Euthyroid Sick Syndrome

Euthyroid sick syndrome is a state of adaptation or dysregulation of thyrotropic feedback control where the level of T3 and T4 are at unusual levels but the thyroid gland does not appear to be dysfunctional.

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Race of Euthyroid Sick Syndrome

No race predilection exist.

Age / Sex of Euthyroid Sick Syndrome

It can affect people at any age.
Thyroid function test results in both sexes are affected equally.

Causes of Euthyroid Sick Syndrome

Include a number of chronic and acute conditions:
• Pneumonia
• Fasting
• Starvation
• Sepsis
• Stress
• Heart failure
• Cardiopulmonary bypass
• Malignancy
• Trauma
• Myocardial infarction
• Chronic renal failure
• Cirrhosis
• Diabetic ketoacidosis

Signs and Symptoms

On physical examination, there are no typical findings for patients with NTI. The examination findings in each patient reflect the characteristics of her or his nonthyroidal disease.

Investigations for Euthyroid Sick Syndrome

• Typical NTI findings are T4 level within the reference range low T3 level, slightly reduced or reference range level of TSH, elevated rT3 level, and a free T4 level that is within the reference range or is elevated.
• In severe NTI, the findings are low T4, low T3, reduced TSH, elevated rT3, and free T4 that is within the reference range or is diminished.


No clear agreement on treatment of NTI with thyroid hormones exists.

Differential diagnosis of Euthyroid Sick Syndrome

• Hashimotos thyroiditis
• Hyperthroidism
• Hypothyroidism
• Thyroid dysfunction

Prognosis of Euthyroid Sick Syndrome

Prognosis of euthyroid sick syndrome depends upon the outcome of the underlying non thyroidal illness.

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