eMedicine Specialties > Endocrinology > Thyroid

Euthyroid Sick Syndrome: Treatment & Medication

Author: Serhat Aytug, MD, Staff Physician, Division of Endocrinology, Diabetes and Metabolism, CrystalRun Healthcare
Coauthor(s): Lawrence E Shapiro, MD, Chief, Division of Endocrinology and Metabolism, Professor of Medicine, Department of Medicine, Winthrop University Hospital
Contributor Information and Disclosures

Updated: Aug 13, 2009

Treatment

Medical Care

There is no prospective study to date demonstrating benefit or harm of thyroid hormone replacement in NTI. Thyroid hormones have been used in the setting of NTI in various settings with T4 and T3 replacement and still remain controversial. De Groot has supported the notion that nonthyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, he proposed  that treatment should be considered with appropriate replacement therapies such as pituitary hormones, hypothalamic factors in addition to thyroid hormones.14

Consultations

Consult an endocrinologist.

Diet

No particular diet is recommended.

Activity

Activity may be performed as tolerated.

Medication

No clear agreement on treatment of NTI with thyroid hormones exists. General consensus is that these patients are euthyroid; therefore, treatment is not required.

More on Euthyroid Sick Syndrome

Overview: Euthyroid Sick Syndrome
Differential Diagnoses & Workup: Euthyroid Sick Syndrome
Treatment & Medication: Euthyroid Sick Syndrome
Follow-up: Euthyroid Sick Syndrome
Multimedia: Euthyroid Sick Syndrome
References
Further Reading
[ CLOSE WINDOW ]

References

  1. 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].

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

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

  10. 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].

  11. 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].

  12. 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].

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

  14. 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].

  15. 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].

  16. 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].

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

  18. 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].

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

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

  21. 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].

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

  23. 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].

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

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

  26. 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].

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

  28. 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].

  29. 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].

[ CLOSE WINDOW ]

Keywords

euthyroid sick syndrome, thyroxine, thyroid hormones, TSH, thyroid TSH, T3 thyroid, TSH T4, thyroid stimulating hormone, T4 levels, T4 thyroid, sick euthyroid syndrome, triiodothyronine, low thyroid levels, T4 hormone, TSH free T4, thyroxine levels, nonthyroidal illness syndrome, low T3 syndrome, low iodothyronine syndrome, thyrotropin, thyroxine-binding globulin, TBG

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Serhat Aytug, MD, Staff Physician, Division of Endocrinology, Diabetes and Metabolism, CrystalRun Healthcare
Serhat Aytug, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, 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.

Medical Editor

Steven R Gambert, MD, MACP, Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine
Steven R Gambert, MD, MACP 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.