Medical Care

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.^[30]

A randomized, doubled-blind, placebo-controlled trial by Zhang et al reported that in children who underwent congenital heart disease repair with cardiopulmonary bypass, the severity of postoperative euthyroid sick syndrome was reduced when oral, small-dose thyroid hormone treatment was administered preoperatively.^[31]

A retrospective study by Li et al indicated that in patients with nonthyroidal illness syndrome associated with enterocutaneous fistula, enteral nutrition therapy can contribute to the syndrome’s resolution.^[32]

Consultations

Consult an endocrinologist.

Diet

No particular diet is recommended.

Activity

Activity may be performed as tolerated.

Medication

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Yu J, Koenig RJ. Induction of type 1 iodothyronine deiodinase to prevent the nonthyroidal illness syndrome in mice. Endocrinology. 2006 Jul. 147(7):3580-5. [QxMD MEDLINE Link].
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. 2003 Jan. 284(1):E228-36. [QxMD MEDLINE Link].
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). 1993 Nov. 39(5):499-518. [QxMD MEDLINE Link].
Melmed S, Geola FL, Reed AW, et al. A comparison of methods for assessing thyroid function in nonthyroidal illness. J Clin Endocrinol Metab. 1982 Feb. 54(2):300-6. [QxMD MEDLINE Link].
Fliers E, Guldenaar SE, Wiersinga WM, Swaab DF. Decreased hypothalamic thyrotropin-releasing hormone gene expression in patients with nonthyroidal illness. J Clin Endocrinol Metab. 1997 Dec. 82 (12):4032-6. [QxMD MEDLINE Link].
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].
Bello G, Pennisi MA, Montini L, et al. Nonthyroidal illness syndrome and prolonged mechanical ventilation in patients admitted to the ICU. Chest. 2009 Jun. 135(6):1448-54. [QxMD MEDLINE Link].
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].
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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].
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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.