Further Outpatient Care

Monitor thyroid function test findings after recovery from NTI.

Further Inpatient Care

Monitor thyroid function test findings during and after recovery from NTI.

Complications

Complications depend on the underlying NTI and other organ systems involved. A study by Rothberger et al, for example, suggested that in patients with acute heart failure, low T3 levels due to euthyroid sick syndrome may be a risk factor for poorer hospital outcomes. The study found that in patients hospitalized with acute heart failure, those with low free T3 levels tended to have greater lengths of stay, higher rates of admission to the intensive care unit, and greater requirement for invasive mechanical ventilation.^[33]

Prognosis

Prognosis depends on the outcome of the underlying NTI.

Patient Education

Patients can be assured that this is a transient phenomenon and that normalization of findings on thyroid function tests is expected with the patient's recovery from NTI.^[34]

For patient education resources, see the Endocrine System Center, as well as Thyroid Problems.

Questions

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Fekete C, Sarkar S, Christoffolete MA, Emerson CH, Bianco AC, Lechan RM. Bacterial lipopolysaccharide (LPS)-induced type 2 iodothyronine deiodinase (D2) activation in the mediobasal hypothalamus (MBH) is independent of the LPS-induced fall in serum thyroid hormone levels. Brain Res. 2005 Sep 14. 1056 (1):97-9. [QxMD MEDLINE Link].
Fekete C, Gereben B, Doleschall M, Harney JW, Dora JM, Bianco AC, et al. Lipopolysaccharide induces type 2 iodothyronine deiodinase in the mediobasal hypothalamus: implications for the nonthyroidal illness syndrome. Endocrinology. 2004 Apr. 145 (4):1649-55. [QxMD MEDLINE Link].
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Tognini S, Marchini F, Dardano A, et al. Non-thyroidal illness syndrome and short-term survival in a hospitalised older population. Age Ageing. 2010 Jan. 39(1):46-50. [QxMD MEDLINE Link].
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Swistek M, Broncel M, Gorzelak-Pabis P, Morawski P, Fabis M, Wozniak E. Euthyroid Sick Syndrome as a Prognostic Indicator of COVID-19 Pulmonary Involvement, Associated With Poorer Disease Prognosis and Increased Mortality. Endocr Pract. 2022 May. 28 (5):494-501. [QxMD MEDLINE Link]. [Full Text].
Wang J, Yuan W, Dong R, Liu N, Liu D, Zhou Y. Predictors for euthyroid sick syndrome and its impact on in-hospital clinical outcomes in high-risk patients undergoing coronary artery bypass grafting. Perfusion. 2019 Nov. 34 (8):679-88. [QxMD MEDLINE Link].
Petrone A, Mormile F, Bruni G, Quartieri M, Bonsignore MR, Marrone O. Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment. Sleep Med. 2016 Jul. 23:21-5. [QxMD MEDLINE Link].
Gangemi EN, Garino F, Berchialla P, et al. Low triiodothyronine serum levels as a predictor of poor prognosis in burn patients. Burns. 2008 Sep. 34(6):817-24. [QxMD MEDLINE Link].
Velissaris T, Tang AT, Wood PJ, et al. Thyroid function during coronary surgery with and without cardiopulmonary bypass. Eur J Cardiothorac Surg. 2009 Jul. 36(1):148-54. [QxMD MEDLINE Link].
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. 2001 Sep. 86(9):4198-205. [QxMD MEDLINE Link].
Pimentel CR, Miano FA, Perone D, et al. Reverse T(3) as a parameter of myocardial function impairment in heart failure. Int J Cardiol. 2009 May 8. [QxMD MEDLINE Link].
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Casulari LA, Mangieri P, Naves LA, et al. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm. Arq Neuropsiquiatr. 2004 Mar. 62(1):26-32. [QxMD MEDLINE Link].
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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. 2006 Jan. 22(1):57-86, vi. [QxMD MEDLINE Link].
Zhang JQ, Yang QY, Xue FS, et al. Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and attenuate myocardial ischemia-reperfusion injury after cardiac surgery with cardiopulmonary bypass in children: a randomized, double-blind, placebo-controlled trial. Medicine (Baltimore). 2018 Sep. 97 (36):e12100. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

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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Author

Serhat Aytug, MD, FACE Endocrinologist, Division of Endocrinology, Diabetes and Metabolism, St Jude Heritage Medical Group; Associate Professor of Medicine – Endocrinology, Diabetes and Metabolism, Council of Higher Education of Turkey

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

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 Association for Physician Leadership, American College of Physicians, American Geriatrics Society, Endocrine Society, Gerontological Society of America, Association of Professors of Medicine

Disclosure: Nothing to disclose.