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Euthyroid Sick Syndrome

Updated : April 16, 2024





Background

Euthyroid Sick Syndrome (ESS) is sometimes known as nonthyroidal illness syndrome. It state that the thyroid function changes in ICU patients during critical emergencies. 

In 75% of cases those who are hospitalized may feel major changes to their hypothalamic-pituitary-thyroid axis. It is seen in individuals with serious diseases and insufficient calories. 

Epidemiology

About 40% to 100% of cases shows a decrease in T3 level. 10% of cases shows reduced TSH level. The highest prevalence is the seriously ill group. 

Anatomy

Pathophysiology

Thyroid hormone inhibitors in blood and tissues prevent thyroid hormone binding to thyroid-binding protein. 

In critically ill patients regulate peripheral type 1 deiodinase activity. It increases central type 2 and 3 deiodinase activity. 

Etiology

There are various causes of ESS mentioned as follows:  

Critical illness, starvation, anorexia nervosa, pneumonia and sepsis. 

Stress, cardiopulmonary bypass, congestive cardiac failure, myocardial infarction, hypothermia, cirrhosis, renal failure, diabetic ketoacidosis. 

Genetics

Prognostic Factors

In acute heart failure patients of T3 Levels the factors involve longer hospital stay, ICU admission and ventilator requirement. 

 

Clinical History

This condition is not specific to a particular age group. Individuals of all age groups are affected, which includes children, adults, and elderly people.  

Physical Examination

Vital Signs 

Cardiovascular Examination  

Respiratory Examination 

Gastrointestinal Examination 

Age group

Associated comorbidity

Euthyroid Sick Syndrome is frequently observed in individuals with critical illnesses, major surgeries, trauma, or severe systemic diseases. Patients with severe infections, particularly those leading to sepsis, may develop Euthyroid Sick Syndrome as part of the physiological response to infection. 

Euthyroid Sick Syndrome has been observed in individuals with heart failure, myocardial infarction, and other cardiovascular diseases. Patients with advanced kidney disease may experience alterations in thyroid hormone levels. 

 

Associated activity

Acuity of presentation

It growths rapidly in response to severe illness and stress. The onset often acute coincides with underlying medical condition. The thyroid hormone abnormalities can be mild. 

Differential Diagnoses

Central Hypothyroidism  

Severe Illness  

Chronic Kidney Disease  

Liver Disease 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Provide supportive care to manage ESS. Nutritional support to address deficiencies is necessary.  

Regular monitoring of thyroid function tests is very important.  

Thyroid hormone levels typically normalize as the underlying illness is treated and resolved.  

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of non-pharmacological approach for Euthyroid Sick Syndrome

Patient should consult with a multidisciplinary care team which includes physicians, nurses, and dietitians. 

Create a comfortable environment to support the patient’s speedy recovery.  

Through daily dietary intake give enough nutritional supplement to patient.  

Importance of treatment for Underlying illness

The focus should be on administering medications to treat the underlying medical condition.   

This may involve antibiotics for infections, anti-inflammatory medications for inflammatory conditions. 

Use of Intervention with a procedure in treating Euthyroid Sick Syndrome

If the underlying illness requires specific interventions or procedures, then these may be performed as part of the overall management plan.   

In situations like where the patient is critically ill, then central venous catheters or central lines may be administered to facilitate the medications, fluids, and nutritional support. 

Use of phases in managing Euthyroid Sick Syndrome

In identification phase of abnormal thyroid function tests and consideration of the clinical context. The initial phase involves managing the underlying medical condition or stressor that initiates ESS.  

Arrange regular monitoring and follow up of the patient’s clinical status. 

Medication

Media Gallary

Euthyroid Sick Syndrome

Updated : April 16, 2024




Euthyroid Sick Syndrome (ESS) is sometimes known as nonthyroidal illness syndrome. It state that the thyroid function changes in ICU patients during critical emergencies. 

In 75% of cases those who are hospitalized may feel major changes to their hypothalamic-pituitary-thyroid axis. It is seen in individuals with serious diseases and insufficient calories. 

About 40% to 100% of cases shows a decrease in T3 level. 10% of cases shows reduced TSH level. The highest prevalence is the seriously ill group. 

Thyroid hormone inhibitors in blood and tissues prevent thyroid hormone binding to thyroid-binding protein. 

In critically ill patients regulate peripheral type 1 deiodinase activity. It increases central type 2 and 3 deiodinase activity. 

There are various causes of ESS mentioned as follows:  

Critical illness, starvation, anorexia nervosa, pneumonia and sepsis. 

Stress, cardiopulmonary bypass, congestive cardiac failure, myocardial infarction, hypothermia, cirrhosis, renal failure, diabetic ketoacidosis. 

In acute heart failure patients of T3 Levels the factors involve longer hospital stay, ICU admission and ventilator requirement. 

 

This condition is not specific to a particular age group. Individuals of all age groups are affected, which includes children, adults, and elderly people.  

Vital Signs 

Cardiovascular Examination  

Respiratory Examination 

Gastrointestinal Examination 

Euthyroid Sick Syndrome is frequently observed in individuals with critical illnesses, major surgeries, trauma, or severe systemic diseases. Patients with severe infections, particularly those leading to sepsis, may develop Euthyroid Sick Syndrome as part of the physiological response to infection. 

Euthyroid Sick Syndrome has been observed in individuals with heart failure, myocardial infarction, and other cardiovascular diseases. Patients with advanced kidney disease may experience alterations in thyroid hormone levels. 

 

It growths rapidly in response to severe illness and stress. The onset often acute coincides with underlying medical condition. The thyroid hormone abnormalities can be mild. 

Central Hypothyroidism  

Severe Illness  

Chronic Kidney Disease  

Liver Disease 

Provide supportive care to manage ESS. Nutritional support to address deficiencies is necessary.  

Regular monitoring of thyroid function tests is very important.  

Thyroid hormone levels typically normalize as the underlying illness is treated and resolved.  

Patient should consult with a multidisciplinary care team which includes physicians, nurses, and dietitians. 

Create a comfortable environment to support the patient’s speedy recovery.  

Through daily dietary intake give enough nutritional supplement to patient.  

The focus should be on administering medications to treat the underlying medical condition.   

This may involve antibiotics for infections, anti-inflammatory medications for inflammatory conditions. 

If the underlying illness requires specific interventions or procedures, then these may be performed as part of the overall management plan.   

In situations like where the patient is critically ill, then central venous catheters or central lines may be administered to facilitate the medications, fluids, and nutritional support. 

In identification phase of abnormal thyroid function tests and consideration of the clinical context. The initial phase involves managing the underlying medical condition or stressor that initiates ESS.  

Arrange regular monitoring and follow up of the patient’s clinical status.