Euthyroid sick syndrome

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Background

  • Refers to abnormal thyroid function tests in the context of systemic non-thyroidal illness, surgery, or fasting
  • Transient abnormalities of thyroid function tests are seen in many hospitalized patients
  • May be classified as
    • Low T3 syndrome
    • Low T3/low T4 syndrome
    • High T4 syndrome
    • Other abnormalities

Clinical Presentation

  • Admitted to hospital for non-thyroidal illness or surgery
    • Most common in patients with severe illness
  • Thyroid function tests are abnormal
    • Most commonly low free T3 with normal free T4 and TSH (70% of hospitalized patients)
    • Low T3 and low T4 is seen in severely or critically ill patients and portends a poor prognosis
    • High total T4 is seen in patients with elevated TBG, as seen in chronic hepatitis, primary biliary cirrhosis, and acute intermittent porphyria
    • High free and total T4 may be seen in patients treated with amiodarone or given CT contrast agents
    • Treatment with heparin can cause a false laboratory measurement of elevated free T4

Further Reading

  • Euthyroid Sick Syndrome: Is It a Misnomer? J Clin Endocrinol Metabol. 1997;82(2):329–334. doi: 10.1210/jcem.82.2.3745