonthyroidal disease. Findings on examination of the thyroid gland are unremarkable.

NTI can have an effect on patients who have preexisting thyroid diseases. Coexisting NTI can mask physical findings of hypothyroidism and hyperthyroidism.

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Causes

  • Multiple explanations have been proposed for the causes of NTI.
    • Accuracy of test assays in NTI
    • Cytokines
    • Deiodination
    • Inhibition of TRH and TSH secretion
    • Inhibition of plasma membrane transport of iodothyronines
    • Thyroid-binding globulin decrease/desialation
    • Reduction in TR expression as well as DNA binding
  • Drugs that influence thyroid function
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Contributor Information and Disclosures
Author

Serhat Aytug, MD  Staff Physician, Division of Endocrinology, Diabetes and Metabolism, Crystal Run Healthcare

Serhat Aytug, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, and Pituitary Society

Disclosure: Nothing to disclose.

Coauthor(s)

Lawrence E Shapiro, MD  Chief, Division of Endocrinology and Metabolism, Professor of Medicine, Department of Medicine, Winthrop University Hospital

Lawrence E Shapiro, MD is a member of the following medical societies: American Diabetes Association, American Thyroid Association, and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven R Gambert, MD  Professor of Medicine, Johns Hopkins University School of Medicine; Director of Geriatric Medicine, University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center

Steven R Gambert, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Don S Schalch, MD  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

  1. Coceani M, Iervasi G, Pingitore A, et al. Thyroid hormone and coronary artery disease: from clinical correlations to prognostic implications. Clin Cardiol. Jul 2009;32(7):380-5. [Medline].

  2. Yu J, Koenig RJ. Induction of type 1 iodothyronine deiodinase to prevent the nonthyroidal illness syndrome in mice. Endocrinology. Jul 2006;147(7):3580-5. [Medline].

  3. Beigneux AP, Moser AH, Shigenaga JK, et al. Sick euthyroid syndrome is associated with decreased TR expression and DNA binding in mouse liver. Am J Physiol Endocrinol Metab. Jan 2003;284(1):E228-36. [Medline].

  4. Docter R, Krenning EP, de Jong M, Hennemann G. The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism. Clin Endocrinol (Oxf). Nov 1993;39(5):499-518. [Medline].

  5. Melmed S, Geola FL, Reed AW, et al. A comparison of methods for assessing thyroid function in nonthyroidal illness. J Clin Endocrinol Metab. Feb 1982;54(2):300-6. [Medline].

  6. Tognini S, Marchini F, Dardano A, et al. Non-thyroidal illness syndrome and short-term survival in a hospitalised older population. Age Ageing. Jan 2010;39(1):46-50. [Medline].

  7. Bello G, Pennisi MA, Montini L, et al. Nonthyroidal illness syndrome and prolonged mechanical ventilation in patients admitted to the ICU. Chest. Jun 2009;135(6):1448-54. [Medline].

  8. Gangemi EN, Garino F, Berchialla P, et al. Low triiodothyronine serum levels as a predictor of poor prognosis in burn patients. Burns. Sep 2008;34(6):817-24. [Medline].

  9. Velissaris T, Tang AT, Wood PJ, et al. Thyroid function during coronary surgery with and without cardiopulmonary bypass. Eur J Cardiothorac Surg. Jul 2009;36(1):148-54. [Medline].

  10. Michalaki M, Vagenakis AG, Makri M. Dissociation of the early decline in serum T(3) concentration and serum IL-6 rise and TNFalpha in nonthyroidal illness syndrome induced by abdominal surgery. J Clin Endocrinol Metab. Sep 2001;86(9):4198-205. [Medline].

  11. Pimentel CR, Miano FA, Perone D, et al. Reverse T(3) as a parameter of myocardial function impairment in heart failure. Int J Cardiol. May 8 2009;[Medline].

  12. Iglesias P, Díez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol. Apr 2009;160(4):503-15. [Medline].

  13. Hekmat R, Javadi Z, Layghian Javan M, et al. Thyroid hormone changes in early kidney transplantation and its correlation with delayed graft function. Urol J. Winter 2010;7(1):30-4. [Medline].

  14. Unachukwu CN, Uchenna DI, Young EE. Endocrine and metabolic disorders associated with human immune deficiency virus infection. West Afr J Med. Jan 2009;28(1):3-9. [Medline].

  15. Kami M, Tanaka Y, Chiba S, et al. Thyroid function after bone marrow transplantation: possible association between immune-mediated thyrotoxicosis and hypothyroidism. Transplantation. Feb 15 2001;71(3):406-11. [Medline].

  16. Casulari LA, Mangieri P, Naves LA, et al. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm. Arq Neuropsiquiatr. Mar 2004;62(1):26-32. [Medline].

  17. Premachandra BN, Kabir MA, Williams IK. Low T3 syndrome in psychiatric depression. J Endocrinol Invest. Jun 2006;29(6):568-72. [Medline].

  18. De Groot LJ. Non-thyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, should be treated with appropriate replacement therapies. Crit Care Clin. Jan 2006;22(1):57-86, vi. [Medline].

  19. Iglesias P, Munoz A, Prado F, et al. Serum thyrotropin concentration is an early marker of normalization of low T3 syndrome in aged hospitalized patients after discharge. J Endocrinol Invest. Feb 24 2010;[Medline].

  20. Afandi B, Schussler GC, Arafeh AH, et al. Selective consumption of thyroxine-binding globulin during cardiac bypass surgery. Metabolism. Feb 2000;49(2):270-4. [Medline].

  21. Afandi B, Vera R, Schussler GC, Yap MG. Concordant decreases of thyroxine and thyroxine binding protein concentrations during sepsis. Metabolism. Jun 2000;49(6):753-4. [Medline].

  22. Braverman LE, Utiger RD. Non thyroidal illness. In: Werner and Ingbar. The Thyroid. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:281-95.

  23. Brent GA, Hershman JM. Thyroxine therapy in patients with severe nonthyroidal illnesses and low serum thyroxine concentration. J Clin Endocrinol Metab. Jul 1986;63(1):1-8. [Medline].

  24. Chopra IJ. Clinical review 86: Euthyroid sick syndrome: is it a misnomer?. J Clin Endocrinol Metab. Feb 1997;82(2):329-34. [Medline].

  25. De Groot LJ. Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab. Jan 1999;84(1):151-64. [Medline].

  26. Maldonado LS, Murata GH, Hershman JM, Braunstein GD. Do thyroid function tests independently predict survival in the critically ill?. Thyroid. 1992;2(2):119-23. [Medline].

  27. McIver B, Gorman CA. Euthyroid sick syndrome: an overview. Thyroid. Feb 1997;7(1):125-32. [Medline].

  28. Mendel CM, Laughton CW, McMahon FA, Cavalieri RR. Inability to detect an inhibitor of thyroxine-serum protein binding in sera from patients with nonthyroid illness. Metabolism. May 1991;40(5):491-502. [Medline].

  29. Moore WT, Eastman RC. Diagnostic Endocrinology. 2nd ed. St. Louis, Mo: Mosby Inc; 1996:181-2, 194.

  30. Schussler GC. The thyroxine-binding proteins. Thyroid. Feb 2000;10(2):141-9. [Medline].

  31. Surks MI, Hupart KH, Pan C, Shapiro LE. Normal free thyroxine in critical nonthyroidal illnesses measured by ultrafiltration of undiluted serum and equilibrium dialysis. J Clin Endocrinol Metab. Nov 1988;67(5):1031-9. [Medline].

  32. Surks MI, Sievert R. Drugs and thyroid function. N Engl J Med. Dec 21 1995;333(25):1688-94. [Medline].

  33. Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev. Spring 1982;3(2):164-217. [Medline].

  34. Wehmann RE, Gregerman RI, Burns WH, et al. Suppression of thyrotropin in the low-thyroxine state of severe nonthyroidal illness. N Engl J Med. Feb 28 1985;312(9):546-52. [Medline].

 
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Euthyroid sick syndrome. Relationship between serum thyroid hormone concentrations and severity of nonthyroidal illness (NTI). Abbreviations: reverse triiodothyronine (rT3), thyroid-stimulating hormone (TSH), free thyroxine (FT4), thyroxine (T4), triiodothyronine (T3).
Euthyroid sick syndrome. Relationship between severity and duration of nonthyroidal illness (NTI) and thyroid hormone levels. Abbreviations: reverse triiodothyronine (rT3), free thyroxine (free T4), thyroxine (T4), triiodothyronine (T3).
 
 
 
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